Youth Risk Behavior Surveillance — United States, 2013

Please note: An erratum has been published for this article. To view the erratum, please click here.

Laura Kann, PhD,1 Steve Kinchen,1 Shari L. Shanklin, MPH,1 Katherine H. Flint, MA,2 Joseph Hawkins, MA,3 William A. Harris, MM,1 Richard Lowry, MD,1 Emily O'Malley Olsen, MSPH,1 Tim McManus, MS,1 David Chyen, MS,1 Lisa Whittle, MPH,1 Eboni Taylor, PhD,1 Zewditu Demissie, PhD,1 Nancy Brener, PhD,1 Jemekia Thornton,1 John Moore, PhD,1 Stephanie Zaza, MD1

1Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC

2ICF International, Rockville, Maryland

3Westat, Rockville, Maryland

Corresponding author: Laura Kann, PhD, Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Telephone: 404-718-8132; E-mail: lkk1@cdc.gov.

Abstract

Problem: Priority health-risk behaviors contribute to the leading causes of morbidity and mortality among youth and adults. Population-based data on these behaviors at the national, state, and local levels can help monitor the effectiveness of public health interventions designed to protect and promote the health of youth nationwide.

Reporting Period Covered: September 2012–December 2013.

Description of the System: The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health-risk behaviors among youth and young adults: 1) behaviors that contribute to unintentional injuries and violence; 2) tobacco use; 3) alcohol and other drug use; 4) sexual behaviors that contribute to unintended pregnancy and sexually transmitted infections (STIs), including human immunodeficiency virus (HIV) infection; 5) unhealthy dietary behaviors; and 6) physical inactivity. In addition, YRBSS monitors the prevalence of obesity and asthma. YRBSS includes a national school-based Youth Risk Behavior Survey (YRBS) conducted by CDC and state and large urban school district school-based YRBSs conducted by state and local education and health agencies. This report summarizes results for 104 health-risk behaviors plus obesity, overweight, and asthma from the 2013 national survey, 42 state surveys, and 21 large urban school district surveys conducted among students in grades 9–12.

Results: Results from the 2013 national YRBS indicated that many high school students are engaged in priority health-risk behaviors associated with the leading causes of death among persons aged 10–24 years in the United States. During the 30 days before the survey, 41.4% of high school students nationwide among the 64.7% who drove a car or other vehicle during the 30 days before the survey had texted or e-mailed while driving, 34.9% had drunk alcohol, and 23.4% had used marijuana. During the 12 months before the survey, 14.8% had been electronically bullied, 19.6% had been bullied on school property, and 8.0% had attempted suicide. Many high school students nationwide are engaged in sexual risk behaviors that contribute to unintended pregnancies and STIs, including HIV infection. Nearly half (46.8%) of students had ever had sexual intercourse, 34.0% had had sexual intercourse during the 3 months before the survey (i.e., currently sexually active), and 15.0% had had sexual intercourse with four or more persons during their life. Among currently sexually active students, 59.1% had used a condom during their last sexual intercourse. Results from the 2013 national YRBS also indicate many high school students are engaged in behaviors associated with chronic diseases, such as cardiovascular disease, cancer, and diabetes. During the 30 days before the survey, 15.7% of high school students had smoked cigarettes and 8.8% had used smokeless tobacco. During the 7 days before the survey, 5.0% of high school students had not eaten fruit or drunk 100% fruit juices and 6.6% had not eaten vegetables. More than one-third (41.3%) had played video or computer games or used a computer for something that was not school work for 3 or more hours per day on an average school day.

Interpretation: Many high school students engage in behaviors that place them at risk for the leading causes of morbidity and mortality. The prevalence of most health-risk behaviors varies by sex, race/ethnicity, and grade and across states and large urban school districts. Long term temporal changes also have occurred. Since the earliest year of data collection, the prevalence of most health-risk behaviors has decreased (e.g., physical fighting, current cigarette use, and current sexual activity), but the prevalence of other health-risk behaviors has not changed (e.g., suicide attempts treated by a doctor or nurse, having ever used marijuana, and having drunk alcohol or used drugs before last sexual intercourse) or has increased (e.g., having not gone to school because of safety concern and obesity and overweight).

Public Health Action: YRBSS data are used widely to compare the prevalence of health-risk behaviors among subpopulations of students; assess trends in health-risk behaviors over time; monitor progress toward achieving 20 national health objectives for Healthy People 2020 and one of the 26 leading health indicators; provide comparable state and large urban school district data; and help develop and evaluate school and community policies, programs, and practices designed to decrease health-risk behaviors and improve health outcomes among youth.

Introduction

In the United States, 70% of all deaths among youth and young adults aged 10–24 years result from four causes: motor vehicle crashes (23%), other unintentional injuries (18%), homicide (15%), and suicide (15%) (1). Among youth aged 15–19 years, substantial morbidity and social problems also result from the estimated 329,772 births (2); 548,032 cases of chlamydia, gonorrhea, and syphilis (3); and 2,240 cases of human immunodeficiency virus (HIV) (4) reported annually. Among adults aged ≥25 years, 57% of all deaths in the United States result from cardiovascular disease (33%) and cancer (24%) (1). These leading causes of morbidity and mortality among youth and adults in the United States are related to six categories of priority health-risk behaviors: 1) behaviors that contribute to unintentional injuries and violence; 2) tobacco use; 3) alcohol and other drug use; 4) sexual behaviors that contribute to unintended pregnancy and sexually transmitted infections (STIs), including HIV infection; 5) unhealthy dietary behaviors; and 6) physical inactivity. These behaviors frequently are interrelated and are established during childhood and adolescence and extend into adulthood. To monitor priority health-risk behaviors in each of these six categories and obesity and asthma among youth and young adults, CDC developed the Youth Risk Behavior Surveillance System (YRBSS) (5). YRBSS includes school-based national, state, and large urban school district Youth Risk Behavior Surveys (YRBS) conducted among representative samples of students in grades 9–12. National, state, and large urban school district surveys have been conducted biennially since 1991 (Table 1). Additional information about the YRBSS is available at http://www.cdc.gov/yrbs.

This report summarizes results for 104 health-risk behaviors plus obesity, overweight, and asthma from the 2013 national YRBS and overall trends in health-risk behaviors during 1991–2013. Data from the 42 state and 21 large urban school district surveys with weighted data for the 2013 YRBSS cycle (Figure) also are included in this report. Data from five states and one large urban school district survey with unweighted data are not included. Among those with weighted data for 2013, one state and two large urban school district surveys were conducted during fall 2012; the national survey, 38 states, and 18 large urban school district surveys were conducted during spring 2013; and three states and one large urban school district survey were conducted during fall 2013.

Methods

Detailed information about the methodology of the national, state, and large urban school district YRBSs has been described elsewhere (5).

Sampling

National Youth Risk Behavior Survey

The sampling frame for the 2013 national YRBS consisted of all regular public* and private† schools with students in at least one of grades 9–12 in the 50 states and the District of Columbia. The sampling frame was obtained from the Market Data Retrieval (MDR) database (6). The MDR database includes information on both public and private schools and the most recent data from the Common Core of Data from the National Center for Education Statistics (7). A three-stage cluster sample design produced a nationally representative sample of students in grades 9–12 who attend public and private schools. The first-stage sampling frame consisted of 1,276 primary sampling units (PSUs), consisting of counties, subareas of large counties, or groups of smaller, adjacent counties. The 1,276 PSUs were categorized into 16 strata according to their metropolitan statistical area (MSA) status (i.e., urban city) and the percentages of black and Hispanic students in the PSUs. From the 1,276 PSUs, 54 were sampled with probability proportional to overall school enrollment size for the PSU.

In the second stage of sampling, 193 schools with any of grades 9–12 were sampled with probability proportional to school enrollment size. The third stage of sampling consisted of random sampling in each of grades 9–12, one or two classrooms from either a required subject (e.g., English or social studies) or a required period (e.g., homeroom or second period). All students in sampled classes were eligible to participate. Schools, classes, and students that refused to participate were not replaced.

To enable a separate analysis of data for black and Hispanic students, two classes per grade, rather than one, were sampled in schools with a high minority enrollment. In the past, three strategies were used to oversample black and Hispanic students: 1) larger sampling rates were used to select PSUs that were in high-black and high-Hispanic strata; 2) a modified measure of size was used to increase the probability of sampling schools with a disproportionately high minority enrollment; and 3) two classes per grade, rather than one, were sampled in schools with a high minority enrollment. Because of increases in the proportions of black and Hispanic students in the population, only selection of two classes per grade was needed in 2013 to achieve adequate precision with minimum variance.

State and Large Urban School District Youth Risk Behaviors

In 2013, a two-stage cluster sample design was used to produce a representative sample of public§ school students in grades 9–12 in 39 states and 21 large urban school districts and of public and private¶ school students in grades 9–12 in three states (Ohio, South Dakota, and Vermont). In the first sampling stage, schools with any of grades 9–12 were sampled with probability proportional to school enrollment size in 40 states and four large urban school districts; all schools with any of grades 9–12 were invited to participate in two states and 17 large urban school districts. In the second sampling stage, intact classes from either a required subject (e.g., English or social studies) or a required period (e.g., homeroom or second period) were sampled randomly in 41 states and 20 large urban school districts, and all students in the sampled classes were eligible to participate. In one state and one large urban school district, all students in sampled schools were eligible to participate.

Data Collection Procedures and Questionnaires

Survey procedures for the national, state, and large urban school district surveys were designed to protect students' privacy by allowing for anonymous and voluntary participation. Before survey administration, local parental permission procedures were followed. Students completed the self-administered questionnaire during one class period and recorded their responses directly on a computer-scannable booklet or answer sheet. CDC's Institutional Review Board approved the protocol for the national YRBS.

The 2013 YRBS standard questionnaire contained 86 questions. For the national questionnaire, the following six questions were added to the standard questionnaire: ever use of hallucinogenic drugs, tested for HIV, participation in muscle strengthening activities, routine sunscreen use, indoor tanning device use, and number of hours of sleep on an average school night. Because these questions are only on the national questionnaire, state and large urban school district data are not available for any variables based on these questions. In addition to four demographic questions and two questions assessing height and weight, the remaining questions on the standard questionnaire and the national questionnaire measured behaviors practiced or experienced by the student (referred to as "behaviors"). States and large urban school districts could add and/or delete questions from the standard questionnaire. Skip patterns, which occur when a particular response to one question indicates to the respondents that they should not answer one or more subsequent questions, were not included in any YRBS questionnaire to protect students' privacy by ensuring all students took about the same amount of time to complete the questionnaire. For state and large urban school districts, only data from standard questions are presented in this report. Information about the reliability of the standard questionnaire has been published elsewhere (8). The standard and national YRBS questionnaires are available at http://www.cdc.gov/healthyyouth/yrbs/questionnaire_rationale.htm.

Data Processing Procedures and Response Rates

For the 2013 national YRBS, 13,633 questionnaires were completed in 148 public and private schools. The national data set was cleaned and edited for inconsistencies. Missing data were not statistically imputed. Among the 13,633 completed questionnaires, 50 failed quality control** and were excluded from analysis, resulting in 13,583 usable questionnaires (Table 2). The school response rate was 77%, the student response rate was 88%, and the overall response rate was 68%†† (Table 2).

Data from each state and large urban school district survey were cleaned and edited for inconsistencies with the same procedures used for the national data set. The percentage of completed questionnaires that failed quality control checks and were excluded from analysis ranged from .06% to 4.56% (median: 0.56%) across the 42 states and from 0.07% to 4.55% (median: 1.05%) across the 21 large urban school districts. The student sample sizes ranged from 1,107 to 53,785 (median: 1,987) across the states and from 1,102 to 10,778 (median: 1,581) across the large urban school districts (Table 2). Among the states, the school response rates ranged from 70% to 100%, student response rates ranged from 60% to 94%, and overall response rates ranged from 60% to 87%. Among the large urban school districts, the school response rates ranged from 89% to 100%, student response rates ranged from 69% to 90%, and overall response rates ranged from 68% to 90% (Table 2).

Race/ethnicity was computed from two questions: 1) "Are you Hispanic or Latino?" (response options were "yes" or "no"), and 2) "What is your race?" (response options were "American Indian or Alaska Native," "Asian," "black or African American," "Native Hawaiian or other Pacific Islander," or "white"). For the second question, students could select more than one response option. For this report, students were classified as "Hispanic/ Latino" and are referred to as "Hispanic" if they answered "yes" to the first question, regardless of how they answered the second question. Students who answered "no" to the first question and selected only "black or African American" to the second question were classified as "black or African American" and are referred to as "black." Students who answered "no" to the first question and selected only "white" to the second question were classified, and are referred to, as "white." Race/ethnicity was classified as missing for students who did not answer the first question and for students who answered "no" to the first question but did not answer the second question.

Students were classified as obese or overweight based on their body mass index (kg/m2) (BMI), which was calculated from self-reported height and weight. The BMI values were compared with sex- and age-specific reference data from the 2000 CDC growth charts (9). Obese was defined as a BMI of ≥95th percentile for age and sex. Overweight was defined as a BMI of ≥85th percentile and <95th percentile for age and sex. These classifications are not intended to diagnose obesity or overweight in individual students, but to provide population-level estimates of obesity and overweight.

Weighting

For the national YRBS, a weight based on student sex, race/ethnicity, and grade was applied to each record to adjust for school and student nonresponse and oversampling of black and Hispanic students. The overall weights were scaled so that the weighted count of students equals the total sample size, and the weighted proportions of students in each grade match the national population proportions. Therefore, weighted estimates are representative of all students in grades 9–12 attending public and private schools in the United States.

Data from states and large urban school districts that had a representative sample of students, appropriate documentation, and an overall response rate of ≥60% were weighted. A weight was applied to each record to adjust for school and student nonresponse and the distribution of students by grade, sex, and race/ethnicity in each jurisdiction, such that the weighted count of students equals the student population in each jurisdiction. Data from 42 state and 21 large urban school districts were weighted. In 39 states and all large urban school districts, weighted estimates are representative of all students in grades 9–12 attending public schools in each jurisdiction. In three states (Ohio, South Dakota, and Vermont), weighted estimates are representative of all students in grades 9–12 attending public and private schools in each jurisdiction.

Analytic Methods

Statistical analyses were conducted on weighted data using SAS (10) and SUDAAN (11) software to account for the complex sampling designs. Prevalence estimates and confidence intervals were computed for all variables and all data sets. In addition, for the national YRBS data, t tests were used to determine pairwise differences between subpopulations (12). Differences between prevalence estimates were considered statistically significant if the t test p value was <0.05 for main effects (sex, race/ethnicity, and grade) and for interactions (sex by race/ethnicity, sex by grade, race/ethnicity by sex, and grade by sex). In the results section, only statistically significant differences in prevalence estimates are reported in the following order: sex, sex by race/ethnicity, sex by grade, race/ethnicity, race/ethnicity by sex, grade, and grade by sex.

To identify long-term temporal changes in health-risk behaviors nationwide, prevalence estimates from the earliest year of data collection to 2013 for each variable assessed with identically worded questions in three or more survey years were examined. Logistic regression analyses were used to account for all available estimates; control for sex, grade, and racial/ ethnic changes over time; and assess linear and quadratic time effects (12). Linear and quadratic time variables were treated as continuous and were coded using orthogonal coefficients calculated with PROC IML in SAS. Separate regression models were used to assess linear and quadratic time trends for every variable. When a significant quadratic trend was detected, Joinpoint software (13) was used to automate identification of the year or "joinpoint" where the nonlinear (i.e., quadratic) trend changed and then regression models were used to assess linear trends occurring in each segment. Cubic and higher order time effects were not assessed. A quadratic time effect indicates a significant but nonlinear trend in prevalence over time. A temporal change that includes a significant linear and quadratic time effect demonstrates nonlinear variation (e.g., leveling off or change in direction) in addition to an overall increase or decrease over time. In addition, to identify 2-year temporal changes in health-risk behaviors nationwide, prevalence estimates from 2011 and 2013 were compared using t tests for each variable assessed with identically worded questions in both survey years. Prevalence estimates were considered statistically different if the t test p value was <0.05.

In the results section, linear and quadratic trends are described followed by results from the t tests used to assess 2-year temporal changes. Information about long term trends and more recent changes are not available due to changes in question or response option wording or because the question was asked for the first time during 2013 for the following variables: drove when drinking alcohol; texted or e-mailed while driving; physical dating violence; sexual dating violence; largest number of drinks in a row was 10 or more; IUD or implant use; and shot, patch, or birth control ring use.

Results

Behaviors that Contribute to Unintentional Injuries

Never or Rarely Wore a Bicycle Helmet

Among the 67.0% of students nationwide who had ridden a bicycle during the 12 months before the survey, 87.9% had never or rarely worn a bicycle helmet (Table 3). The prevalence of having never or rarely worn a bicycle helmet was higher among male (88.6%) than female (87.0%) students and higher among black male (96.2%) and Hispanic male (93.7%) than black female (90.6%) and Hispanic female (90.9%) students, respectively. The prevalence of having never or rarely worn a bicycle helmet was higher among black (93.9%) and Hispanic (92.4%) than white (85.7%) students, higher among Hispanic female (90.9%) than white female (85.7%) students, higher among black male (96.2%) and Hispanic male (93.7%) than white male (85.8%) students, and higher among black male (96.2%) than Hispanic male (93.7%) students.

During 1991–2013, a significant linear decrease occurred overall in the prevalence of having never or rarely worn a bicycle helmet (96.2%–87.9%). A significant quadratic trend also was identified. The prevalence of having never or rarely worn a bicycle helmet decreased during 1991–2005 (96.2%–83.4%) and then increased during 2005–2013 (83.4%–87.9%). The prevalence of having never or rarely worn a bicycle helmet did not change significantly from 2011 (87.5%) to 2013 (87.9%).

Across 31 states, the prevalence of having never or rarely worn a bicycle helmet ranged from 60.0% to 93.2% (median: 87.7%) (Table 4). Across 16 large urban school districts, the prevalence ranged from 75.1% to 93.6% (median: 88.2%).

Never or Rarely Wore a Seat Belt

Nationwide, 7.6% of students never or rarely wore a seat belt when riding in a car driven by someone else (Table 3). The prevalence of having never or rarely worn a seat belt was higher among male (9.1%) than female (6.1%) students; higher among white male (8.5%) and black male (11.8%) than white female (4.7%) and black female (7.1%) students, respectively; and higher among 9th-grade male (9.8%), 10th-grade male (8.4%), 11th-grade male (9.7%), and 12th-grade male (8.3%) than 9th-grade female (7.1%), 10th-grade female (5.7%), 11th-grade female (6.3%), and 12th-grade female (5.1%) students, respectively. The prevalence of having never or rarely worn a seat belt was higher among black (9.5%) and Hispanic (8.8%) than white (6.6%) students, higher among black female (7.1%) and Hispanic female (8.7%) than white female (4.7%) students, and higher among black male (11.8%) than white male (8.5%) students.

During 1991–2013, a significant linear decrease occurred overall in the prevalence of having never or rarely worn a seat belt (25.9%–7.6%). A significant quadratic trend was not identified. The prevalence of having never or rarely worn a seat belt did not change significantly from 2011 (7.7%) to 2013 (7.6%).

Across 40 states, the prevalence of having never or rarely worn a seat belt ranged from 5.6% to 16.1% (median: 8.7%) (Table 4). Across 19 large urban school districts, the prevalence ranged from 4.7% to 25.0% (median: 10.3%).

Rode with a Driver Who Had Been Drinking Alcohol

During the 30 days before the survey, 21.9% of students nationwide had ridden one or more times in a car or other vehicle driven by someone who had been drinking alcohol (Table 5). The prevalence of having ridden with a driver who had been drinking alcohol was higher among black female (24.8%) than black male (18.9%) students. The prevalence of having ridden with a driver who had been drinking alcohol was higher among Hispanic (29.1%) than white (19.7%) and black (21.9%) students, higher among Hispanic female (29.2%) than white female (19.9%) and black female (24.8%) students, higher among black female (24.8%) than white female (19.9%) students, and higher among Hispanic male (28.9%) than white male (19.6%) and black male (18.9%) students. The prevalence of having ridden with a driver who had been drinking alcohol was higher among 12th-grade (24.2%) than 9th-grade (19.4%) students, higher among 11th-grade male (23.4%) and 12th-grade male (25.3%) than 9th-grade male (18.1%) students, and higher among 12th grade male (25.3%) than 10th grade male (19.9%) students.

During 1991–2013, a significant linear decrease occurred overall in the prevalence of having ridden with a driver who had been drinking alcohol (39.9%–21.9%). A significant quadratic trend was not identified. The prevalence of having ridden with a driver who had been drinking alcohol did not change significantly from 2011 (24.1%) to 2013 (21.9%).

Across 38 states, the prevalence of having ridden with a driver who had been drinking alcohol ranged from 12.4% to 29.6% (median: 20.5%) (Table 6). Across 20 large urban school districts, the prevalence ranged from 15.2% to 32.0% (median: 23.6%).

Drove When Drinking Alcohol

Among the 64.3% of students nationwide who drove a car or other vehicle during the 30 days before the survey,§§ 10.0% had driven a car or other vehicle one or more times when they had been drinking alcohol during the 30 days before the survey (Table 5). The prevalence of having driven a car or other vehicle when they had been drinking alcohol was higher among male (12.0%) than female (7.8%) students; higher among white male (12.4%) and Hispanic male (14.5%) than white female (8.2%) and Hispanic female (8.4%) students, respectively; and higher among 11th-grade male (14.0%) and 12th grade male (15.7%) than 11th-grade female (8.0%) and 12th-grade female (10.5%) students, respectively. The prevalence of having driven a car or other vehicle when they had been drinking alcohol was higher among white (10.4%) and Hispanic (11.6%) than black (6.2%) students, higher among Hispanic female (8.4%) than black female (5.4%) students, and higher among white male (12.4%) and Hispanic male (14.5%) than black male (6.9%) students. The prevalence of having driven a car or other vehicle when they had been drinking alcohol was higher among 12th-grade (13.1%) than 9th-grade (8.0%) students, higher among 11th-grade (11.0%) and 12th-grade (13.1%) than 10th-grade (6.2%) students, higher among 12th-grade female (10.5%) than 9th-grade female (6.1%) students, higher among 11th-grade female (8.0%) and 12th-grade female (10.5%) than 10th-grade female (4.6%) students, higher among 12th-grade male (15.7%) than 9th-grade male (9.6%) students, and higher among 11th-grade male (14.0%) and 12th-grade male (15.7%) than 10th-grade male (7.4%) students.

Across 41 states, the prevalence of having driven a car or other vehicle when they had been drinking alcohol among students who drove a car or other vehicle during the 30 days before the survey ranged from 2.5% to 12.6% (median: 8.6%) (Table 6). Across 19 large urban school districts, the prevalence ranged from 4.0% to 11.2% (median: 7.5%).

Texted or E-mailed While Driving

Among the 64.7% of students nationwide who drove a car or other vehicle during the 30 days before the survey,§§ 41.4% had texted or e-mailed while driving a car or other vehicle on at least one day during the 30 days before the survey (Table 7). The prevalence of having texted or e-mailed while driving was higher among Hispanic male (39.5%) than Hispanic female (32.1%) students. The prevalence of having texted or e-mailed while driving was higher among white (45.8%) than black (29.1%) and Hispanic (36.0%) students, higher among Hispanic (36.0%) than black (29.1%) students, higher among white female (46.7%) than black female (26.5%) and Hispanic female (32.1%) students, higher among white male (45.1%) than black male (31.5%) and Hispanic male (39.5%) students, and higher among Hispanic male (39.5%) than black male (31.5%) students. The prevalence of having texted or e-mailed while driving was higher among 10th-grade (26.5%), 11th-grade (49.0%), and 12th-grade (60.3%) than 9th-grade (16.9%) students; higher among 11th-grade (49.0%) and 12th-grade (60.3%) than 10th-grade (26.5%) students; higher among 12th-grade (60.3%) than 11th-grade (49.0%) students; higher among 10th-grade female (25.0%), 11th-grade female (48.7%), 12th-grade female (59.5%) than 9th-grade female (15.1%) students; higher among 11th-grade female (48.7%) and 12th-grade female (59.5%) than 10th-grade female (25.0%) students; higher among 12th-grade female (59.5%) than 11th-grade female (48.7%) students; higher among 10th-grade male (27.8%), 11th-grade male (49.6%), and 12th-grade male (61.0%) than 9th-grade male (18.3%) students; higher among 11th-grade male (49.6%) and 12th-grade male (61.0%) than 10th-grade male (27.8%) students; and higher among 12th-grade male (61.0%) than 11th-grade male (49.6%) students.

Across 37 states, the prevalence of having texted or e-mailed while driving among students who drove a car or other vehicle during the 30 days before the survey ranged from 32.3% to 61.3% (median: 43.3%) (Table 8). Across 15 large urban school districts, the prevalence ranged from 18.9% to 42.6% (median: 34.9%).

Behaviors that Contribute to Violence

Carried a Weapon

Nationwide, 17.9% of students had carried a weapon (e.g., gun, knife, or club) on at least one day during the 30 days before the survey (Table 9). The prevalence of having carried a weapon was higher among male (28.1%) than female (7.9%) students; higher among white male (33.4%), black male (18.2%), and Hispanic male (23.8%) than white female (8.3%), black female (7.2%), and Hispanic female (7.7%) students, respectively; and higher among 9th-grade male (26.4%), 10th-grade male (26.4%), 11th-grade male (30.5%), and 12th-grade male (29.5%) than 9th-grade female (8.6%), 10th-grade female (9.2%), 11th-grade female (5.9%), and 12th-grade female (7.5%) students, respectively. The prevalence of having carried a weapon was higher among white (20.8%) than black (12.5%) and Hispanic (15.5%) students, higher among Hispanic (15.5%) than black (12.5%) students, higher among white male (33.4%) than black male (18.2%) and Hispanic male (23.8%) students, and higher among Hispanic male (23.8%) than black male (18.2%) students. The prevalence of having carried a weapon was higher among 10th-grade female (9.2%) than 11th-grade female (5.9%) students.

During 1991–2013, a significant linear decrease occurred overall in the prevalence of having carried a weapon (26.1%–17.9%). A significant quadratic trend also was identified. The prevalence of having carried a weapon decreased during 1991–1997 (26.1%–18.3%) and then did not change significantly during 1997–2013 (18.3%–17.9%). The prevalence of having carried a weapon did not change significantly from 2011 (16.6%) to 2013 (17.9%).

Across 34 states, the prevalence of having carried a weapon ranged from 10.2% to 28.8% (median: 18.4%) (Table 10). Across 20 large urban school districts, the prevalence ranged from 8.3% to 20.0% (median: 12.3%).

Carried a Gun

Nationwide, 5.5% of students had carried a gun on at least 1 day during the 30 days before the survey (Table 9). The prevalence of having carried a gun was higher among male (9.4%) than female (1.6%) students; higher among white male (10.7%), black male (9.8%), and Hispanic male (7.5%) than white female (1.7%), black female (1.1%), and Hispanic female (1.9%) students, respectively; and higher among 9th-grade male (9.1%), 10th-grade male (8.4%), 11th-grade male (10.5%), and 12th-grade male (9.9%) than 9th-grade female (1.9%), 10th-grade female (1.6%), 11th-grade female (1.1%), and 12th-grade female (1.6%) students, respectively. The prevalence of having carried a gun was higher among white male (10.7%) than Hispanic male (7.5%) students.

During 1993–2013, a significant linear decrease occurred overall in the prevalence of having carried a gun (7.9%-5.5%). A significant quadratic trend also was identified. The prevalence of having carried a gun decreased during 1993–1997 (7.9%–5.9%) and then did not change significantly during 1997–2013 (5.9%–5.5%). The prevalence of having carried a gun did not change significantly from 2011 (5.1%) to 2013 (5.5%).

Across 26 states, the prevalence of having carried a gun ranged from 2.9% to 13.3% (median: 6.9%) (Table 10). Across 20 large urban school districts, the prevalence ranged from 2.3% to 7.2% (median: 4.4%).

Carried a Weapon on School Property

Nationwide, 5.2% of students had carried a weapon (e.g., a gun, knife, or club) on school property on at least 1 day during the 30 days before the survey (Table 11). The prevalence of having carried a weapon on school property was higher among male (7.6%) than female (3.0%) students; higher among white male (8.3%), black male (5.3%), and Hispanic male (7.0%) than white female (3.1%), black female (2.7%), and Hispanic female (2.5%) students, respectively; and higher among 9th-grade male (6.4%), 10th-grade male (6.7%), 11th-grade male (8.7%), and 12th-grade male (8.7%) than 9th-grade female (3.3%), 10th-grade female (2.9%), 11th-grade female (3.3%), and 12th-grade female (2.1%) students, respectively. The prevalence of having carried a weapon on school property was higher among white (5.7%) than black (3.9%) students and higher among white male (8.3%) than black male (5.3%) students.

During 1993–2013, a significant linear decrease occurred overall in the prevalence of having carried a weapon on school property (11.8%-5.2%). A significant quadratic trend also was identified. The prevalence of having carried a weapon on school property decreased during 1993–1999 (11.8%–6.9%) and then decreased more gradually from 1999–2013 (6.9%–5.2%). The prevalence of having carried a weapon on school property did not change significantly from 2011 (5.4%) to 2013 (5.2%).

Across 34 states, the prevalence of having carried a weapon on school property ranged from 2.7% to 10.4% (median: 5.4%) (Table 12). Across 20 large urban school districts, the prevalence ranged from 2.1% to 9.3% (median: 4.1%).

Threatened or Injured with a Weapon on School Property

Nationwide, 6.9% of students had been threatened or injured with a weapon (e.g., a gun, knife, or club) on school property one or more times during the 12 months before the survey (Table 11). The prevalence of having been threatened or injured with a weapon on school property was higher among male (7.7%) than female (6.1%) students; higher among black male (10.1%) than black female (6.8%) students; and higher among 11th-grade male (8.1%) and 12th-grade male (6.8%) than 11th-grade female (5.6%) and 12th-grade female (3.1%) students, respectively. The prevalence of having been threatened or injured with a weapon on school property was higher among black (8.4%) and Hispanic (8.5%) than white (5.8%) students, higher among Hispanic female (7.5%) than white female (5.4%) students, and higher among black male (10.1%) and Hispanic male (9.5%) than white male (6.2%) students. The prevalence of having been threatened or injured with a weapon on school property was higher among 9th-grade (8.5%), 10th-grade (7.0%), and 11th-grade (6.8%) than 12th-grade (4.9%) students and higher among 9th-grade female (7.7%), 10th-grade female (7.4%), and 11th-grade female (5.6%) than 12th-grade female (3.1%) students.

During 1993–2013, a significant linear decrease occurred overall in the prevalence of having been threatened or injured with a weapon on school property (7.3%–6.9%). A significant quadratic trend also was identified. The prevalence of having been threatened or injured with a weapon on school property did not change significantly from 1993–2003 (7.3%–9.2%) and then decreased from 2003–2013 (9.2%–6.9%). The prevalence of having been threatened or injured with a weapon on school property did not change significantly from 2011 (7.4%) to 2013 (6.9%).

Across 35 states, the prevalence of having been threatened or injured with a weapon on school property ranged from 4.3% to 10.9% (median: 6.4%) (Table 12). Across 21 large urban school districts, the prevalence ranged from 4.3% to 11.6% (median: 7.6%).

In a Physical Fight

Nationwide, 24.7% of students had been in a physical fight one or more times during the 12 months before the survey (Table 13). The prevalence of having been in a physical fight was higher among male (30.2%) than female (19.2%) students; higher among white male (27.1%) and Hispanic male (34.2%) than white female (14.6%) and Hispanic female (22.8%) students, respectively; and higher among 9th-grade male (33.2%), 10th-grade male (30.9%), 11th-grade male (31.6%), and 12th-grade male (23.8%) than 9th-grade female (23.3%), 10th-grade female (21.9%), 11th-grade female (16.7%), and 12th-grade female (13.9%) students, respectively. The prevalence of having been in a physical fight was higher among black (34.7%) than white (20.9%) and Hispanic (28.4%) students, higher among Hispanic (28.4%) than white (20.9%) students, higher among black female (32.1%) than white female (14.6%) and Hispanic female (22.8%) students, higher among Hispanic female (22.8%) than white female (14.6%) students, and higher among black male (37.5%) and Hispanic male (34.2%) than white male (27.1%) students. The prevalence of having been in a physical fight was higher among 9th-grade (28.3%) than 11th-grade (24.0%) and 12th-grade (18.8%) students; higher among 10th-grade (26.4%) and 11th-grade (24.0%) than 12th-grade (18.8%) students; higher among 9th-grade female (23.3%) and 10th-grade female (21.9%) than 11th grade female (16.7%) and 12th-grade female (13.9%) students; and higher among 9th-grade male (33.2%), 10th-grade male (30.9%), and 11th-grade male (31.6%) than 12th-grade male (23.8%) students.

During 1991–2013, a significant linear decrease occurred overall in the prevalence of having been in a physical fight (42.5%–24.7%). A significant quadratic trend was not identified. The prevalence of having been in a physical fight also decreased from 2011 (32.8%) to 2013 (24.7%).

Across 37 states, the prevalence of having been in a physical fight ranged from 16.7% to 31.0% (median: 22.8%) (Table 14). Across 19 large urban school districts, the prevalence ranged from 17.2% to 37.6% (median: 26.3%).

Injured in a Physical Fight

During the 12 months before the survey, 3.1% of students nationwide had been in a physical fight one or more times in which they were injured and had to be treated by a doctor or nurse (Table 13). The prevalence of having been injured in a physical fight was higher among male (3.8%) than female (2.4%) students; higher among white male (2.7%) than white female (1.5%) students; and higher among 10th-grade male (4.2%) and 11th-grade male (4.0%) than 10th-grade female (2.4%) and 11th-grade female (1.9%) students, respectively. The prevalence of having been injured in a physical fight was higher among black (4.4%) and Hispanic (4.7%) than white (2.1%) students, higher among black female (4.1%) and Hispanic female (3.6%) than white female (1.5%) students, and higher among black male (4.7%) and Hispanic male (5.9%) than white male (2.7%) students.

During 1991–2013, a significant linear decrease occurred overall in the prevalence of having been injured in a physical fight (4.4%–3.1%). A significant quadratic trend was not identified. The prevalence of having been injured in a physical fight also decreased from 2011 (3.9%) to 2013 (3.1%).

Across 30 states, the prevalence of having been injured in a physical fight ranged from 2.1% to 9.3% (median: 2.9%) (Table 14). Across 18 large urban school districts, the prevalence ranged from 2.1% to 10.2% (median: 4.2%).

In a Physical Fight on School Property

Nationwide, 8.1% of students had been in a physical fight on school property one or more times during the 12 months before the survey (Table 15). The prevalence of having been in a physical fight on school property was higher among male (10.7%) than female (5.6%) students; higher among white male (8.9%) and Hispanic male (12.1%) than white female (3.8%) and Hispanic female (6.7%) students, respectively; and higher among 9th-grade male (13.0%), 10th-grade male (10.2%), 11th-grade male (10.9%), and 12th-grade male (7.3%) than 9th-grade female (8.6%), 10th-grade female (6.3%), 11th-grade female (4.1%), and 12th-grade female (2.6%) students, respectively. The prevalence of having been in a physical fight on school property was higher among black (12.8%) than white (6.4%) and Hispanic (9.4%) students, higher among Hispanic (9.4%) than white (6.4%) students, higher among black female (11.2%) than white female (3.8%) and Hispanic female (6.7%) students, higher among Hispanic female (6.7%) than white female (3.8%) students, and higher among black male (14.5%) and Hispanic male (12.1%) than white male (8.9%) students. The prevalence of having been in a physical fight on school property was higher among 9th-grade (10.9%) than 10th-grade (8.3%), 11th-grade (7.5%), and 12th-grade (4.9%) students; higher among 10th-grade (8.3%) and 11th-grade (7.5%) than 12th-grade (4.9%) students; higher among 9th-grade female (8.6%) than 10th-grade female (6.3%), 11th-grade female (4.1%), and 12th-grade female (2.6%) students; higher among 10th-grade female (6.3%) than 11th-grade female (4.1%) and 12th-grade female (2.6%) students; higher among 9th-grade male (13.0%) than 10th-grade male (10.2%) and 12th-grade male (7.3%) students; and higher among 10th-grade male (10.2%) and 11th-grade male (10.9%) than 12th-grade male (7.3%) students.

During 1993–2013, a significant linear decrease occurred overall in the prevalence of having been in a physical fight on school property (16.2%–8.1%). A significant quadratic trend was not identified. The prevalence of having been in a physical fight on school property also decreased from 2011 (12.0%) to 2013 (8.1%).

Across 35 states, the prevalence of having been in a physical fight on school property ranged from 4.6% to 14.3% (median: 8.1%) (Table 16). Across 20 large urban school districts, the prevalence ranged from 5.5% to 16.9% (median: 10.5%).

Did Not Go to School Because of Safety Concerns

Nationwide, 7.1% of students had not gone to school on at least 1 day during the 30 days before the survey because they felt they would be unsafe at school or on their way to or from school (i.e., did not go to school because of safety concerns) (Table 15). The prevalence of having not gone to school because of safety concerns was higher among female (8.7%) than male (5.4%) students; higher among white female (7.4%) and Hispanic female (12.6%) than white male (3.8%) and Hispanic male (6.9%) students, respectively; and higher among 9th-grade female (9.9%), 10th-grade female (10.7%), and 11th-grade female (8.1%) than 9th-grade male (5.5%), 10th-grade male (5.3%), and 11th-grade male (5.8%) students, respectively. The prevalence of having not gone to school because of safety concerns was higher among black (7.9%) and Hispanic (9.8%) than white (5.6%) students, higher among Hispanic female (12.6%) than white female (7.4%) and black female (8.0%) students, and higher among black male (7.8%) and Hispanic male (6.9%) than white male (3.8%) students. The prevalence of having not gone to school because of safety concerns was higher among 9th-grade (7.7%) and 10th-grade (8.0%) than 12th-grade (5.5%) students and higher among 9th-grade female (9.9%) and 10th-grade female (10.7%) than 12th-grade female (5.9%) students.

During 1993–2013, a significant linear increase occurred overall in the prevalence of having not gone to school because of safety concerns (4.4%–7.1%). A significant quadratic trend was not identified. The prevalence of having not gone to school because of safety concerns did not change significantly from 2011 (5.9%) to 2013 (7.1%).

Across 39 states, the prevalence of having not gone to school because of safety concerns ranged from 3.6% to 13.1% (median: 7.2%) (Table 16). Across 21 large urban school districts, the prevalence ranged from 3.9% to 16.8% (median: 10.8%).

Electronically Bullied

Nationwide, 14.8% of students had been electronically bullied, including being bullied through e-mail, chat rooms, instant messaging, websites, or texting, during the 12 months before the survey (Table 17). The prevalence of having been electronically bullied was higher among female (21.0%) than male (8.5%) students; higher among white female (25.2%), black female (10.5%), and Hispanic female (17.1%) than white male (8.7%), black male (6.9%), and Hispanic male (8.3%) students, respectively; and higher among 9th-grade female (22.8%), 10th-grade female (21.9%), 11th-grade female (20.6%), and 12th-grade female (18.3%) than 9th-grade male (9.4%), 10th-grade male (7.2%), 11th-grade male (8.9%), and 12th-grade male (8.6%) students, respectively. The prevalence of having been electronically bullied was higher among white (16.9%) than black (8.7%) and Hispanic (12.8%) students, higher among Hispanic (12.8%) than black (8.7%) students, higher among white female (25.2%) than black female (10.5%) and Hispanic female (17.1%) students, and higher among Hispanic female (17.1%) than black female (10.5%) students. The prevalence of having been electronically bullied was higher among 9th-grade (16.1%) than 12th-grade (13.5%) students and higher among 9th-grade female (22.8%) than 12th-grade female (18.3%) students.

Because this question was asked for the first time in 2011, linear and quadratic trends are not available. The prevalence of having been electronically bullied decreased from 2011 (16.2%) to 2013 (14.8%).

Across 40 states, the prevalence of having been electronically bullied ranged from 11.9% to 20.6% (median: 15.4%) (Table 18). Across 21 large urban school districts, the prevalence ranged from 7.9% to 23.0% (median: 10.1%).

Bullied on School Property

Nationwide, 19.6% of students had been bullied on school property during the 12 months before the survey (Table 17). The prevalence of having been bullied on school property was higher among female (23.7%) than male (15.6%) students; higher among white female (27.3%), black female (15.1%), and Hispanic female (20.7%) than white male (16.2%), black male (10.2%), and Hispanic male (14.8%) students, respectively; and higher among 9th-grade female (29.2%), 10th-grade female (28.8%), 11th-grade female (20.3%), and 12th-grade female (15.5%) than 9th-grade male (20.8%), 10th-grade male (15.8%), 11th-grade male (13.1%), and 12th-grade male (11.2%) students, respectively. The prevalence of having been bullied on school property was higher among white (21.8%) than black (12.7%) and Hispanic (17.8%) students, higher among Hispanic (17.8%) than black (12.7%) students, higher among white female (27.3%) than black female (15.1%) and Hispanic female (20.7%) students; higher among Hispanic female (20.7%) than black female (15.1%) students, and higher among white male (16.2%) and Hispanic male (14.8%) than black male (10.2%) students. The prevalence of having been bullied on school property was higher among 9th-grade (25.0%) and 10th-grade (22.2%) than 11th-grade (16.8%) and 12th-grade (13.3%) students; higher among 11th-grade (16.8%) than 12th-grade (13.3%) students; higher among 9th-grade female (29.2%) and 10th-grade female (28.8%) than 11th-grade female (20.3%) and 12th-grade female (15.5%) students; higher among 11th-grade female (20.3%) than 12th-grade female (15.5%) students; higher among 9th-grade male (20.8%) than 10th-grade male (15.8%), 11th-grade male (13.1%), and 12th-grade male (11.2%) students; and higher among 10th-grade male (15.8%) than 12th-grade male (11.2%) students.

During 2009–2013, significant linear and quadratic trends were not identified in the prevalence of having been bullied on school property. The prevalence of having been bullied on school property did not change from significantly from 2011 (20.1%) to 2013 (19.6%).

Across 40 states, the prevalence of having been bullied on school property ranged from 15.7% to 26.3% (median: 21.2%) (Table 18). Across 21 large urban school districts, the prevalence ranged from 10.9% to 27.9% (median: 13.4%).

Forced to Have Sexual Intercourse

Nationwide, 7.3% of students had ever been physically forced to have sexual intercourse when they did not want to (Table 19). The prevalence of having been forced to have sexual intercourse was higher among female (10.5%) than male (4.2%) students; higher among white female (9.1%), black female (11.5%), and Hispanic female (12.2%) than white male (3.1%), black male (5.2%), and Hispanic male (5.2%) students, respectively; and higher among 9th-grade female (8.3%), 10th-grade female (11.8%), 11th-grade female (10.5%), and 12th-grade female (11.2%) than 9th-grade male (3.8%), 10th-grade male (2.8%), 11th-grade male (4.7%), and 12th-grade male (5.5%) students, respectively. The prevalence of having been forced to have sexual intercourse was higher among black (8.4%) and Hispanic (8.7%) than white (6.1%) students and higher among black male (5.2%) and Hispanic male (5.2%) than white male (3.1%) students. The prevalence of having been forced to have sexual intercourse was higher among 10th-grade (7.2%), 11th-grade (7.7%), and 12th-grade (8.4%) than 9th-grade (6.1%) students; higher among 10th-grade female (11.8%) and 12th-grade female (11.2%) than 9th grade female (8.3%) students; and higher among 11th-grade male (4.7%) and 12th-grade male (5.5%) than 10th-grade male (2.8%) students.

During 2001-2013, significant linear and quadratic changes were not identified in the prevalence of having been forced to have sexual intercourse. The prevalence of having been forced to have sexual intercourse did not change significantly from 2011 (8.0%) to 2013 (7.3%).

Across 36 states, the prevalence of having been forced to have sexual intercourse ranged from 5.7% to 11.6% (median: 8.6%) (Table 20). Across 18 large urban school districts, the prevalence ranged from 6.4% to 11.5% (median: 9.0%).

Physical Dating Violence

Among the 73.9% of students nationwide who dated or went out with someone during the 12 months before the survey, 10.3% had been hit, slammed into something, or injured with an object or weapon on purpose by someone they were dating or going out with one or more times during the 12 months before the survey (i.e., physical dating violence) (Table 21). The prevalence of physical dating violence was higher among female (13.0%) than male (7.4%) students; higher among white female (12.9%), black female (12.3%), and Hispanic female (13.6%) than white male (6.4%), black male (8.2%), and Hispanic male (7.0%) students, respectively; and higher among 9th-grade female (11.9%), 10th-grade female (13.4%), 11th-grade female (12.4%), and 12th-grade female (13.9%) than 9th-grade male (5.7%), 10th-grade male (6.4%), 11th-grade male (8.2%), and 12th-grade male (9.5%) students, respectively. The prevalence of physical dating violence was higher among 12th-grade (11.7%) than 9th-grade (8.8%) students and higher among 12th-grade male (9.5%) than 9th-grade male (5.7%) and 10th-grade male (6.4%) students.

Across 38 states, the prevalence of physical dating violence ranged from 7.0% to 14.8% (median: 9.6%) (Table 22). Across 20 large urban school districts, the prevalence ranged from 7.4% to 16.8% (median: 9.4%).

Sexual Dating Violence

Among the 73.9% of students nationwide who dated or went out with someone during the 12 months before the survey, 10.4% of students had been kissed, touched, or physically forced to have sexual intercourse when they did not want to by someone they were dating or going out with one or more times during the 12 months before the survey (i.e., sexual dating violence) (Table 21). The prevalence of sexual dating violence was higher among female (14.4%) than male (6.2%) students; higher among white female (14.6%) and Hispanic female (16.0%) than white male (4.8%) and Hispanic male (6.7%) students, respectively; and higher among 9th-grade female (15.7%), 10th-grade female (15.9%), 11th-grade female (12.0%), and 12th-grade female (13.9%) than 9th-grade male (5.9%), 10th-grade male (5.0%), 11th-grade male (7.3%), and 12th-grade male (6.4%) students, respectively. The prevalence of sexual dating violence was higher among white female (14.6%) and Hispanic female (16.0%) than black female (8.8%) students and higher among black male (8.9%) than white male (4.8%) and Hispanic male (6.7%) students. The prevalence of sexual dating violence was higher among 10th-grade female (15.9%) than 11th-grade female (12.0%) students and higher among 11th-grade male (7.3%) than 10th-grade male (5.0%) students.

Across 31 states, the prevalence of sexual dating violence ranged from 7.8% to 13.8% (median: 10.5%) (Table 22). Across 17 large urban school districts, the prevalence ranged from 8.0% to 13.0% (median: 9.9%).

Felt Sad or Hopeless

During the 12 months before the survey, 29.9% of students nationwide had felt so sad or hopeless almost every day for 2 or more weeks in a row that they stopped doing some usual activities (Table 23). The prevalence of having felt sad or hopeless was higher among female (39.1%) than male (20.8%) students; higher among white female (35.7%), black female (35.8%), and Hispanic female (47.8%) than white male (19.1%), black male (18.8%), and Hispanic male (25.4%) students, respectively; and higher among 9th-grade female (40.8%), 10th-grade female (38.8%), 11th-grade female (39.9%), and 12th-grade female (36.2%) than 9th-grade male (18.2%), 10th-grade male (20.3%), 11th-grade male (23.1%), and 12th-grade male (21.8%) students, respectively. The prevalence of having felt sad or hopeless was higher among Hispanic (36.8%) than white (27.3%) and black (27.5%) students, higher among Hispanic female (47.8%) than white female (35.7%) and black female (35.8%) students, and higher among Hispanic male (25.4%) than white male (19.1%) and black male (18.8%) students. The prevalence of having felt sad or hopeless was higher among 9th-grade female (40.8%) than 12th-grade female (36.2%) students and higher among 11th-grade male (23.1%) and 12th-grade male (21.8%) than 9th-grade male (18.2%) students.

During 1999-2013, significant linear and quadratic trends were not identified in the prevalence of having felt sad or hopeless. The prevalence of having felt sad or hopeless did not change significantly from 2011 (28.5%) to 2013 (29.9%).

Across 42 states, the prevalence of having felt sad or hopeless ranged from 19.5% to 36.4% (median: 27.1%) (Table 24). Across 21 large urban school districts, the prevalence ranged from 21.1% to 32.5% (median: 28.4%).

Seriously Considered Attempting Suicide

Nationwide, 17.0% of students had seriously considered attempting suicide during the 12 months before the survey (Table 25). The prevalence of having seriously considered attempting suicide was higher among female (22.4%) than male (11.6%) students; higher among white female (21.1%), black female (18.6%), and Hispanic female (26.0%) than white male (11.4%), black male (10.2%), and Hispanic male (11.5%) students, respectively; and higher among 9th-grade female (24.6%), 10th-grade female (23.4%), 11th-grade female (22.3%), and 12th-grade female (18.7%) than 9th-grade male (9.9%), 10th-grade male (11.3%), 11th-grade male (14.0%), and 12th-grade male (11.0%) students, respectively. The prevalence of having seriously considered attempting suicide was higher among Hispanic (18.9%) than white (16.2%) and black (14.5%) students and higher among Hispanic female (26.0%) than white female (21.1%) and black female (18.6%) students. The prevalence of having seriously considered attempting suicide was higher among 9th-grade (17.2%), 10th-grade (17.3%), and 11th-grade (18.2%) than 12th-grade (14.9%) students; higher among 9th-grade female (24.6%) and 10th-grade female (23.4%) than 12th-grade female (18.7%) students; and higher among 11th-grade male (14.0%) than 9th-grade male (9.9%) and 12th-grade male (11.0%) students.

During 1991–2013, a significant linear decrease occurred overall in the prevalence of having seriously considered attempting suicide (29.0%–17.0%). A significant quadratic trend also was identified. The prevalence of having seriously considered attempting suicide decreased from 1991–2009 (29.0%–13.8%) and then increased from 2009–2013 (13.8%–17.0%). The prevalence of having seriously considered attempting suicide did not change significantly from 2011 (15.8%) to 2013 (17.0%).

Across 41 states, the prevalence of having seriously considered attempting suicide ranged from 12.0% to 19.2% (median: 15.6%) (Table 26). Across 21 large urban school districts, the prevalence ranged from 12.7% to 17.0% (median: 14.3%).

Made a Suicide Plan

During the 12 months before the survey, 13.6% of students nationwide had made a plan about how they would attempt suicide (Table 25). The prevalence of having made a suicide plan was higher among female (16.9%) than male (10.3%) students; higher among white female (15.6%), black female (13.1%), and Hispanic female (20.1%) than white male (10.1%), black male (7.7%), and Hispanic male (11.2%) students, respectively; and higher among 9th-grade female (17.4%), 10th-grade female (17.9%), 11th-grade female (17.0%), and 12th-grade female (14.8%) than 9th-grade male (8.6%), 10th-grade male (10.4%), 11th-grade male (11.4%), and 12th-grade male (10.8%) students, respectively. The prevalence of having made a suicide plan was higher among Hispanic (15.7%) than white (12.8%) and black (10.4%) students, higher among white (12.8%) than black (10.4%) students, higher among Hispanic female (20.1%) than white female (15.6%) and black female (13.1%) students, and higher among white male (10.1%) and Hispanic male (11.2%) than black male (7.7%) students. The prevalence of having made a suicide plan was higher among 11th-grade male (11.4%) than 9th-grade male (8.6%) students.

During 1991–2013, a significant linear decrease occurred overall in the prevalence of having made a suicide plan (18.6%–13.6%). A significant quadratic trend also was identified. The prevalence of having made a suicide plan decreased from 1991–2009 (18.6%–10.9%) and then increased from 2009–2013 (10.9%–13.6%). The prevalence of having made a suicide plan did not change significantly from 2011 (12.8%) to 2013 (13.6%).

Across 39 states, the prevalence of having made a suicide plan ranged from 9.8% to 17.4% (median: 13.0%) (Table 26). Across 20 large urban school districts, the prevalence ranged from 10.1% to 16.8% (median: 12.8%).

Attempted Suicide

Nationwide, 8.0% of students had attempted suicide one or more times during the 12 months before the survey (Table 27). The prevalence of having attempted suicide was higher among female (10.6%) than male (5.4%) students; higher among white female (8.5%), black female (10.7%), and Hispanic female (15.6%) than white male (4.2%), black male (6.8%), and Hispanic male (6.9%) students, respectively; and higher among 9th-grade female (13.8%) and 10th-grade female (12.0%) than 9th-grade male (4.8%) and 10th-grade male (5.3%) students, respectively. The prevalence of having attempted suicide was higher among Hispanic (11.3%) than white (6.3%) and black (8.8%) students, higher among black (8.8%) than white (6.3%) students, higher among Hispanic female (15.6%) than white female (8.5%) and black female (10.7%) students, and higher among black male (6.8%) and Hispanic male (6.9%) than white male (4.2%) students. The prevalence of having attempted suicide was higher among 9th-grade (9.3%) and 10th-grade (8.6%) than 12th-grade (6.2%) students, higher among 9th-grade female (13.8%) than 11th-grade female (8.8%) and 12th-grade female (7.2%) students, and higher among 10th-grade female (12.0%) than 12th-grade female (7.2%) students.

During 1991–2013, a significant linear decrease occurred overall in the prevalence of having attempted suicide (7.3%–8.0%).¶¶ A significant quadratic trend was not identified. The prevalence of having attempted suicide did not change significantly from 2011 (7.8%) to 2013 (8.0%).

Across 40 states, the prevalence of having attempted suicide ranged from 5.5% to 14.3% (median: 8.5%) (Table 28). Across 21 large urban school districts, the prevalence ranged from 6.8% to 14.8% (median: 9.1%).

Suicide Attempt Treated by a Doctor or Nurse

During the 12 months before the survey, 2.7% of students nationwide had made a suicide attempt that resulted in an injury, poisoning, or overdose that had to be treated by a doctor or nurse (Table 27). The prevalence of having made a suicide attempt that resulted in an injury, poisoning, or overdose that had to be treated by a doctor or nurse was higher among female (3.6%) than male (1.8%) students; higher among white female (2.8%) and Hispanic female (5.4%) than white male (1.1%) and Hispanic male (2.8%) students, respectively, and higher among 9th-grade female (4.5%) and 10th-grade female (3.7%) than 9th-grade male (1.6%) and 10th-grade male (1.6%) students, respectively. The prevalence of having made a suicide attempt that resulted in an injury, poisoning, or overdose that had to be treated by a doctor or nurse was higher among Hispanic (4.1%) than white (2.0%) and black (2.7%) students, higher among Hispanic female (5.4%) than white female (2.8%) and black female (3.2%) students, and higher among Hispanic male (2.8%) than white male (1.1%) students.

During 1991-2013, significant linear and quadratic trends were not identified in the prevalence of having made a suicide attempt that resulted in an injury, poisoning, or overdose that had to be treated by a doctor or nurse. The prevalence of having made a suicide attempt that resulted in an injury, poisoning, or overdose that had to be treated by a doctor or nurse did not change significantly from 2011 (2.4%) to 2013 (2.7%).

Across 34 states, the prevalence of having made a suicide attempt that resulted in an injury, poisoning, or overdose that had to be treated by a doctor or nurse ranged from 1.4% to 5.6% (median: 3.0%) (Table 28). Across 21 large urban school districts, the prevalence ranged from 2.1% to 6.5% (median: 3.6%).

Tobacco Use

Ever Smoked Cigarettes

Nationwide, 41.1% of students had ever tried cigarette smoking (even one or two puffs) (i.e., ever smoked cigarettes) (Table 29). The prevalence of having ever smoked cigarettes was higher among male (42.5%) than female (39.6%) students. The prevalence of having ever smoked cigarettes was higher among white (42.9%) and Hispanic (43.2%) than black (34.0%) students, higher among white female (41.9%) and Hispanic female (41.4%) than black female (31.7%) students, and higher among white male (43.9%) and Hispanic male (45.1%) than black male (36.5%) students. The prevalence of having ever smoked cigarettes was higher among 10th-grade (39.0%), 11th-grade (47.0%), and 12th-grade (48.1%) than 9th-grade (31.7%) students; higher among 11th-grade (47.0%) and 12th-grade (48.1%) than 10th-grade (39.0%) students; higher among 10th-grade female (37.7%), 11th-grade female (45.2%), and 12th-grade female (46.5%) than 9th-grade female (30.3%) students; higher among 11th-grade female (45.2%) and 12th-grade female (46.5%) than 10th-grade female (37.7%) students; higher among 10th-grade male (40.2%), 11th-grade male (49.1%), and 12th-grade male (49.7%) than 9th-grade male (33.1%) students; and higher among 11th-grade male (49.1%) and 12th-grade male (49.7%) than 10th-grade male (40.2%) students.

During 1991–2013, a significant linear decrease occurred overall in the prevalence of having ever smoked cigarettes (70.1%–41.1%). A significant quadratic trend also was identified. The prevalence of having ever smoked cigarettes did not change significantly from 1991–1999 (70.1%–70.4%) and then decreased from 1999–2013 (70.4%–41.1%). The prevalence of having ever smoked cigarettes also decreased from 2011 (44.7%) to 2013 (41.1%).

Across 34 states, the prevalence of having ever smoked cigarettes ranged from 18.3% to 52.1% (median: 40.4%) (Table 30). Across 18 large urban school districts, the prevalence ranged from 26.8% to 45.2% (median: 32.8%).

Smoked a Whole Cigarette Before Age 13 Years

Nationwide, 9.3% of students had smoked a whole cigarette for the first time before age 13 years (Table 29). The prevalence of having smoked a whole cigarette before age 13 years was higher among male (10.8%) than female (7.8%) students; higher among white male (11.6%), black male (9.6%), and Hispanic male (10.9%) than white female (8.6%), black female (4.1%), and Hispanic female (7.6%) students, respectively; and higher among 11th-grade male (13.7%) and 12th-grade male (9.1%) than 11th-grade female (8.3%) and 12th-grade female (5.5%) students, respectively. The prevalence of having smoked a whole cigarette before age 13 years was higher among white (10.1%) and Hispanic (9.2%) than black (6.7%) students and higher among white female (8.6%) and Hispanic female (7.6%) than black female (4.1%) students. The prevalence of having smoked a whole cigarette before age 13 years was higher among 9th-grade (9.5%) and 11th-grade (10.9%) than 12th-grade (7.3%) students, higher among 9th-grade female (8.7%) than 12th-grade female (5.5%) students, and higher among 11th-grade male (13.7%) than 12th-grade male (9.1%) students.

During 1991–2013, a significant linear decrease occurred overall in the prevalence of having smoked a whole cigarette before age 13 years (23.8%–9.3%). A significant quadratic trend also was identified. The prevalence of having smoked a whole cigarette before age 13 years did not change significantly from 1991–1999 (23.8%–24.7%) and then decreased from 1999–2013 (24.7%–9.3%). The prevalence of having smoked a whole cigarette before age 13 years did not change significantly from 2011 (10.3%) to 2013 (9.3%).

Across 39 states, the prevalence of having smoked a whole cigarette ranged from 3.7% to 15.6% (median: 8.9%) (Table 30). Across 20 large urban school districts, the prevalence ranged from 3.7% to 12.0% (median: 7.8%).

Current Cigarette Use

Nationwide, 15.7% of students had smoked cigarettes on at least 1 day during the 30 days before the survey (i.e., current cigarette use) (Table 31). The prevalence of current cigarette use was higher among black male (10.5%) than black female (6.2%) students and higher among 11th-grade male (23.4%) than 11th-grade female (18.9%) students. The prevalence of current cigarette use was higher among white (18.6%) than black (8.2%) and Hispanic (14.0%) students, higher among Hispanic (14.0%) than black (8.2%) students, higher among white female (18.1%) than black female (6.2%) and Hispanic female (13.1%) students, higher among Hispanic female (13.1%) than black female (6.2%) students, and higher among white male (19.1%) and Hispanic male (15.0%) than black male (10.5%) students. The prevalence of current cigarette use was higher among 10th-grade (13.2%), 11th-grade (21.1%), and 12th-grade (19.2%) than 9th-grade (10.2%) students; higher among 11th-grade (21.1%) and 12th-grade (19.2%) than 10th-grade (13.2%) students; higher among 11th-grade female (18.9%) and 12th-grade female (18.7%) than 9th-grade female (10.0%) and 10th-grade female (12.6%) students; higher among 10th-grade male (13.6%), 11th-grade male (23.4%), and 12th-grade male (19.6%) than 9th-grade male (10.3%) students; and higher among 11th-grade male (23.4%) and 12th-grade male (19.6%) than 10th-grade male (13.6%) students.

During 1991–2013, a significant linear decrease occurred overall in the prevalence of current cigarette use (27.5%–15.7%). A significant quadratic trend also was identified. The prevalence of current cigarette use increased from 1991–1997 (27.5%–36.4%) and then decreased from 1997–2013 (36.4%–15.7%). The prevalence of current cigarette use did not change significantly from 2011 (18.1%) to 2013 (15.7%).

Across 41 states, the prevalence of current cigarette use ranged from 4.4% to 19.6% (median: 13.8%) (Table 32). Across 20 large urban school districts, the prevalence ranged from 3.4% to 11.3% (median: 7.7%).

Current Frequent Cigarette Use

Nationwide, 5.6% of students had smoked cigarettes 20 or more days during the 30 days before the survey (i.e., current frequent cigarette use) (Table 31). The prevalence of current frequent cigarette use was higher among black male (3.6%) than black female (2.0%) students. The prevalence of current frequent cigarette use was higher among white (7.6%) than black (2.7%) and Hispanic (2.9%) students, higher among white female (7.7%) than black female (2.0%) and Hispanic female (2.4%) students, and higher among white male (7.6%) than black male (3.6%) and Hispanic male (3.4%) students. The prevalence of current frequent cigarette use was higher among 11th-grade (7.6%) and 12th-grade (8.4%) than 9th-grade (2.9%) and 10th-grade (4.0%) students, higher among 11th-grade female (6.8%) than 9th-grade female (2.5%) students, higher among 12th-grade female (8.2%) than 9th-grade female (2.5%) and 10th-grade female (4.2%) students, and higher among 11th-grade male (8.4%) and 12th-grade male (8.6%) than 9th-grade male (3.2%) and 10th-grade male (3.8%) students.

During 1991–2013, a significant linear decrease occurred overall in the prevalence of current frequent cigarette use (12.7%–5.6%). A significant quadratic trend also was identified. The prevalence of current frequent cigarette use increased from 1991–1997 (12.7%–16.7%) and then decreased from 1997–2013 (16.7%–5.6%). The prevalence of current frequent cigarette use did not change significantly from 2011 (6.4%) to 2013 (5.6%).

Across 41 states, the prevalence of current frequent cigarette use ranged from 1.3% to 8.9% (median: 4.6%) (Table 32). Across large urban school districts, the prevalence ranged from 0.7% to 3.3% (median: 2.2%).

Smoked More than 10 Cigarettes per Day

Among the 15.7% of students nationwide who currently smoked cigarettes, 8.6% of students had smoked more than 10 cigarettes per day on the days they smoked during the 30 days before the survey (Table 33). The prevalence of having smoked more than 10 cigarettes per day was higher among male (10.9%) than female (6.3%) students. The prevalence of having smoked more than 10 cigarettes per day was higher among white (10.6%) than black (2.9%) and Hispanic (5.1%) students and higher among white male (13.0%) than black male (4.6%) and Hispanic male (6.5%) students.

During 1991–2013, a significant linear decrease occurred overall in the prevalence of having smoked more than 10 cigarettes per day (18.0%–8.6%). A significant quadratic trend was not identified. The prevalence of having smoked more than 10 cigarettes per day did not change significantly from 2011 (7.8%) to 2013 (8.6%).

Across 30 states, the prevalence of having smoked more than 10 cigarettes per day ranged from 2.4% to 15.7% (median: 9.2%) (Table 34). Across 10 large urban school districts, the prevalence ranged from 2.4% to 10.7% (median: 6.1%).

Tried to Quit Smoking Cigarettes

Among the 15.7% of students nationwide who currently smoked cigarettes, 48.0% had tried to quit smoking cigarettes during the 12 months before the survey (Table 33). The prevalence of having tried to quit smoking cigarettes was higher among female (51.0%) than male (45.4%) students and higher among 11th-grade female (54.5%) than 11th-grade male (45.8%) students. The prevalence of having tried to quit smoking cigarettes was higher among black (61.0%) than white (48.0%) and Hispanic (42.4%) students and higher among black male (54.9%) than Hispanic male (41.0%) students.

During 2001–2013, a significant linear decrease occurred overall in the prevalence of having tried to quit smoking cigarettes (57.4%–48.0%). A significant quadratic trend was not identified. The prevalence of having tried to quit smoking cigarettes did not change significantly from 2011 (49.9%) to 2013 (48.0%).

Across 29 states, the prevalence of having tried to quit smoking cigarettes ranged from 44.8% to 67.1% (median: 51.9%) (Table 34 ). Across 11 large urban school districts, the prevalence ranged from 38.6% to 57.9% (median: 52.7%).

Smoked Cigarettes on School Property

Nationwide, 3.8% of students had smoked cigarettes on school property on at least 1 day during the 30 days before the survey (Table 35). The prevalence of having smoked cigarettes on school property was higher among black male (2.3%) than black female (0.9%) students. The prevalence of having smoked cigarettes on school property was higher among white (4.9%) than black (1.6%) and Hispanic (2.9%) students, higher among Hispanic (2.9%) than black (1.6%) students, higher among white female (5.0%) than black female (0.9%) and Hispanic female (2.7%) students, higher among Hispanic female (2.7%) than black female (0.9%) students, and higher among white male (4.7%) than black male (2.3%) students. The prevalence of having smoked cigarettes on school property was higher among 11th-grade (5.3%) and 12th-grade (4.7%) than 9th-grade (2.5%) and 10th-grade (2.9%) students, higher among 12th-grade female (4.6%) than 9th-grade female (2.6%) students, and higher among 11th-grade male (5.7%) and 12th-grade male (4.9%) than 9th-grade male (2.3%) and 10th-grade male (3.1%) students.

During 1993–2013, a significant linear decrease occurred overall in the prevalence of having smoked cigarettes on school property (13.2%–3.8%). A significant quadratic trend also was identified. The prevalence of having smoked cigarettes on school property did not change significantly from 1993–1997 (13.2%–14.6%) and then decreased from 1997–2013 (14.6%–3.8%). The prevalence of having smoked cigarettes on school property decreased from 2011 (4.9%) to 2013 (3.8%).

Across 29 states, the prevalence of having smoked cigarettes on school property ranged from 1.4% to 5.6% (median: 3.4%) (Table 36). Across 17 large urban school districts, the prevalence ranged from 0.9% to 4.4% (median: 2.6%).

Bought Cigarettes in a Store or Gas Station

Among the 12.4% of students who currently smoked cigarettes and were aged <18 years, 18.1% had usually obtained their own cigarettes by buying them in a store (e.g., convenience store, supermarket, or discount store) or gas station during the 30 days before the survey (Table 35). The prevalence of having bought their own cigarettes in a store or gas station was higher among male (20.4%) than female (15.6%) students and higher among 11th-grade male (29.0%) than 11th-grade female (17.7%) students. The prevalence of having bought their own cigarettes in a store or gas station was higher among 11th-grade (23.8%) and 12th-grade (24.1%) than 9th-grade (10.3%) students, higher among 11th-grade (23.8%) than 10th-grade (13.5%) students, and higher among 11th-grade male (29.0%) than 9th-grade male (10.6%) and 10th-grade male (14.3%) students.

During 2001–2013, a significant linear decrease occurred overall in the prevalence of students having bought their own cigarettes in a store or gas station (19.0%–18.1%). A significant quadratic tend also was identified. The prevalence of having bought their own cigarettes in a store or gas station decreased from 2001–2009 (19.0%–14.1%) and then did not change significantly from 2009–2013 (14.1%–18.1%). The prevalence of having bought their own cigarettes in a store or gas station did not change significantly from 2011 (14.0%) to 2013 (18.1%).

Across 28 states, the prevalence of having bought their own cigarettes in a store or gas station ranged from 4.5% to 28.7% (median: 12.8%) (Table 36). Across 5 large urban school districts, the prevalence ranged from 12.1% to 24.6% (median: 23.9%).

Ever Smoked Cigarettes Daily

Nationwide, 8.8% of students had ever smoked at least one cigarette every day for 30 days (i.e., ever smoked cigarettes daily) (Table 37). The prevalence of having ever smoked cigarettes daily was higher among black male (5.5%) than black female (3.1%) students. The prevalence of having ever smoked cigarettes daily was higher among white (11.3%) than black (4.3%) and Hispanic (6.1%) students, higher among Hispanic (6.1%) than black (4.3%) students, higher among white female (11.7%) than black female (3.1%) and Hispanic female (5.2%) students, higher among Hispanic female (5.2%) than black female (3.1%) students, and higher among white male (10.9%) than black male (5.5%) and Hispanic male (7.0%) students. The prevalence of having ever smoked cigarettes daily was higher among 10th-grade (6.9%), 11th-grade (11.7%), and 12th-grade (12.2%) than 9th-grade (5.1%) students; higher among 11th-grade (11.7%) and 12th-grade (12.2%) than 10th-grade (6.9%) students; higher among 10th-grade female (7.1%), 11th-grade female (11.9%), and 12th-grade female (11.5%) than 9th-grade female (4.7%) students; higher among 11th-grade female (11.9%) and 12th-grade female (11.5%) than 10th-grade female (7.1%) students; and higher among 11th-grade male (11.5%) and 12th-grade male (13.0%) than 9th-grade male (5.4%) and 10th-grade male (6.7%) students.

During 2001–2013, a significant linear decrease occurred overall in the prevalence of having ever smoked cigarettes daily (20.0%–8.8%). A significant quadratic trend was not identified. The prevalence of having ever smoked cigarettes daily did not change significantly from 2011 (10.2%) to 2013 (8.8%).

Across 26 states, the prevalence of having ever smoked cigarettes daily ranged from 2.6% to 13.9% (median: 8.2%) (Table 38). Across 18 large urban school districts, the prevalence ranged from 2.4% to 7.0% (median: 5.0%).

Currently Smoked Cigarettes Daily

Nationwide, 4.0% of students had smoked cigarettes on all 30 days during the 30 days before the survey (i.e., currently smoked cigarettes daily) (Table 37). The prevalence of having currently smoked cigarettes daily was higher among white (5.6%) than black (1.7%) and Hispanic (1.9%) students, higher among white female (5.5%) than black female (1.3%) and Hispanic female (1.2%) students, and higher among white male (5.7%) than black male (2.2%) and Hispanic male (2.5%) students. The prevalence of having currently smoked cigarettes daily was higher among 11th-grade (5.1%) and 12th-grade (6.1%) than 9th-grade (2.2%) and 10th-grade (2.9%) students, higher among 11th-grade female (4.4%) than 9th-grade female (1.8%) students, higher among 12th-grade female (6.3%) than 9th-grade female (1.8%) and 10th-grade female (2.7%) students, and higher among 11th-grade male (6.0%) and 12th-grade male (5.9%) than 9th-grade male (2.5%) and 10th-grade male (3.1%) students.

During 1991–2013, a significant linear decrease occurred overall in the prevalence of having currently smoked cigarettes daily (9.8%–4.0%). A significant quadratic trend also was identified. The prevalence of having currently smoked cigarettes daily increased from 1991–1999 (9.8%–12.8%) and then decreased from 1999–2013 (12.8%–4.0%). The prevalence of having currently smoked cigarettes daily did not change significantly from 2011 (4.8%) to 2013 (4.0%).

Across 41 states, the prevalence of having currently smoked cigarettes daily ranged from 0.9% to 6.7% (median: 3.4%) (Table 38). Across 20 large urban school districts, the prevalence ranged from 0.4% to 2.5% (median: 1.5%).

Current Smokeless Tobacco Use

Nationwide, 8.8% of students had used smokeless tobacco (e.g., chewing tobacco, snuff, or dip) on at least 1 day during the 30 days before the survey (i.e., current smokeless tobacco use) (Table 39). The prevalence of current smokeless tobacco use was higher among male (14.7%) than female (2.9%) students; higher among white male (20.6%), black male (4.4%), and Hispanic male (7.7%) than white female (3.1%), black female (1.0%), and Hispanic female (3.5%) students, respectively; and higher among 9th-grade male (11.2%), 10th-grade male (13.7%), 11th-grade male (18.2%), and 12th-grade male (16.6%) than 9th-grade female (3.4%), 10th-grade female (2.4%), 11th-grade female (3.1%), and 12th-grade female (2.4%) students, respectively. The prevalence of current smokeless tobacco use was higher among white (11.9%) than black (2.7%) and Hispanic (5.6%) students, higher among Hispanic (5.6%) than black (2.7%) students, higher among white female (3.1%) and Hispanic female (3.5%) than black female (1.0%) students, higher among white male (20.6%) than black male (4.4%) and Hispanic male (7.7%) students, and higher among Hispanic male (7.7%) than black male (4.4%) students. The prevalence of current smokeless tobacco use was higher among 11th-grade (10.5%) than 9th-grade (7.3%) students and higher among 11th-grade male (18.2%) and 12th-grade male (16.6%) than 9th-grade male (11.2%) students.

During 1995-2013, a significant linear trend was not identified in the prevalence of current smokeless tobacco use. A significant quadratic trend was identified. The prevalence of current smokeless tobacco use decreased from 1995–1999 (11.4%–7.8%) and then did not change significantly from 1999–2013 (7.8%–8.8%). The prevalence of current smokeless tobacco use did not change significantly from 2011 (7.7%) to 2013 (8.8%).

Across 38 states, the prevalence of current smokeless tobacco use ranged from 2.6% to 15.9% (median: 8.3%) (Table 40). Across 20 large urban school districts, the prevalence ranged from 2.1% to 8.7% (median: 4.3%).

Current Cigar Use

Nationwide, 12.6% of students had smoked cigars, cigarillos, or little cigars on at least 1 day during the 30 days before the survey (i.e., current cigar use) (Table 39). The prevalence of current cigar use was higher among male (16.5%) than female (8.7%) students; higher among white male (18.1%), black male (14.0%), and Hispanic male (14.7%) than white female (8.0%), black female (9.4%), and Hispanic female (9.2%) students, respectively; and higher among 9th-grade male (11.1%), 10th-grade male (13.8%), 11th-grade male (19.7%), and 12th-grade male (23.0%) than 9th-grade female (6.9%), 10th-grade female (7.7%), 11th-grade female (9.9%), and 12th-grade female (10.4%) students, respectively. The prevalence of current cigar use was higher among white male (18.1%) than black male (14.0%) students. The prevalence of current cigar use was higher among 11th-grade (14.7%) and 12th-grade (16.7%) than 9th-grade (9.0%) and 10th-grade (10.8%) students, higher among 12th-grade female (10.4%) than 9th-grade female (6.9%) students, and higher among 11th-grade male (19.7%) and 12th-grade male (23.0%) than 9th-grade male (11.1%) and 10th-grade male (13.8%) students.

During 1997–2013, a significant linear decrease occurred overall in the prevalence of current cigar use (22.0%–12.6%). A significant quadratic trend also was identified. The prevalence of current cigar use decreased from 1997–2001 (22.0%–15.2%) and then decreased more gradually from 2001–2013 (15.2%–12.6%). The prevalence of current cigar use did not change significantly from 2011 (13.1%) to 2013 (12.6%).

Across 36 states, the prevalence of current cigar use ranged from 4.1% to 17.1% (median: 12.4%) (Table 40). Across 19 large urban school districts, the prevalence ranged from 5.6% to 16.6% (median: 8.6%).

Current Tobacco Use

Nationwide, 22.4% of students had reported current cigarette use, current smokeless tobacco use, or current cigar use (i.e., current tobacco use) (Table 41). The prevalence of current tobacco use was higher among male (27.0%) than female (17.8%) students; higher among white male (33.2%), black male (17.8%), and Hispanic male (20.7%) than white female (20.7%), black female (11.1%), and Hispanic female (15.3%) students, respectively; and higher among 9th-grade male (18.1%), 10th-grade male (24.1%), 11th-grade male (33.6%), and 12th-grade male (34.3%) than 9th-grade female (12.8%), 10th-grade female (15.5%), 11th-grade female (21.3%), and 12th-grade female (22.4%) students, respectively. The prevalence of current tobacco use was higher among white (26.9%) than black (14.3%) and Hispanic (18.0%) students, higher among white female (20.7%) than black female (11.1%) and Hispanic female (15.3%) students, and higher among white male (33.2%) than black male (17.8.%) and Hispanic male (20.7%) students. The prevalence of current tobacco use was higher among 10th-grade (19.9%), 11th-grade (27.2%), and 12th-grade (28.2%) than 9th-grade (15.5%) students; higher among 11th-grade (27.2%) and 12th-grade (28.2%) than 10th-grade (19.9%) students; higher among 11th-grade female (21.3%) and 12th-grade female (22.4%) than 9th-grade female (12.8%) and 10th-grade female (15.5%) students; higher among 10th-grade male (24.1%), 11th-grade male (33.6%), and 12th-grade male (34.3%) than 9th-grade male (18.1%) students; and higher among 11th-grade male (33.6%) and 12th-grade male (34.3%) than 10th-grade male (24.1%) students.

During 1997–2013, a significant linear decrease occurred overall in the prevalence of current tobacco use (43.4%–22.4%). A significant quadratic trend also was identified. The prevalence of current tobacco use decreased from 1997–2003 (43.4%–27.5%) and then decreased more gradually from 2003–2013 (27.5%–22.4%). The prevalence of current tobacco use did not change significantly from 2011 (23.4%) to 2013 (22.4%).

Across 35 states, the prevalence of current tobacco use ranged from 5.6% to 29.7% (median: 19.6%) (Table 42). Across 18 large urban school districts, the prevalence ranged from 8.2% to 17.6% (median: 11.5%).

Alcohol and Other Drug Use

Ever Drank Alcohol

Nationwide, 66.2% of students had had at least one drink of alcohol on at least 1 day during their life (i.e., ever drank alcohol) (Table 43). The prevalence of having ever drunk alcohol was higher among female (67.9%) than male (64.4%) students; higher among black female (66.8%) and Hispanic female (75.6%) than black male (59.8%) and Hispanic male (69.0%) students, respectively; and higher among 9th-grade female (58.8%) than 9th-grade male (52.4%) students. The prevalence of having ever drunk alcohol was higher among Hispanic (72.4%) than white (65.9%) and black (63.4%) students, higher among Hispanic female (75.6%) than white female (66.6%) and black female (66.8%) students, and higher among Hispanic male (69.0%) than black male (59.8%) students. The prevalence of having ever drunk alcohol was higher among 10th-grade (64.0%), 11th-grade (71.2%), and 12th-grade (75.6%) than 9th-grade (55.6%) students; higher among 11th-grade (71.2%) and 12th-grade (75.6%) than 10th-grade (64.0%) students; higher among 12th-grade (75.6%) than 11th-grade (71.2%) students; higher among 10th-grade female (66.1%), 11th-grade female (72.0%), and 12th-grade female (76.3%) than 9th-grade female (58.8%) students; higher among 12th-grade female (76.3%) than 10th-grade female (66.1%) students; higher among 10th-grade male (61.9%), 11th-grade male (70.3%), and 12th-grade male (74.9%) than 9th-grade male (52.4%) students; and higher among 11th-grade male (70.3%) and 12th-grade male (74.9%) than 10th-grade male (61.9%) students.

During 1991–2013, a significant linear decrease occurred overall in the prevalence of having ever drunk alcohol (81.6%–66.2%). A significant quadratic trend also was identified. The prevalence of having ever drunk alcohol did not change significantly from 1991–1999 (81.6%–81.0%) and then decreased from 1999–2013 (81.0%–66.2%). The prevalence of having ever drunk alcohol also decreased from 2011 (70.8%) to 2013 (66.2%).

Across 31 states, the prevalence of having ever drunk alcohol ranged from 30.7% to 70.5% (median: 63.2%) (Table 44). Across 19 large urban school districts, the prevalence ranged from 46.0% to 69.2% (median: 61.3%).

Drank Alcohol Before Age 13 Years

Nationwide, 18.6% of students had drunk alcohol (other than a few sips) for the first time before age 13 years (Table 43). The prevalence of having drunk alcohol for the first time before age 13 years was higher among male (20.5%) than female (16.6%) students; higher among white male (19.6%) and black male (23.3%) than white female (13.8%) and black female (18.7%) students, respectively; and higher among 11th-grade male (21.1%) and 12th-grade male (16.6%) than 11th-grade female (13.3%) and 12th-grade female (12.9%) students, respectively. The prevalence of having drunk alcohol for the first time before age 13 years was higher among black (21.0%) and Hispanic (21.8%) than white (16.7%) students, higher among black female (18.7%) and Hispanic female (20.2%) than white female (13.8%) students, and higher among black male (23.3%) than white male (19.6%) students. The prevalence of having drunk alcohol for the first time before age 13 years was higher among 9th-grade (22.2%) than 11th-grade (17.2%) and 12th-grade (14.7%) students, higher among 10th-grade (19.2%) than 12th-grade (14.7%) students, higher among 9th-grade female (20.5%) and 10th-grade female (18.7%) than 11th-grade female (13.3%) and 12th-grade female (12.9%) students, and higher among 9th-grade male (23.9%) than 10th-grade male (19.6%) and 12th-grade male (16.6%) students.

During 1991–2013, a significant linear decrease occurred overall in the prevalence of having drunk alcohol for the first time before age 13 years (32.7%–18.6%). A significant quadratic trend also was identified. The prevalence of having drunk alcohol for the first time before age 13 years did not change significantly from 1991–1999 (32.7%–32.2%) and then decreased from 1999–2013 (32.2%–18.6%). The prevalence of having drunk alcohol for the first time before age 13 years decreased from 2011 (20.5%) to 2013 (18.6%).

Across 40 states, the prevalence of having drunk alcohol for the first time before age 13 years ranged from 8.8% to 25.6% (median: 18.1%) (Table 44). Across 20 large urban school districts, the prevalence ranged from 15.3% to 22.8% (median: 18.9%).

Current Alcohol Use

Nationwide, 34.9% of students had had at least one drink of alcohol on at least 1 day during the 30 days before the survey (i.e., current alcohol use) (Table 45). The prevalence of current alcohol use was higher among white (36.3%) and Hispanic (37.5%) than black (29.6) students, higher among Hispanic female (39.7%) than black female (31.3%) students, and higher among white male (36.9%) and Hispanic male (35.2%) than black male (27.7%) students. The prevalence of current alcohol use was higher among 10th-grade (30.9%), 11th-grade (39.2%), and 12th-grade (46.8%) than 9th-grade (24.4%) students; higher among 11th-grade (39.2%) and 12th-grade (46.8%) than 10th-grade (30.9%) students; higher among 12th-grade (46.8%) than 11th-grade (39.2%) students; higher among 10th-grade female (33.2%), 11th-grade female (37.5%), and 12th-grade female (45.7%) than 9th-grade female (26.2%) students; higher among 12th-grade female (45.7%) than 10th-grade female (33.2%) and 11th-grade female (37.5%) students; higher among 10th-grade male (28.6%), 11th-grade male (41.0%), and 12th-grade male (48.0%) than 9th-grade male (22.7%) students; higher among 11th-grade male (41.0%) and 12th-grade male (48.0%) than 10th-grade male (28.6%) students; and higher among 12th-grade male (48.0%) than 11th-grade male (41.0%) students.

During 1991-2013, a significant linear decrease occurred overall in the prevalence of current alcohol use (50.8%–34.9%). A significant quadratic trend also was identified. The prevalence of current alcohol use did not change significantly during 1991–1999 (50.8%–50.0%) and then decreased during 1999–2013 (50.0%–34.9%). The prevalence of current alcohol use decreased from 2011 (38.7%) to 2013 (34.9%).

Across 41 states, the prevalence of current alcohol use ranged from 11.0% to 39.3% (median: 32.7%) (Table 46). Across 21 large urban school districts, the prevalence ranged from 18.6% to 38.7% (median: 31.0%).

Someone Gave Alcohol to Them

Among the 34.9% of students nationwide who currently drank alcohol, 41.8% had usually obtained the alcohol they drank by someone giving it to them during the 30 days before the survey (Table 45). The prevalence of having someone give alcohol to them was higher among female (46.7% ) than male (36.7%) students; higher among white female (49.2%) and Hispanic female (45.5%) than white male (36.9%) and Hispanic male (37.2%) students, respectively; and higher among 9th-grade female (50.9%), 10th-grade female (47.8%), and 12th-grade female (43.9%) than 9th-grade male (38.5%), 10th-grade male (37.6%), and 12th-grade male (33.6%) students, respectively. The prevalence of having someone give alcohol to them was higher among white (42.9%) than black (34.9%) students and higher among white female (49.2%) than black female (38.8%) students. The prevalence of having someone give alcohol to them was higher among 9th-grade (45.1%) and 11th-grade (42.7%) than 12th-grade (38.7%) students.

During 2007–2013, significant linear and quadratic trends were not identified in the prevalence of having someone give alcohol to them. The prevalence of having someone give alcohol to them did not change significantly from 2011 (40.0%) to 2013 (41.8%).

Across 36 states, the prevalence of having someone give alcohol to them ranged from 28.6% to 44.1% (median: 38.3%) (Table 46). Across 19 large urban school districts, the prevalence ranged from 26.3% to 44.1% (median: 37.1%).

Five or More Drinks in a Row

Nationwide, 20.8% of students had had five or more drinks of alcohol in a row (i.e., within a couple of hours) on at least 1 day during the 30 days before the survey (Table 47). The prevalence of having five or more drinks of alcohol in a row was higher among white male (25.3%) than white female (21.1%) students and higher among 11th-grade male (27.6%) and 12th-grade male (32.3%) than 11th-grade female (21.6%) and 12th-grade female (26.2%) students, respectively. The prevalence of having five or more drinks of alcohol in a row was higher among white (23.2%) and Hispanic (22.6%) than black (12.4%) students, higher among white female (21.1%) and Hispanic female (22.6%) than black female (11.5%) students, and higher among white male (25.3%) and Hispanic male (22.7%) than black male (13.1%) students. The prevalence of having five or more drinks of alcohol in a row was higher among 10th-grade (17.4%), 11th-grade (24.6%), and 12th-grade (29.2%) than 9th-grade (13.5%) students; higher among 11th-grade (24.6%) and 12th-grade (29.2%) than 10th-grade (17.4%) students; higher among 12th-grade (29.2%) than 11th-grade (24.6%) students; higher among 10th-grade female (17.7%), 11th-grade female (21.6%), and 12th-grade female (26.2%) than 9th-grade female (13.6%) students; higher among 12th-grade female (26.2%) than 10th-grade female (17.7%) students; higher among 11th-grade male (27.6%) and 12th-grade male (32.3%) than 9th-grade male (13.5%) and 10th-grade male (17.1%) students; and higher among 12th-grade male (32.3%) than 11th-grade male (27.6%) students.

During 1991–2013, a significant linear decrease occurred overall in the prevalence of having five or more drinks of alcohol in a row (31.3%–20.8%). A significant quadratic trend also was identified. The prevalence of having five or more drinks of alcohol in a row increased from 1991–1999 (31.3%–31.5%) and then decreased from 1999–2013 (31.5%–20.8%). The prevalence of having five or more drinks of alcohol in a row did not change significantly from 2011 (21.9%) to 2013 (20.8%).

Across 42 states, the prevalence of having five or more drinks of alcohol in a row ranged from 5.9% to 24.4% (median: 18.3%) (Table 48). Across 21 large urban school districts, the prevalence ranged from 8.9% to 19.6% (median: 13.9%).

Largest Number of Drinks in a Row Was 10 or More

Nationwide, 6.1% of students reported that the largest number of drinks that they had had in a row (i.e., within a couple of hours) during the 30 days before the survey was 10 or more (Table 47). The prevalence of reporting 10 or more as the largest number of drinks in a row was higher among male (8.0%) than female (4.2%) students; higher among white male (9.9%) than white female (4.4%) students; and higher among 10th-grade male (6.8%), 11th-grade male (11.0%), and 12th-grade male (11.2%) than 10th-grade female (3.8%), 11th-grade female (4.8%), and 12th-grade female (4.9%) students, respectively. The prevalence of reporting 10 or more as the largest number of drinks in a row was higher among white (7.1%) and Hispanic (7.1%) than black (1.6%) students, higher among white female (4.4%) and Hispanic female (5.8%) than black female (1.5%) students, and higher among white male (9.9%) and Hispanic male (8.5%) than black male (1.7%) students. The prevalence of reporting 10 or more as the largest number of drinks in a row was higher among 10th-grade (5.3%), 11th-grade (7.8%), and 12th-grade (7.9%) than 9th-grade (3.5%) students; higher among 11th-grade (7.8%) and 12th-grade (7.9%) than 10th-grade (5.3%) students; higher among 10th-grade male (6.8%), 11th-grade male (11.0%), and 12th-grade male (11.2%) than 9th-grade male (3.9%) students; and higher among 11th-grade male (11.0%) and 12th-grade male (11.2%) than 10th-grade male (6.8%) students.

Across 27 states, the prevalence of reporting 10 or more as the largest number of drinks in a row ranged from 1.2% to 9.0% (median: 4.3%) (Table 48). Across 15 large urban school districts, the prevalence ranged from 1.0% to 4.5% (median: 3.2%).

Ever Used Marijuana

Nationwide, 40.7% of students had used marijuana one or more times during their life (i.e., ever used marijuana) (Table 49). The prevalence of having ever used marijuana was higher among male (42.1%) than female (39.2%) students, higher among white male (38.6%) than white female (34.8%) students, and higher among 12th-grade male (50.9%) than 12th-grade female (46.4%) students. The prevalence of having ever used marijuana was higher among black (46.8%) and Hispanic (48.8%) than white (36.7%) students, higher among black female (45.4%) and Hispanic female (47.6%) than white female (34.8%) students, and higher among black male (48.2%) and Hispanic male (50.0%) than white male (38.6%) students. The prevalence of having ever used marijuana was higher among 10th-grade (39.1%), 11th-grade (46.4%), and 12th-grade (48.6%) than 9th-grade (30.1%) students; higher among 11th-grade (46.4%) and 12th-grade (48.6%) than 10th-grade (39.1%) students; higher among 10th-grade female (37.4%), 11th-grade female (45.1%), and 12th-grade female (46.4%) than 9th-grade female (29.0%) students; higher among 11th-grade female (45.1%) and 12th-grade female (46.4%) than 10th-grade female (37.4%) students; higher among 10th-grade male (40.7%), 11th-grade male (47.8%), and 12th-grade male (50.9%) than 9th-grade male (31.1%) students; and higher among 11th-grade male (47.8%) and 12th-grade male (50.9%) than 10th-grade male (40.7%) students.

During 1991–2013, a significant linear trend was not identified in the prevalence of having ever used marijuana. A significant quadratic trend was identified. The prevalence of having ever used marijuana increased from 1991–1997 (31.3%–47.1%) and then decreased from 1997–2013 (47.1%–40.7%). The prevalence of having ever used marijuana did not change significantly from 2011 (39.9%) to 2013 (40.7%).

Across 35 states, the prevalence of having ever used marijuana ranged from 16.8% to 43.3% (median: 36.6%) (Table 50). Across 19 large urban school districts, the prevalence ranged from 28.2% to 54.4% (median: 42.9%).

Tried Marijuana Before Age 13 Years

Nationwide, 8.6% of students had tried marijuana for the first time before age 13 years (Table 49). The prevalence of having tried marijuana before age 13 years was higher among male (11.1%) than female (6.2%) students; higher among white male (8.6%), black male (17.0%), and Hispanic male (13.7%) than white female (4.5%), black female (6.1%), and Hispanic female (9.8%) students, respectively; and higher among 9th-grade male (11.8%), 10th-grade male (11.4%), 11th-grade male (11.6%), and 12th-grade male (9.5%) than 9th-grade female (7.7%), 10th-grade female (7.8%), 11th-grade female (5.7%), and 12th-grade female (3.0%) students, respectively. The prevalence of having tried marijuana before age 13 years was higher among black (11.5%) and Hispanic (11.7%) than white (6.6%) students, higher among Hispanic female (9.8%) than white female (4.5%) and black female (6.1%) students, and higher among black male (17.0%) and Hispanic male (13.7%) than white male (8.6%) students. The prevalence of having tried marijuana before age 13 years was higher among 9th-grade (9.8%), 10th-grade (9.6%), and 11th-grade (8.6%) than 12th-grade (6.2%) students and higher among 9th-grade female (7.7%), 10th-grade female (7.8%), and 11th-grade female (5.7%) than 12th-grade female (3.0%) students.

During 1991–2013, a significant linear trend was not identified in the prevalence of having tried marijuana before age 13 years. A significant quadratic trend was identified. The prevalence of having tried marijuana before age 13 years increased from 1991–1999 (7.4%–11.3%) and then decreased from 1999–2013 (11.3%–8.6%). The prevalence of having tried marijuana before age 13 years did not change significantly from 2011 (8.1%) to 2013 (8.6%).

Across 41 states, the prevalence of having tried marijuana before age 13 years ranged from 3.7% to 17.3% (median: 8.1%) (Table 50). Across 21 large urban school districts, the prevalence ranged from 5.9% to 17.8% (median: 9.5%).

Current Marijuana Use

Nationwide, 23.4% of students had used marijuana one or more times during the 30 days before the survey (i.e., current marijuana use) (Table 51). The prevalence of current marijuana use was higher among male (25.0%) than female (21.9%) students, higher among white male (22.8%) than white female (18.0%) students, and higher among 11th-grade male (28.4%) and 12th-grade male (30.9%) than 11th-grade female (22.8%) and 12th-grade female (24.6%) students, respectively. The prevalence of current marijuana use was higher among black (28.9%) and Hispanic (27.6%) than white (20.4%) students, higher among black female (27.1%) and Hispanic female (27.4%) than white female (18.0%) students, and higher among black male (30.6%) and Hispanic male (27.7%) than white male (22.8%) students. The prevalence of current marijuana use was higher among 10th-grade (23.5%), 11th-grade (25.5%), and 12th-grade (27.7%) than 9th-grade (17.7%) students; higher among 12th-grade (27.7%) than 10th-grade (23.5%) students; higher among 10th-grade female (22.7%), 11th-grade female (22.8%), and 12th-grade female (24.6%) than 9th-grade female (17.6%) students; higher among 10th-grade male (24.3%), 11th-grade male (28.4%), and 12th-grade male (30.9%) than 9th-grade male (17.7%) students; and higher among 12th-grade male (30.9%) than 10th-grade male (24.3%) students.

During 1991–2013, a significant linear increase occurred overall in the prevalence of current marijuana use (14.7%–23.4%). A significant quadratic trend also was identified. The prevalence of current marijuana use increased from 1991–1995 (14.7%–25.3%) and then decreased from 1995–2013 (25.3%–23.4%). The prevalence of current marijuana use did not change significantly from 2011 (23.1%) to 2013 (23.4%).

Across 42 states, the prevalence of current marijuana use ranged from 7.6% to 27.8% (median: 19.7%) (Table 52). Across 21 large urban school districts, the prevalence ranged from 16.2% to 32.2% (median: 23.4%).

Ever Used Cocaine

Nationwide, 5.5% of students had used any form of cocaine (e.g., powder, crack,*** or freebase†††) one or more times during their life (i.e., ever used cocaine) (Table 53). The prevalence of having ever used cocaine was higher among male (6.6%) than female (4.5%) students, higher among white male (5.9%) and black male (3.0%) than white female (3.7%) and black female (1.2%) students, respectively, and higher among 12th-grade male (9.5%) than 12th-grade female (4.7%) students. The prevalence of having ever used cocaine was higher among Hispanic (9.5%) than white (4.8%) and black (2.1%) students, higher among white (4.8%) than black (2.1%) students, higher among Hispanic female (8.1%) than white female (3.7%) and black female (1.2%) students, higher among white female (3.7%) than black female (1.2%) students, higher among Hispanic male (10.9%) than white male (5.9%) and black male (3.0%) students, and higher among white male (5.9%) than black male (3.0%) students. The prevalence of having ever used cocaine was higher among 11th-grade (6.8%) and 12th-grade (7.1%) than 9th-grade (4.4%) and 10th-grade (4.0%) students, higher among 11th-grade female (5.8%) than 10th-grade female (3.1%) students, and higher among 11th-grade male (7.9%) and 12th-grade male (9.5%) than 9th-grade male (4.6%) and 10th-grade male (5.0%) students.

During 1991-2013, a significant linear trend was not identified in the prevalence of having ever used cocaine. A significant quadratic trend was identified. The prevalence of having ever used cocaine increased from 1991–1999 (5.9%–9.5%) and then decreased from 1999–2013 (9.5%–5.5%). The prevalence of having ever used cocaine decreased from 2011 (6.8%) to 2013 (5.5%).

Across 37 states, the prevalence of having ever used cocaine ranged from 3.2% to 10.3% (median: 5.4%) (Table 54). Across 20 large urban school districts, the prevalence ranged from 3.1% to 11.2% (median: 6.4%).

Ever Used Hallucinogenic Drugs

Nationwide, 7.1% of students had used hallucinogenic drugs (e.g., LSD, acid, PCP, angel dust, mescaline, or mushrooms) one or more times during their life (i.e., ever used hallucinogenic drugs) (Table 53). The prevalence of having ever used hallucinogenic drugs was higher among male (8.8%) than female (5.5%) students; higher among white male (9.8%) and black male (3.4%) than white female (5.4%) and black female (1.0%) students, respectively; and higher among 10th-grade male (8.1%), 11th-grade male (11.0%), and 12th-grade male (11.7%) than 10th-grade female (5.0%), 11th-grade female (6.6%), and 12th-grade female (5.9%) students, respectively. The prevalence of having ever used hallucinogenic drugs was higher among white (7.6%) and Hispanic (8.4%) than black (2.2%) students, higher among white female (5.4%) and Hispanic female (8.0%) than black female (1.0%) students, and higher among white male (9.8%) and Hispanic male (8.9%) than black male (3.4%) students. The prevalence of having ever use hallucinogenic drugs was higher among 11th-grade (8.7%) and 12th-grade (8.8%) than 9th-grade (4.6%) students; higher among 12th-grade (8.8%) than 10th-grade (6.6%) students; higher among 11th-grade female (6.6%) than 9th-grade female (4.1%) students; higher among 10th-grade male (8.1%), 11th-grade male (11.0%), and 12th-grade male (11.7%) than 9th-grade male (5.0%) students; and higher among 12th-grade male (11.7%) than 10th-grade male (8.1%) students.

During 2001–2013, a significant linear decrease occurred overall in the prevalence of having ever used hallucinogenic drugs (13.3%–7.1%). A significant quadratic trend also was identified. The prevalence of having ever used hallucinogenic drugs decreased from 2001–2005 (13.3%-8.5%) and then did not change significantly from 2005-2013 (8.5%–7.1%). The prevalence of having ever used hallucinogenic drugs also decreased from 2011 (8.7%) to 2013 (7.1%).

Ever Used Inhalants

Nationwide, 8.9% of students had sniffed glue, breathed the contents of aerosol spray cans, or inhaled any paints or sprays to get high one or more times during their life (i.e., ever used inhalants) (Table 55). The prevalence of having ever used inhalants was higher among female (10.0%) than male (7.9%) students; higher among Hispanic female (14.3%) than Hispanic male (8.9%) students; and higher among 9th-grade female (11.9%) and 10th-grade female (9.4%) than 9th-grade male (8.2%) and 10th-grade male (6.4%) students, respectively. The prevalence of having ever used inhalants was higher among Hispanic (11.7%) than white (8.6%) and black (6.8%) students, higher among Hispanic female (14.3%) than white female (9.1%) and black female (7.9%) students, and higher among white male (8.1%) and Hispanic male (8.9%) than black male (5.5%) students. The prevalence of having ever used inhalants was higher among 9th-grade (10.1%) and 11th-grade (9.9%) than 12th-grade (7.6%) students and higher among 9th-grade female (11.9%) and 11th-grade female (11.0%) than 12th-grade female (7.1%) students.

During 1995–2013, a significant linear decrease occurred overall in the prevalence of having ever used inhalants (20.3%–8.9%). A significant quadratic trend also was identified. The prevalence of having ever used inhalants decreased from 1995–1999 (20.3%–14.6%) and then decreased more slowly from 1999–2013 (14.6%–8.9%). The prevalence of having ever used inhalants also decreased from 2011 (11.4%) to 2013 (8.9%).

Across 36 states, the prevalence of having ever used inhalants ranged from 5.9% to 14.5% (median: 9.2%) (Table 56). Across 17 large urban school districts, the prevalence ranged from 5.9% to 13.4% (median: 10.4%).

Ever Used Ecstasy

Nationwide, 6.6% of students had used ecstasy (also called "MDMA") one or more times during their life (i.e., ever used ecstasy) (Table 55). The prevalence of having ever used ecstasy was higher among male (7.6%) than female (5.5%) students; higher among white male (6.9%) and black male (7.0%) than white female (4.6%) and black female (2.1%) students, respectively; and higher among 10th-grade male (6.7%) than 10th-grade female (4.2%) students. The prevalence of having ever used ecstasy was higher among Hispanic (9.4%) than white (5.8%) and black (4.4%) students, higher among Hispanic female (10.1%) than white female (4.6%) and black female (2.1%) students, and higher among white female (4.6%) than black female (2.1%) students. The prevalence of having ever used ecstasy was higher among 10th-grade (5.5%), 11th-grade (8.5%), and 12th-grade (8.6%) than 9th-grade (4.0%) students; higher among 11th-grade (8.5%) and 12th-grade (8.6%) than 10th-grade (5.5%) students; higher among 11th-grade female (7.5%) and 12th-grade female (7.1%) than 9th-grade female (3.3%) and 10th-grade female (4.2%) students; higher among 11th-grade male (9.4%) and 12th-grade male (10.1%) than 9th-grade male (4.7%) students; and higher among 12th-grade male (10.1%) than 10th-grade male (6.7%) students.

During 2001–2013, a significant linear decrease occurred overall in the prevalence of having ever used ecstasy (11.1%–6.6%). A significant quadratic trend also was identified. The prevalence of having ever used ecstasy decreased from 2001–2005 (11.1%–6.3%) and then did not change significantly from 2005–2013 (6.3%–6.6%). The prevalence of having ever used ecstasy decreased from 2011 (8.2%) to 2013 (6.6%).

Across 30 states, the prevalence of having ever used ecstasy ranged from 3.2% to 11.2% (median: 6.9%) (Table 56). Across 18 large urban school districts, the prevalence ranged from 4.1% to 14.5% (median: 8.2%).

Ever Used Heroin

Nationwide, 2.2% of students had used heroin (also called "smack," "junk," or "China White") one or more times during their life (i.e., ever used heroin) (Table 57). The prevalence of having ever used heroin was higher among male (2.8%) than female (1.6%) students; higher among white male (2.3%) and black male (2.4%) than white female (1.1%) and black female (0.8%) students, respectively; and higher among 10th-grade male (2.8%) and 12th-grade male (3.1%) than 10th-grade female (1.1%) and 12th-grade female (1.2%) students, respectively. The prevalence of having ever used heroin was higher among Hispanic (3.4%) than white (1.7%) and black (1.6%) students, higher among Hispanic female (3.0%) than white female (1.1%) and black female (0.8%) students, and higher among Hispanic male (3.9%) than white male (2.3%) and black male (2.4%) students.

During 1999–2013, significant linear and quadratic trends were not identified in the prevalence of having ever used heroin. The prevalence of having ever used heroin decreased from 2011 (2.9%) to 2013 (2.2%).

Across 29 states, the prevalence of having ever used heroin ranged from 1.1% to 7.8% (median: 3.3%) (Table 58). Across 18 large urban school districts, the prevalence ranged from 1.6% to 7.4% (median: 3.0%).

Ever Used Methamphetamines

Nationwide, 3.2% of students had used methamphetamines (also called "speed," "crystal," "crank," or "ice") one or more times during their life (i.e., ever used methamphetamines) (Table 57). The prevalence of having ever used methamphetamines was higher among black male (2.1%) than black female (0.5%) students and higher among 12th-grade male (4.4%) than 12th-grade female (2.2%) students. The prevalence of having ever used methamphetamines was higher among Hispanic (4.5%) than white (3.0%) and black (1.3%) students, higher among white (3.0%) than black (1.3%) students, higher among Hispanic female (4.9%) than white female (2.8%) and black female (0.5%) students, higher among white female (2.8%) than black female (0.5%) students, and higher among Hispanic male (4.2%) than black male (2.1%) students. The prevalence of having ever used methamphetamines was higher among 11th-grade (3.9%) than 9th-grade (2.4%) students, higher among 11th-grade female (4.3%) than 9th-grade female (2.2%) students, and higher among 12th-grade male (4.4%) than 9th-grade male (2.7%) students.

During 1999–2013, a significant linear decrease occurred overall in the prevalence of having ever used methamphetamines (9.1%–3.2%). A significant quadratic trend was not identified. The prevalence of having ever used methamphetamines did not change significantly from 2011 (3.8%) to 2013 (3.2%).

Across 35 states, the prevalence of having ever used methamphetamines ranged from 1.6% to 8.9% (median: 3.7%) (Table 58). Across 19 large urban school districts, the prevalence ranged from 2.4% to 7.3% (median: 4.0%).

Ever Took Steroids Without a Doctor's Prescription

Nationwide, 3.2% of students had taken steroid pills or shots without a doctor's prescription one or more times during their life (i.e., ever took steroids without a doctor's prescription) (Table 59). The prevalence of having ever taken steroids without a doctor's prescription was higher among male (4.0%) than female (2.2%) students; higher among white male (3.8%) and black male (3.3%) than white female (1.8%) and black female (1.3%) students, respectively; and higher among 12th-grade male (5.1%) than 12th-grade female (1.2%) students. The prevalence of having ever taken steroids without a doctor's prescription was higher among Hispanic (4.2%) than white (2.8%) and black (2.3%) students, higher among Hispanic female (3.6%) than white female (1.8%) and black female (1.3%) students, and higher among Hispanic male (5.0%) than black male (3.3%) students. The prevalence of having ever taken steroids without a doctor's prescription was higher among 9th-grade female (2.3%) and 10th-grade female (2.8%) than 12th-grade female (1.2%) students.

During 1991–2013, a significant linear increase occurred overall in the prevalence of having ever taken steroids without a doctor's prescription (2.7%–3.2%). A significant quadratic trend also was identified. The prevalence of having ever taken steroids without a doctor's prescription increased from 1991–2001 (2.7%–5.0%) and then decreased from 2001–2013 (5.0%–3.2%). The prevalence of having ever taken steroids without a doctor's prescription did not change significantly from 2011 (3.6%) to 2013 (3.2%).

Across 26 states, the prevalence of having ever taken steroids without a doctor's prescription ranged from 1.5% to 8.8% (median: 3.6%) (Table 60). Across 16 large urban school districts, the prevalence ranged from 2.0% to 6.3% (median: 3.5%).

Ever Took Prescription Drugs Without a Doctor's Prescription

Nationwide, 17.8% of students had taken prescription drugs (e.g., Oxycontin, Percocet, Vicodin, codeine, Adderall, Ritalin, or Xanax) without a doctor's prescription one or more times during their life (i.e., ever took prescription drugs without a doctor's prescription) (Table 59). The prevalence of having ever taken prescription drugs without a doctor's prescription was higher among black male (15.7%) than black female (11.1%) students, higher among 9th-grade female (14.0%) than 9th-grade male (10.9%) students, and higher among 12th grade male (24.0%) than 12th-grade female (18.6%) students. The prevalence of having ever taken prescription drugs without a doctor's prescription was higher among white (18.7%) and Hispanic (19.2%) than black (13.3%) students and higher among white female (18.0%) and Hispanic female (19.9%) than black female (11.1%) students. The prevalence of having ever taken prescription drugs without a doctor's prescription was higher among 10th-grade (17.3%), 11th-grade (20.8%), and 12th-grade (21.3%) than 9th-grade (12.4%) students; higher among 11th-grade (20.8%) and 12th-grade (21.3%) than 10th-grade (17.3%) students; higher among 11th-grade female (19.5%) and 12th-grade female (18.6%) than 9th-grade female (14.0%) students; higher among 10th-grade male (17.6%), 11th-grade male (22.3%), and 12th-grade male (24.0%) than 9th-grade male (10.9%) students; and higher among 11th-grade male (22.3%) and 12th-grade male (24.0%) than 10th-grade male (17.6%) students.

Because this question was asked for the first time in 2011, linear and quadratic trends are not available. The prevalence of having ever taken prescription drugs without a doctor's prescription decreased from 2011 (20.7%) to 2013 (17.8%).

Across 34 states, the prevalence of having ever taken prescription drugs without a doctor's prescription ranged from 8.7% to 21.5% (median: 16.2%) (Table 60). Across 18 large urban school districts, the prevalence ranged from 7.8% to 18.1% (median: 13.2%).

Ever Injected Any Illegal Drug

Nationwide, 1.7% of students had used a needle to inject any illegal drug into their body one or more times during their life (i.e., ever injected any illegal drug) (Table 61). The prevalence of having ever injected any illegal drug was higher among male (2.2%) than female (1.3%) students; higher among white male (2.1%) than white female (0.9%) students; and higher among 10th-grade male (2.3%), 11th-grade male (2.2%), and 12th-grade male (2.6%) than 10th-grade female (1.2%), 11th-grade female (1.0%), and 12th-grade female (1.1%) students, respectively. The prevalence of having ever injected any illegal drug was higher among Hispanic female (2.0%) than white female (0.9%) students.

During 1995-2013, significant linear and quadratic trends were not identified in the prevalence of having ever injected any illegal drug. The prevalence of having ever injected any illegal drug did not change significantly from 2011 (2.3%) to 2013 (1.7%).

Across 29 states, the prevalence of having ever injected any illegal drug ranged from 1.0% to 4.7% (median: 2.5%) (Table 62). Across 16 large urban school districts, the prevalence ranged from 1.6% to 7.2% (median: 2.6%).

Offered, Sold, or Given an Illegal Drug on School Property

Nationwide, 22.1% of students had been offered, sold, or given an illegal drug by someone on school property during the 12 months before the survey (Table 61). The prevalence of having been offered, sold, or given an illegal drug on school property was higher among male (24.5%) than female (19.7%) students; higher among white male (23.1%) and black male (21.7%) than white female (17.5%) and black female (15.6%) students, respectively; and higher among 11th-grade male (26.4%) and 12th-grade male (24.0%) than 11th-grade female (20.2%) and 12th-grade female (13.7%) students, respectively. The prevalence of having been offered, sold, or given an illegal drug on school property was higher among Hispanic (27.4%) than white (20.4%) and black (18.6%) students, higher among Hispanic female (26.7%) than white female (17.5%) and black female (15.6%) students, and higher among Hispanic male (28.1%) than white male (23.1%) and black male (21.7%) students. The prevalence of having been offered, sold, or given an illegal drug on school property was higher among 9th-grade (22.4%), 10th-grade (23.2%), and 11th-grade (23.2%) than 12th-grade (18.8%) students and higher among 9th-grade female (21.9%), 10th-grade female (21.7%), and 11th-grade female (20.2%) than 12th-grade female (13.7%) students.

During 1993–2013, a significant linear decrease occurred overall in the prevalence of having been offered, sold, or given an illegal drug on school property (24.0%–22.1%). A significant quadratic trend also was identified. The prevalence of having been offered, sold, or given an illegal drug on school property increased from 1993–1997 (24.0%–31.7%) and then decreased from 1997–2013 (31.7%–22.1%). The prevalence of having been offered, sold, or given an illegal drug on school property also decreased from 2011 (25.6%) to 2013 (22.1%).

Across 36 states, the prevalence of having been offered, sold, or given an illegal drug on school property ranged from 12.1% to 32.8% (median: 22.7%) (Table 62). Across 19 large urban school districts, the prevalence ranged from 21.9% to 32.6% (median: 28.7%).

Sexual Behaviors that Contribute to Unintended Pregnancy and Sexually Transmitted Infections, Including HIV Infection

Ever Had Sexual Intercourse

Nationwide, 46.8% of students had ever had sexual intercourse (Table 63). The prevalence of having ever had sexual intercourse was higher among black male (68.4%) and Hispanic male (51.7%) than black female (53.4%) and Hispanic female (46.9%) students, respectively. The prevalence of having ever had sexual intercourse was higher among black (60.6%) than white (43.7%) and Hispanic (49.2%) students, higher among black female (53.4%) than white female (45.3%) students, higher among black male (68.4%) than white male (42.2%) and Hispanic male (51.7%) students, and higher among Hispanic male (51.7%) than white male (42.2%) students. The prevalence of having ever had sexual intercourse was higher among 10th-grade (41.4%), 11th-grade (54.1%), and 12th-grade (64.1%) than 9th-grade (30.0%) students; higher among 11th-grade (54.1%) and 12th-grade (64.1%) than 10th-grade (41.4%) students; higher among 12th-grade (64.1%) than 11th-grade (54.1%) students; higher among 10th-grade female (41.7%), 11th-grade female (53.9%), and 12th-grade female (62.8%) than 9th-grade female (28.1%) students; higher among 11th-grade female (53.9%) and 12th-grade female (62.8%) than 10th-grade female (41.7%) students; higher among 12th-grade female (62.8%) than 11th-grade female (53.9%) students; higher among 10th-grade male (41.1%), 11th-grade male (54.3%), and 12th-grade male (65.4%) than 9th-grade male (32.0%) students; higher among 11th-grade male (54.3%) and 12th-grade male (65.4%) than 10th-grade male (41.1%) students; and higher among 12th-grade male (65.4%) than 11th-grade male (54.3%) students.

During 1991–2013, a significant linear decrease occurred overall in the prevalence of having ever had sexual intercourse (54.1%–46.8%). A significant quadratic trend also was identified. The prevalence of having ever had sexual intercourse decreased from 1991–2001 (54.1%–45.6%) and then did not change significantly from 2001–2013 (45.6%–46.8%). The prevalence of having ever had sexual intercourse did not change significantly from 2011 (47.4%) to 2013 (46.8%).

Across 36 states, the prevalence of having ever had sexual intercourse ranged from 35.2% to 54.2% (median: 43.4%) (Table 64). Across 20 large urban school districts, the prevalence ranged from 25.8% to 59.7% (median: 45.2%).

Had Sexual Intercourse Before Age 13 Years

Nationwide, 5.6% of students had had sexual intercourse for the first time before age 13 years (Table 63). The prevalence of having had sexual intercourse before age 13 years was higher among male (8.3%) than female (3.1%) students; higher among white male (4.4%), black male (24.0%), and Hispanic male (9.2%) than white female (2.1%), black female (4.9%), and Hispanic female (3.8%) students, respectively; and higher among 9th-grade male (8.7%), 10th-grade male (8.7%), 11th-grade male (8.0%), and 12th-grade male (7.4%) than 9th-grade female (2.9%), 10th-grade female (3.2%), 11th-grade female (3.3%), and 12th-grade female (2.5%) students, respectively. The prevalence of having had sexual intercourse before age 13 years was higher among black (14.0%) than white (3.3%) and Hispanic (6.4%) students, higher among Hispanic (6.4%) than white (3.3%) students, higher among black female (4.9%) and Hispanic female (3.8%) than white female (2.1%) students, higher among black male (24.0%) than white male (4.4%) and Hispanic male (9.2%) students, and higher among Hispanic male (9.2%) than white male (4.4%) students.

During 1991–2013, a significant linear decrease occurred overall in the prevalence of having had sexual intercourse before age 13 years (10.2%–5.6%). A significant quadratic trend also was identified. The prevalence of having had sexual intercourse before age 13 years decreased from 1991–1997 (10.2%–7.2%) and then decreased more slowly from 1997–2013 (7.2%–5.6%). The prevalence of having had sexual intercourse before age 13 years did not change significantly from 2011 (6.2%) to 2013 (5.6%).

Across 38 states, the prevalence of having had sexual intercourse before age 13 years ranged from 2.6% to 11.8% (median: 4.7%) (Table 64). Across 21 large urban school districts, the prevalence ranged from 3.6% to 15.2% (median: 7.3%).

Had Sexual Intercourse with Four or More Persons During Their Life

Nationwide, 15.0% of students had had sexual intercourse with four or more persons during their life (Table 65). The prevalence of having had sexual intercourse with four or more persons was higher among male (16.8%) than female (13.2%) students; higher among black male (37.5%) and Hispanic male (16.5%) than black female (15.8%) and Hispanic female (10.5%) students, respectively; and higher among 9th-grade male (9.1%), 10th-grade male (14.5%), and 12th-grade male (25.7%) than 9th-grade female (4.4%), 10th-grade female (10.7%), and 12th-grade female (21.1%) students, respectively. The prevalence of having had sexual intercourse with four or more persons was higher among black (26.1%) than white (13.3%) and Hispanic (13.4%) students, higher among white female (14.1%) and black female (15.8%) than Hispanic female (10.5%) students, higher among black male (37.5%) than white male (12.4%) and Hispanic male (16.5%) students, and higher among Hispanic male (16.5%) than white male (12.4%) students. The prevalence of having had sexual intercourse with four or more persons was higher among 10th-grade (12.6%), 11th-grade (18.5%), and 12th-grade (23.4%) than 9th-grade (6.7%) students; higher among 11th-grade (18.5%) and 12th-grade (23.4%) than 10th-grade (12.6%) students; higher among 12th-grade (23.4%) than 11th-grade (18.5%) students; higher among 10th-grade female (10.7%), 11th-grade female (17.9%), and 12th-grade female (21.1%) than 9th-grade female (4.4%) students; higher among 11th-grade female (17.9%) and 12th-grade female (21.1%) than 10th-grade female (10.7%) students; higher among 10th-grade male (14.5%), 11th-grade male (19.1%), and 12th-grade male (25.7%) than 9th-grade male (9.1%) students; higher among 11th-grade male (19.1%) and 12th-grade male (25.7%) than 10th-grade male (14.5%) students; and higher among 12th-grade male (25.7%) than 11th-grade male (19.1%) students.

During 1991–2013, a significant linear decrease occurred overall in the prevalence of having had sexual intercourse with four or more persons (18.7%–15.0%). A significant quadratic trend also was identified. The prevalence of having had sexual intercourse with four or more persons decreased from 1991–2003 (18.7%–14.4%) and then did not change significantly from 2003-2013 (14.4%–15.0%). The prevalence of having had sexual intercourse with four or more persons did not change significantly from 2011 (15.3%) to 2013 (15.0%).

Across 35 states, the prevalence of having had sexual intercourse with four or more persons ranged from 7.7% to 19.7% (median: 12.6%) (Table 66). Across 21 large urban school districts, the prevalence ranged from 7.3% to 22.8% (median: 15.5%).

Currently Sexually Active

Nationwide, 34.0% of students had had sexual intercourse with at least one person during the 3 months before the survey (i.e., currently sexually active) (Table 65). The prevalence of being currently sexually active was higher among white female (35.9%) than white male (29.7%) students, higher among black male (47.0%) than black female (37.6%) students, and higher among 10th-grade female (31.8%) than 10th-grade male (27.0%) students. The prevalence of being currently sexually active was higher among black (42.1%) than white (32.8%) and Hispanic (34.7%) students and higher among black male (47.0%) than white male (29.7%) and Hispanic male (34.7%) students. The prevalence of being currently sexually active was higher among 10th-grade (29.4%), 11th-grade (40.2%), and 12th-grade (49.3%) than 9th-grade (19.6%) students; higher among 11th-grade (40.2%) and 12th-grade (49.3%) than 10th-grade (29.4%) students; higher among 12th-grade (49.3%) than 11th-grade (40.2%) students; higher among 10th-grade female (31.8%), 11th-grade female (40.7%), and 12th-grade female (50.7%) than 9th-grade female (19.8%) students; higher among 11th-grade female (40.7%) and 12th-grade female (50.7%) than 10th-grade female (31.8%) students; higher among 12th-grade female (50.7%) than 11th-grade female (40.7%) students; higher among 10th-grade male (27.0%), 11th-grade male (39.6%), and 12th-grade male (47.8%) than 9th-grade male (19.3%) students; higher among 11th-grade male (39.6%) and 12th-grade male (47.8%) than 10th-grade male (27.0%) students; and higher among 12th-grade male (47.8%) than 11th-grade male (39.6%) students.

During 1991–2013, a significant linear decrease occurred overall in the prevalence of being currently sexually active (37.5%–34.0%). A significant quadratic trend was not identified. The prevalence of being currently sexually active did not change significantly from 2011 (33.7%) to 2013 (34.0%).

Across 36 states, the prevalence of being currently sexually active ranged from 24.7% to 40.5% (median: 30.9%) (Table 66). Across 20 large urban school districts, the prevalence ranged from 19.1% to 41.3% (median: 31.0%).

Condom Use

Among the 34.0% of currently sexually active student nationwide, 59.1% reported that either they or their partner had used a condom during last sexual intercourse (Table 67). The prevalence of having used a condom during last sexual intercourse was higher among male (65.8%) than female (53.1%) students; higher among white male (61.8%), black male (73.0%), and Hispanic male (66.5%) than white female (53.2%), black female (55.3%), and Hispanic female (50.7%) students, respectively; and higher among 9th-grade male (69.5), 10th-grade male (69.3%), 11th-grade male (70.6%), and 12th-grade male (58.0%) than 9th-grade female (56.5%), 10th-grade female (55.5%), 11th-grade female (54.8%), and 12th-grade female (48.4%) students, respectively. The prevalence of having used a condom during last sexual intercourse was higher among black (64.7%) than white (57.1%) and Hispanic (58.3%) students and higher among black male (73.0%) than white male (61.8%) students. The prevalence of having used a condom during last sexual intercourse was higher among 9th-grade (62.7%), 10th-grade (61.7%), and 11th-grade (62.3%) than 12th-grade (53.0%) students and higher among 9th-grade male (69.5%), 10th-grade male (69.3%), and 11th-grade male (70.6%) than 12th-grade male (58.0%) students.

During 1991–2013, a significant linear increase occurred overall in the prevalence of having used a condom during last sexual intercourse (46.2%–59.1%). A significant quadratic trend also was identified. The prevalence of having used a condom during last sexual intercourse increased from 1991–2003 (46.2%–63.0%) and then decreased from 2003–2013 (63.0%–59.1%). The prevalence of having used a condom during last sexual intercourse did not change from 2011 (60.2%) to 2013 (59.1%).

Across 36 states, the prevalence of having used a condom during last sexual intercourse ranged from 45.9% to 67.6% (median: 58.5%) (Table 68). Across 20 large urban school districts, the prevalence ranged from 55.7% to 70.1% (median: 63.6%).

Birth Control Pill Use

Among the 34.0% of currently sexually active students nationwide, 19.0% reported that either they or their partner had used birth control pills to prevent pregnancy before last sexual intercourse (Table 67). The prevalence of having used birth control pills before last sexual intercourse was higher among female (22.4%) than male (15.1%) students; higher among white female (30.7%) than white male (20.1%) students; and higher among 9th-grade female (14.7%), 11th-grade female (23.2%), and 12th-grade female (27.6%) than 9th-grade male (7.7%), 11th-grade male (15.1%), and 12th-grade male (19.3%) students, respectively. The prevalence of having used birth control pills before last sexual intercourse was higher among white (25.9%) than black (8.2%) and Hispanic (9.0%) students, higher among white female (30.7%) than black female (7.3%) and Hispanic female (7.3%) students, and higher among white male (20.1%) than black male (9.0%) and Hispanic male (10.8%) students. The prevalence of having used birth control pills before last sexual intercourse was higher among 10th-grade (16.7%), 11th-grade (19.3%), and 12th-grade (23.7%) than 9th-grade (11.4%) students; higher among 12th-grade (23.7%) than 10th-grade (16.7%) and 11th-grade (19.3%) students; higher among 12th-grade female (27.6%) than 9th-grade female (14.7%) and 10th-grade female (19.2%) students; higher among 11th-grade male (15.1%) and 12th-grade male (19.3%) than 9th-grade male (7.7%) students; and higher among 12th-grade male (19.3%) than 11th-grade male (15.1%) students.

During 1991–2013, a significant linear trend was not identified in the prevalence of having used birth control pills before last sexual intercourse. A significant quadratic trend was identified. The prevalence of having used birth control pills before last sexual intercourse decreased from 1991–1995 (20.8%–17.4%) and then increased from 1995–2013 (17.4%–19.0%). The prevalence of having used birth control pills before last sexual intercourse did not change significantly from 2011 (18.0%) to 2013 (19.0%).

Across 34 states, the prevalence of having used birth control pills before last sexual intercourse ranged from 12.3% to 35.7% (median: 20.0%) (Table 68). Across 20 large urban school districts, the prevalence ranged from 7.4% to 24.2% (median: 10.6%).

IUD or Implant Use

Among the 34.0% of currently sexually active students nationwide, 1.6% reported that either they or their partner had used an IUD (such as Mirena or ParaGard) or implant (such as Implanon or Nexplanon) to prevent pregnancy before last sexual intercourse (Table 69). The prevalence of having used an IUD or implant before last sexual intercourse was higher among white male (1.8%) than black male (0.4%) students. The prevalence of having used an IUD or implant before last sexual intercourse was higher among 11th-grade (1.5%) and 12th-grade (2.5%) than 9th-grade (0.5%) students, higher among 12th-grade (2.5%) than 10th-grade (0.9%) students, higher among 11th-grade male (1.3%) and 12th-grade male (2.4%) than 9th-grade male (0.0%) students, and higher among 12th-grade male (2.4%) than 10th-grade male (0.4%) students.

Across 34 states, the prevalence of having used an IUD or implant before last sexual intercourse ranged from 0.3% to 5.0% (median: 2.3%) (Table 70). Across 20 large urban school districts, the prevalence ranged from 0.3% to 7.8% (median: 1.8%).

Shot, Patch, or Birth Control Ring Use

Among the 34.0% of currently sexually active students nationwide, 4.7% reported that either they or their partner had used a shot (such as Depo-Provera), patch (such as OrthoEvra), or birth control ring (such as NuvaRing) to prevent pregnancy before last sexual intercourse (Table 69). The prevalence of having used a shot, patch, or birth control ring before last sexual intercourse was higher among female (5.6%) than male (3.7%) students, higher among black female (10.1%) than black male (1.8%) students, and higher among 9th-grade female (2.9%) than 9th-grade male (0.6%) students. The prevalence of having used a shot, patch, or birth control ring before last sexual intercourse was higher among black female (10.1%) than white female (4.8%) students and higher among white male (4.8%) than black male (1.8%) students. The prevalence of having used a shot, patch, or birth control ring before last sexual intercourse was higher among 10th-grade (4.5%), 11th-grade (5.0%), and 12th-grade (6.0%) than 9th-grade (1.8%) students; higher among 11th-grade female (6.6%) and 12th-grade female (6.3%) than 9th-grade female (2.9%) students; and higher among 10th-grade male (3.3%), 11th-grade male (3.3%), and 12th-grade male (5.7%) than 9th-grade male (0.6%) students.

Across 34 states, the prevalence of having used a shot, patch, or birth control ring before last sexual intercourse ranged from 1.3% to 9.5% (median: 5.8%) (Table 70). Across 20 large urban school districts, the prevalence ranged from 0.5% to 11.2% (median: 4.1%).

Birth Control Pill; IUD or Implant; or Shot, Patch, or Birth Control Ring Use

Among the 34.0% of currently sexually active students nationwide, 25.3% reported that either they or their partner had used birth control pills; an IUD (such as Mirena or ParaGard) or implant (such as Implanon or Nexplanon); or a shot (such as Depo-Provera), patch (such as OrthoEvra), or birth control ring (such as NuvaRing) to prevent pregnancy before last sexual intercourse (Table 71). The prevalence of having used birth control pills; an IUD or implant; or a shot, patch, or birth control ring before last sexual intercourse was higher among female (29.8%) than male (20.1%) students; higher among white female (37.5%) and black female (19.2%) than white male (26.6%) and black male (11.2%) students, respectively; and higher among 9th-grade female (18.6%), 11th-grade female (31.5%), and 12th-grade female (36.5%) than 9th-grade male (8.3%), 11th-grade male (19.7%), and 12th-grade male (27.4%) students, respectively. The prevalence of having used birth control pills; an IUD or implant; or a shot, patch, or birth control ring before last sexual intercourse was higher among white (32.6%) than black (15.0%) and Hispanic (14.5%) students, higher among white female (37.5%) than black female (19.2%) and Hispanic female (13.9%) students, and higher among white male (26.6%) than black male (11.2%) and Hispanic male (15.2%) students. The prevalence of having used birth control pills; an IUD or implant; or a shot, patch, or birth control ring before last sexual intercourse was higher among 10th-grade (22.1%), 11th-grade (25.9%), and 12th-grade (32.2%) than 9th-grade (13.7%) students; higher among 12th-grade (32.2%) than 10th-grade (22.1%) and 11th-grade (25.9%) students; higher among 11th-grade female (31.5%) and 12th-grade female (36.5%) than 9th-grade female (18.6%) students; higher among 12th-grade female (36.5%) than 10th-grade female (26.0%) students; higher among 10th-grade male (17.4%), 11th-grade male (19.7%), and 12th-grade male (27.4%) than 9th-grade male (8.3%) students; and higher among 12th-grade male (27.4%) than 10th-grade male (17.4%) and 11th-grade male (19.7%) students.

Because the response options this variable is based on were used for the first time in 2011, linear and quadratic trends are not available. The prevalence of having used birth control pills; an IUD or implant; or a shot, patch, or birth control ring before last sexual intercourse did not change significantly from 2011 (23.3%) to 2013 (25.3%).

Across 34 states, the prevalence of having used birth control pills; an IUD or implant; or a shot, patch, or birth control ring before last sexual intercourse ranged from 19.8% to 44.6% (median: 27.5%) (Table 72). Across 20 large urban school districts, the prevalence ranged from 10.2% to 41.4% (median: 18.1%).

Condom Use and Birth Control Pill; IUD or Implant; or Shot, Patch, or Birth Control Ring Use

Among the 34.0% of currently sexually active students nationwide, 8.8% reported that either they or their partner had used both a condom during last sexual intercourse and birth control pills; an IUD (such as Mirena or ParaGard) or implant (such as Implanon or Nexplanon); or a shot (such as Depo-Provera), patch (such as OrthoEvra), or birth control ring (such as NuvaRing) to prevent pregnancy before last sexual intercourse (Table 71). The prevalence of having used both a condom during last sexual intercourse and birth control pills; an IUD or implant; or a shot, patch, or birth control ring before last sexual intercourse was higher among female (10.2%) than male (7.2%) students; higher among white female (13.0%) than white male (9.2%) students; higher among Hispanic male (6.1%) than Hispanic female (3.0%) students; and higher among 9th-grade female (7.0%) and 12th-grade female (11.1%) than 9th-grade male (2.4%) and 12th-grade male (7.9%) students, respectively. The prevalence of having used both a condom during last sexual intercourse and birth control pills; an IUD or implant; or a shot, patch, or birth control ring before last sexual intercourse was higher among white (11.3%) than black (5.6%) and Hispanic (4.5%) students, higher among white female (13.0%) than black female (7.1%) and Hispanic female (3.0%) students, and higher among white male (9.2%) than black male (4.3%) students. The prevalence of having used both a condom during last sexual intercourse and birth control pills; an IUD or implant; or a shot, patch, or birth control ring before last sexual intercourse was higher among 11th-grade (11.1%) and 12th-grade (9.6%) than 9th-grade (4.8%) students, higher among 12th-grade female (11.1%) than 9th-grade female (7.0%) students, and higher among 11th-grade male (10.5%) and 12th-grade male (7.9%) than 9th-grade male (2.4%) and 10th-grade male (4.7%) students.

Because the response options this variable is based on were used for the first time in 2011, linear and quadratic trends are not available. The prevalence of having used both a condom during last sexual intercourse and birth control pills; an IUD or implant; or a shot, patch, or birth control ring before last sexual intercourse did not change significantly from 2011 (9.5%) to 2013 (8.8%).

Across 34 states, the prevalence of having used both a condom during last sexual intercourse and birth control pills; an IUD or implant; or a shot, patch, or birth control ring before last sexual intercourse ranged from 6.6% to 17.0% (median: 9.8%) (Table 72). Across 20 large urban school districts, the prevalence ranged from 2.4% to 15.7% (median: 7.4%).

Did Not Use Any Method to Prevent Pregnancy

Among the 34.0% of currently sexually active students nationwide, 13.7% reported that neither they nor their partner had used any method to prevent pregnancy during last sexual intercourse (Table 73). The prevalence of not having used any method to prevent pregnancy was higher among female (15.7%) than male (11.5%) students; higher among black female (21.2%) and Hispanic female (23.7%) than black male (11.2%) and Hispanic male (15.4%) students, respectively; and higher among 10th-grade female (17.3%) than 10th-grade male (10.2%) students. The prevalence of not having used any method to prevent pregnancy was higher among black (15.9%) and Hispanic (19.7%) than white (11.1%) students, higher among black female (21.2%) and Hispanic female (23.7%) than white female (11.9%) students, and higher among Hispanic male (15.4%) than white male (10.1%) students.

During 1991–2013, a significant linear decrease occurred overall in the prevalence of not having used any method to prevent pregnancy (16.5%–13.7%). A significant quadratic trend also was identified. The prevalence of not having used any method to prevent pregnancy decreased from 1991–2007 (16.5%–12.2%) and then did not change from 2007–2013 (12.2%–13.7%). The prevalence of not having used any method to prevent pregnancy did not change significantly from 2011 (12.9%) to 2013 (13.7%).

Across 34 states, the prevalence of not having used any method to prevent pregnancy ranged from 7.6% to 19.0% (median: 13.3%) (Table 74). Across 20 large urban school districts, the prevalence ranged from 7.0% to 24.2% (median: 17.3%).

Drank Alcohol or Used Drugs Before Last Sexual Intercourse

Among the 34.0% of currently sexually active students nationwide, 22.4% had drunk alcohol or used drugs before last sexual intercourse (Table 73). The prevalence of having drunk alcohol or used drugs before last sexual intercourse was higher among male (25.9%) than female (19.3%) students; higher among white male (25.1%) than white female (18.2%) students; and higher among 9th-grade male (27.6%), 11th-grade male (27.8%), and 12th-grade male (25.7%) than 9th-grade female (16.7%), 11th-grade female (19.0%), and 12th-grade female (18.4%) students, respectively.

During 1991–2013, a significant linear trend was not identified in the prevalence of having drunk alcohol or used drugs before last sexual intercourse. A significant quadratic trend was identified. The prevalence of having drunk alcohol or used drugs before last sexual intercourse increased from 1991–1999 (21.6%–24.8%) and then decreased from 1999–2013 (24.8%–22.4%). The prevalence of having drunk alcohol or used drugs before last sexual intercourse did not change significantly from 2011 (22.1%) to 2013 (22.4%).

Across 35 states, the prevalence of having drunk alcohol or used drugs before last sexual intercourse ranged from 15.3% to 27.7% (median: 20.8%) (Table 74). Across 20 large urban school districts, the prevalence ranged from 17.1% to 32.5% (median: 21.9%).

Taught in School About AIDS or HIV Infection

Nationwide, 85.3% of students had ever been taught in school about AIDS or HIV infection (Table 75). The prevalence of having been taught in school about AIDS or HIV infection was higher among white (86.6%) than black (81.9%) students and higher among white male (86.3%) than black male (80.6%) students. The prevalence of having been taught in school about AIDS or HIV infection was higher among 10th-grade (85.3%), 11th-grade (87.4%), and 12th-grade (88.0%) than 9th-grade (81.3%) students; higher among 10th-grade female (86.2%), 11th-grade female (88.2%), and 12th-grade female (89.3%) than 9th-grade female (80.1%) students; and higher among 11th-grade male (86.7%) and 12th-grade male (86.6%) than 9th-grade male (82.4%) students.

During 1991-2013. a significant linear trend was not identified in the prevalence of having been taught in school about AIDS or HIV infection. A significant quadratric trend was identified. The prevalence of having been taught in school about AIDS or HIV infection increased from 1991–1997 (83.3%–91.5%) and then decreased from 1997–2013 (91.5%–85.3%). The prevalence of having been taught in school about AIDS or HIV infection did not change significantly from 2011 (84.0%) to 2013 (85.3%).

Across 33 states, the prevalence of having been taught in school about AIDS or HIV infection ranged from 73.1% to 87.5% (median: 82.6%) (Table 76). Across 20 large urban school districts, the prevalence ranged from 68.3% to 88.6% (median: 79.3%).

Tested for HIV

Nationwide, 12.9% of students had ever been tested for HIV, not including tests done when donating blood (Table 75). The prevalence of having been tested for HIV was higher among female (14.6%) than male (11.2%) students; higher among white female (12.7%) than white male (8.7%) students; and higher among 10th-grade female (12.6%), 11th-grade female (17.3%), and 12th-grade female (21.3%) than 10th-grade male (8.5%), 11th-grade male (13.2%), and 12th-grade male (13.1%) students, respectively. The prevalence of having been tested for HIV was higher among black (19.8%) than white (10.7%) and Hispanic (12.8%) students, higher among black female (20.9%) than white female (12.7%) and Hispanic female (13.4%) students, higher among black male (18.7%) than white male (8.7%) and Hispanic male (12.2%) students, and higher among Hispanic male (12.2%) than white male (8.7%) students. The prevalence of having been tested for HIV was higher among 11th-grade (15.3%) and 12th-grade (17.2%) than 9th-grade (9.1%) and 10th-grade (10.6%) students; higher among 10th-grade female (12.6%), 11th-grade female (17.3%), and 12th-grade female (21.3%) than 9th-grade female (7.8%) students; higher among 11th-grade female (17.3) and 12th-grade female (21.3%) than 10th-grade female (12.6%) students; higher among 12th-grade female (21.3%) than 11th-grade female (17.3%) students; and higher among 11th-grade male (13.2%) and 12th-grade male (13.1%) than 10th-grade male (8.5%) students.

During 2005–2013, significant linear and quadratic trends were not identified in the prevalence of having been tested for HIV. The prevalence of having been tested for HIV did not change significantly from 2011 (12.9%) to 2013 (12.9%).

Dietary Behaviors

Did Not Eat Fruit or Drink 100% Fruit Juices

Nationwide, 5.0% of students had not eaten fruit or drunk 100% fruit juices during the 7 days before the survey (Table 77). The prevalence of not having eaten fruit or drunk 100% fruit juices was higher among male (6.1%) than female (4.0%) students; higher among white male (6.3%) than white female (3.5%) students; and higher among 9th-grade male (6.7%), 11th-grade male (7.2%), and 12th-grade male (4.9%) than 9th-grade female (4.4%), 11th-grade female (4.3%), and 12th-grade female (3.3%) students, respectively. The prevalence of not having eaten fruit or drunk 100% fruit juices was higher among black (6.9%) than white (4.9%) and Hispanic (4.1%) students, higher among black female (6.5%) than white female (3.5%) and Hispanic female (3.6%) students, and higher among black male (7.4%) than Hispanic male (4.6%) students. The prevalence of not having eaten fruit or drunk 100% fruit juices was higher among 11th-grade (5.7%) than 12th-grade (4.1%) students and higher among 11th-grade male (7.2%) than 12th-grade male (4.9%) students.

During 1999–2013, a significant linear decrease occurred overall in the prevalence of not having eaten fruit or drunk 100% fruit juices (5.4%–5.0%). A significant quadratic trend was not identified. The prevalence of not having eaten fruit or drunk 100% fruit juices did not change significantly from 2011 (4.8%) to 2013 (5.0%).

Across 37 states, the prevalence of not having eaten fruit or drunk 100% fruit juices ranged from 3.4% to 10.2% (median: 5.9%) (Table 78). Across 21 large urban school districts, the prevalence ranged from 4.4% to 11.4% (median: 6.7%).

Ate Fruit or Drank 100% Fruit Juices One or More Times per Day

Nationwide, 62.6% of students had eaten fruit or drunk 100% fruit juices one or more times per day during the 7 days before the survey (Table 77). The prevalence of having eaten fruit or drunk 100% fruit juices one or more times per day was higher among male (65.3%) than female (60.0%) students; higher among white male (62.9%), black male (67.6%), and Hispanic male (69.0%) than white female (58.5%), black female (59.7%), and Hispanic female (61.2%) students, respectively; and higher among 9th-grade male (66.4%) and 10th-grade male (66.1%) than 9th-grade female (58.0%) and 10th-grade female (61.1%) students, respectively. The prevalence of having eaten fruit or drunk 100% fruit juices one or more times per day was higher among Hispanic (65.0%) than white (60.7%) students and higher among Hispanic male (69.0%) than white male (62.9%) students. The prevalence of having eaten fruit or drunk 100% fruit juices one or more times per day was higher among 10th-grade female (61.1%) than 9th-grade female (58.0%) students.

During 1999–2013, significant linear and quadratic trends were not identified for having eaten fruit or drunk 100% fruit juices one or more times per day. The prevalence of having eaten fruit or drunk 100% fruit juices one or more times per day did not change significantly from 2011 (64.0%) to 2013 (62.6%).

Across 37 states, the prevalence of having eaten fruit or drunk 100% fruit juices one or more times per day ranged from 48.9% to 67.9% (median: 60.8%) (Table 78). Across 21 large urban school districts, the prevalence ranged from 47.0% to 69.0% (median: 59.3%).

Ate Fruit or Drank 100% Fruit Juices Two or More Times per Day

Nationwide, 33.2% of students had eaten fruit or drunk 100% fruit juices two or more times per day during the 7 days before the survey (Table 79). The prevalence of having eaten fruit or drunk 100% fruit juices two or more times per day was higher among male (35.9%) than female (30.6%) students; higher among white male (32.1%), black male (42.3%), and Hispanic male (40.3%) than white female (27.9%), black female (33.9%), and Hispanic female (33.6%) students, respectively; and higher among 9th-grade male (37.0%) and 10th-grade male (37.1%) than 9th-grade female (30.2%) and 10th-grade female (30.7%) students, respectively. The prevalence of having eaten fruit or drunk 100% fruit juices two or more times per day was higher among black (38.0%) and Hispanic (36.9%) than white (30.0%) students, higher among black female (33.9%) and Hispanic female (33.6%) than white female (27.9%) students, and higher among black male (42.3%) and Hispanic male (40.3%) than white male (32.1%) students.

During 1999–2013, a significant linear trend was not identified in the prevalence of having eaten fruit or drunk 100% fruit juices two or more times per day. A significant quadratic trend was identified. The prevalence of having eaten fruit or drunk 100% fruit juices two or more times per day decreased from 1999–2005 (34.8%–30.1%) and then increased from 2005–2013 (30.1%–33.2%). The prevalence of having eaten fruit or drunk 100% fruit juices two or more times per day did not change significantly from 2011 (34.0%) to 2013 (33.2%).

Across 37 states, the prevalence of having eaten fruit or drunk 100% fruit juices two or more times per day ranged from 24.0% to 34.3% (median: 29.4%) (Table 80). Across 21 large urban school districts, the prevalence ranged from 21.3% to 36.7% (median: 31.3%).

Ate Fruit or Drank 100% Fruit Juices Three or More Times per Day

Nationwide, 21.9% of students had eaten fruit or drunk 100% fruit juices three or more times per day during the 7 days before the survey (Table 79). The prevalence of having eaten fruit or drunk 100% fruit juices three or more times per day was higher among male (24.0%) than female (19.9%) students; higher among white male (20.0%), black male (31.5%), and Hispanic male (29.1%) than white female (16.0%), black female (27.0%), and Hispanic female (23.2%) students, respectively; and higher among 9th-grade male (25.3%) than 9th-grade female (19.7%) students. The prevalence of having eaten fruit or drunk 100% fruit juices three or more times per day was higher among black (29.1%) and Hispanic (26.1%) than white (18.0%) students, higher among black female (27.0%) and Hispanic female (23.2%) than white female (16.0%) students, and higher among black male (31.5%) and Hispanic male (29.1%) than white male (20.0%) students. The prevalence of having eaten fruit or drunk 100% fruit juices three or more times per day was higher among 9th-grade male (25.3%) than 12th-grade male (21.1%) students.

During 1999–2013, a significant linear trend was not identified in the prevalence of having eaten fruit or drunk 100% fruit juices three or more times per day. A significant quadratic trend was identified. The prevalence of having eaten fruit or drunk 100% fruit juices three or more times per day decreased from 1999–2003 (24.9%–21.1%) and then did not change from 2003–2013 (21.1%–21.9%). The prevalence of having eaten fruit or drunk 100% fruit juices three or more times per day did not change from 2011 (22.4%) to 2013 (21.9%).

Across 37 states, the prevalence of having eaten fruit or drunk 100% fruit juices three or more times per day ranged from 14.1% to 22.2% (median: 18.4%) (Table 80). Across 21 large urban school districts, the prevalence ranged from 15.5% to 26.4% (median: 20.7%).

Did Not Eat Vegetables

Nationwide, 6.6% of students had not eaten vegetables§§§ during the 7 days before the survey (Table 81). The prevalence of not having eaten vegetables was higher among male (7.5%) than female (5.7%) students; higher among white male (5.7%) than white female (3.3%) students; and higher among 11th-grade male (7.9%) and 12th-grade male (6.7%) than 11th-grade female (4.7%) and 12th-grade female (4.3%) students, respectively. The prevalence of not having eaten vegetables was higher among black (11.3%) and Hispanic (9.3%) than white (4.5%) students, higher among black female (12.1%) than white female (3.3%) and Hispanic female (8.5%) students, higher among Hispanic female (8.5%) than white female (3.3%) students, and higher among black male (10.5%) and Hispanic male (10.2%) than white male (5.7%) students. The prevalence of not having eaten vegetables was higher among 9th-grade (7.4%) than 12th-grade (5.5%) students and higher among 9th-grade female (6.8%) than 12th-grade female (4.3%) students.

During 1999–2013, a significant linear increase occurred overall in the prevalence of not having eaten vegetables (4.2%–6.6%). A significant quadratic trend was not identified. The prevalence of not having eaten vegetables did not change significantly from 2011 (5.7%) to 2013 (6.6%).

Across 32 states, the prevalence of not having eaten vegetables ranged from 3.3% to 11.1% (median: 6.2%) (Table 82). Across 19 large urban school districts, the prevalence ranged from 5.1% to 13.5% (median: 9.1%).

Ate Vegetables One or More Times per Day

Nationwide, 61.5% of students had eaten vegetables one or more times per day during the 7 days before the survey (Table 81). The prevalence of having eaten vegetables one or more times per day was higher among black male (55.4%) than black female (48.5%) students. The prevalence of having eaten vegetables one or more times per day was higher among white (64.8%) than black (51.9%) and Hispanic (56.9%) students, higher among Hispanic (56.9%) than black (51.9%) students, higher among white female (66.0%) than black female (48.5%) and Hispanic female (55.8%) students, higher among Hispanic female (55.8%) than black female (48.5%) students, and higher among white male (63.5%) than black male (55.4%) and Hispanic male (58.0%) students. The prevalence of having eaten vegetables one or more times per day was higher among 11th-grade (62.8%) and 12th-grade (63.1%) than 9th-grade (59.1%) students and higher among 11th-grade female (63.0%) and 12th-grade female (64.5%) than 9th-grade female (57.8%) students.

During 1999–2013, significant linear and quadratic trends were not identified for having eaten vegetables one or more times per day. The prevalence of having eaten vegetables one or more times per day did not change significantly from 2011 (62.3%) to 2013 (61.5%).

Across 32 states, the prevalence of having eaten vegetables one or more times per day ranged from 52.6% to 69.2% (median: 61.5%) (Table 82). Across 19 large urban school districts, the prevalence ranged from 46.1% to 71.1% (median: 54.2%).

Ate Vegetables Two or More Times per Day

Nationwide, 28.4% of students had eaten vegetables two or more times per day during the 7 days before the survey (Table 83). The prevalence of having eaten vegetables two or more times per day was higher among male (29.6%) than female (27.1%) students and higher among black male (29.4%) and Hispanic male (30.2%) than black female (23.2%) and Hispanic female (25.7%) students, respectively. The prevalence of having eaten vegetables two or more times per day was higher among 11th-grade (29.0%) and 12th-grade (30.7%) than 9th-grade (25.7%) students, higher among 11th-grade female (28.6%) and 12th-grade female (29.2%) than 9th-grade female (23.7%) students, and higher among 12th-grade male (32.2%) than 9th-grade male (27.6%) students.

During 1999-2013, significant linear and quadratic trends were not identified for having eaten vegetables two or more times per day. The prevalence of having eaten vegetables two or more times per day did not change significantly from 2011 (28.3%) to 2013 (28.4%).

Across 32 states, the prevalence of having eaten vegetables two or more times per day ranged from 21.7% to 33.5% (median: 26.4%) (Table 84). Across 19 large urban school districts, the prevalence ranged from 20.1% to 35.5% (median: 23.4%).

Ate Vegetables Three or More Times per Day

Nationwide, 15.7% of students had eaten vegetables three or more times per day during the 7 days before the survey (Table 83). The prevalence of having eaten vegetables three or more times per day was higher among male (17.0%) than female (14.3%) students and higher among black male (20.4%) and Hispanic male (18.8%) than black female (15.1%) and Hispanic female (15.0%) students, respectively. The prevalence of having eaten vegetables three or more times per day was higher among black (17.6%) and Hispanic (16.9%) than white (14.2%) students and higher among black male (20.4%) and Hispanic male (18.8%) than white male (15.0%) students.

During 1999–2013, a significant linear increase occurred overall in the prevalence of having eaten vegetables three or more times per day (14.0%–15.7%). A significant quadratic trend also was identified. The prevalence of having eaten vegetables three or more times per day did not change significantly from 1999–2007 (14.0%–13.2%) and then increased from 2007–2013 (13.2%–15.7%). The prevalence of having eaten vegetables three or more times per day did not change significantly from 2011 (15.3%) to 2013 (15.7%).

Across 32 states, the prevalence of having eaten vegetables three or more times per day ranged from 9.7% to 17.5% (median: 12.4%) (Table 84). Across 19 large urban school districts, the prevalence ranged from 9.6% to 17.5% (median: 12.8%).

Did Not Drink Milk

Nationwide, 19.4% of students had not drunk milk during the 7 days before the survey (Table 85). The prevalence of not having drunk milk was higher among female (25.4%) than male (13.2%) students; higher among white female (21.0%), black female (44.2%), and Hispanic female (23.4%) than white male (10.2%), black male (23.4%), and Hispanic male (13.3%) students, respectively; and higher among 9th-grade female (23.4%), 10th-grade female (25.3%), 11th-grade female (25.5%), and 12th-grade female (27.7%) than 9th-grade male (12.9%), 10th-grade male (11.5%), 11th-grade male (15.8%), and 12th-grade male (13.0%) students, respectively. The prevalence of not having drunk milk was higher among black (34.1%) than white (15.6%) and Hispanic (18.4%) students, higher among Hispanic (18.4%) than white (15.6%) students, higher among black female (44.2%) than white female (21.0%) and Hispanic female (23.4%) students, higher among black male (23.4%) than white male (10.2%) and Hispanic male (13.3%) students, and higher among Hispanic male (13.3%) than white male (10.2%) students. The prevalence of not having drunk milk was higher among 11th-grade (20.8%) than 9th-grade (18.1%) students and higher among 11th-grade male (15.8%) than 10th-grade male (11.5%) students.

During 1999–2013, a significant linear increase occurred overall in the prevalence of not having drunk milk (17.0%–19.4%). A significant quadratic trend was not identified. The prevalence of not having drunk milk did not change significantly from 2011 (17.3%) to 2013 (19.4%).

Across 33 states, the prevalence of not having drunk mild ranged from 11.1% to 28.5% (median: 21.3%) (Table 86). Across 19 large urban school districts, the prevalence ranged from 17.4% to 42.6% (median: 26.3%).

Drank One or More Glasses per Day of Milk

Nationwide, 40.3% of students had drunk one or more glasses per day of milk during the 7 days before the survey (Table 85). The prevalence of having drunk one or more glasses per day of milk was higher among male (49.0%) than female (31.7%) students; higher among white male (53.2%), black male (35.2%), and Hispanic male (47.3%) than white female (35.7%), black female (17.8%), and Hispanic female (30.8%) students, respectively; and higher among 9th-grade male (51.0%), 10th-grade male (51.5%), 11th-grade male (45.8%), and 12th-grade male (46.5%) than 9th-grade female (33.1%), 10th-grade female (33.9%), 11th-grade female (29.5%), and 12th-grade female (29.9%) students, respectively. The prevalence of having drunk one or more glasses per day of milk was higher among white (44.5%) than black (26.2%) and Hispanic (38.9%) students, higher among Hispanic (38.9%) than black (26.2%) students, higher among white female (35.7%) than black female (17.8%) and Hispanic female (30.8%) students, higher among Hispanic female (30.8%) than black female (17.8%) students, higher among white male (53.2%) than black male (35.2%) and Hispanic male (47.3%) students, and higher among Hispanic male (47.3%) than black male (35.2%) students. The prevalence of having drunk one or more glasses per day of milk was higher among 9th-grade (42.1%) and 10th-grade (42.7%) than 11th-grade (37.5%) and 12th-grade (38.1%) students, higher among 10th-grade female (33.9%) than 11th-grade female (29.5%) students, and higher among 9th-grade male (51.0%) and 10th-grade male (51.5%) than 11th-grade male (45.8%) and 12th-grade male (46.5%) students.

During 1999–2013, a significant linear decrease occurred overall in the prevalence of having drunk one or more glasses per day of milk (47.1%–40.3%). A significant quadratic trend was not identified. The prevalence of having drunk one or more glasses per day of milk also decreased from 2011 (44.4%) to 2013 (40.3%).

Across 33 states, the prevalence of having drunk one or more glasses per day of milk ranged from 26.0% to 56.4% (median: 37.0%) (Table 86). Across 19 large urban school districts, the prevalence ranged from 13.5% to 39.6% (median: 29.4%).

Drank Two or More Glasses per Day of Milk

Nationwide, 25.9% of students had drunk two or more glasses per day of milk during the 7 days before the survey (Table 87). The prevalence of having drunk two or more glasses per day of milk was higher among male (33.4%) than female (18.5%) students; higher among white male (36.8%), black male (23.8%), and Hispanic male (32.0%) than white female (21.6%), black female (9.7%), and Hispanic female (17.8%) students, respectively; and higher among 9th-grade male (35.1%), 10th-grade male (36.0%), 11th-grade male (32.0%), and 12th-grade male (29.2%) than 9th-grade female (21.2%), 10th-grade female (18.3%), 11th-grade female (16.7%), and 12th-grade female (17.6%) students, respectively. The prevalence of having drunk two or more glasses per day of milk was higher among white (29.2%) than black (16.5%) and Hispanic (24.8%) students, higher among Hispanic (24.8%) than black (16.5%) students, higher among white female (21.6%) and Hispanic female (17.8%) than black female (9.7%) students, higher among white male (36.8%) than black male (23.8%) and Hispanic male (32.0%) students, and higher among Hispanic male (32.0%) than black male (23.8%) students. The prevalence of having drunk two or more glasses per day of milk was higher among 9th-grade (28.2%) than 11th-grade (24.1%) and 12th-grade (23.3%) students, higher among 10th-grade (27.2%) than 12th-grade (23.3%) students, and higher among 9th-grade male (35.1%) and 10th-grade male (36.0%) than 12th-grade male (29.2%) students.

During 1999–2013, a significant linear decrease occurred overall in the prevalence of having drunk two or more glasses per day of milk (33.6%–25.9%). A significant quadratic trend was not identified. The prevalence of having drunk two or more glasses per day of milk also decreased from 2011 (29.9%) to 2013 (25.9%).

Across 33 states, the prevalence of having drunk two or more glasses per day of milk ranged from 14.0% to 42.4% (median: 22.2%) (Table 88). Across 19 large urban school districts, the prevalence ranged from 8.0% to 25.7% (median: 16.9%).

Drank Three or More Glasses per Day of Milk

Nationwide, 12.5% of students had drunk three or more glasses per day of milk during the 7 days before the survey (Table 87). The prevalence of having drunk three or more glasses per day of milk was higher among male (16.9%) than female (8.1%) students; higher among white male (18.4%), black male (14.5%), and Hispanic male (14.7%) than white female (9.8%), black female (4.1%), and Hispanic female (7.3%) students, respectively; and higher among 9th-grade male (17.6%), 10th-grade male (17.2%), 11th-grade male (17.4%), and 12th-grade male (14.5%) than 9th-grade female (9.4%), 10th-grade female (7.8%), 11th-grade female (8.2%), and 12th-grade female (6.8%) students, respectively. The prevalence of having drunk three or more glasses per day of milk was higher among white (14.1%) than black (9.1%) and Hispanic (10.9%) students, higher among white female (9.8%) than black female (4.1%) and Hispanic female (7.3%) students, higher among Hispanic female (7.3%) than black female (4.1%) students, and higher among white male (18.4%) than black male (14.5%) and Hispanic male (14.7%) students. The prevalence of having drunk three or more glasses per day of milk was higher among 9th-grade (13.5%) than 12th-grade (10.6%) students and higher among 9th-grade female (9.4%) than 12th-grade female (6.8%) students.

During 1999–2013, a significant linear decrease occurred overall in the prevalence of having drunk three or more glasses per day of milk (18.0%–12.5%). A significant quadratic trend was not identified. The prevalence of having drunk three or more glasses per day of milk also decreased from 2011 (14.9%) to 2013 (12.5%).

Across 33 states, the prevalence of having drunk three or more glasses per day of milk ranged from 6.8% to 22.2% (median: 10.5%) (Table 88). Across 19 large urban school districts, the prevalence ranged from 4.1% to 11.2% (median: 8.2%).

Did Not Drink Soda or Pop

Nationwide, 22.3% of students had not drunk soda or pop (not including diet soda or diet pop) during the 7 days before the survey (Table 89). The prevalence of not having drunk soda or pop was higher among female (24.8%) than male (19.8%) students; higher among white female (26.1%) than white male (18.1%) students; and higher among 9th-grade female (22.5%), 10th-grade female (25.1%), 11th-grade female (27.1%), and 12th-grade female (25.2%) than 9th-grade male (17.7%), 10th-grade male (19.8%), 11th-grade male (21.0%), and 12th-grade male (20.9%) students, respectively. The prevalence of not having drunk soda or pop was higher among white female (26.1%) than black female (19.8%) students. The prevalence of not having drunk soda or pop was higher among 11th-grade (24.1%) and 12th-grade (23.0%) than 9th-grade (20.1%) students, higher among 11th-grade female (27.1%) than 9th-grade female (22.5%) students, and higher among 12th-grade male (20.9%) than 9th-grade male (17.7%) students.

During 2007–2013, a significant linear increase occurred overall in the prevalence of not having drunk soda or pop (18.6%–22.3%). A significant quadratic trend was not identified. The prevalence of not having drunk soda or pop did not change significantly from 2011 (20.9%) to 2013 (22.3%).

Across 38 states, the prevalence of not having drunk soda or pop ranged from 17.1% to 35.5% (median: 25.3%) (Table 90). Across 21 large urban school districts, the prevalence ranged from 16.7% to 36.8% (median: 25.5%).

Drank Soda or Pop One or More Times per Day

Nationwide, 27.0% of students had drunk a can, bottle, or glass of soda or pop (not counting diet soda or diet pop) one or more times per day during the 7 days before the survey (Table 89). The prevalence of having drunk soda or pop one or more times per day was higher among male (29.9%) than female (24.1%) students; higher among white male (32.9%) and Hispanic male (24.8%) than white female (25.0%) and Hispanic female (20.5%) students, respectively; and higher among 9th-grade male (32.0%), 11th-grade male (30.9%), and 12th-grade male (29.1%) than 9th-grade female (26.6%), 11th-grade female (22.9%), and 12th-grade female (23.0%) students, respectively. The prevalence of having drunk soda or pop one or more times per day was higher among white (29.0%) and black (30.2%) than Hispanic (22.6%) students, higher among black female (28.8%) than Hispanic female (20.5%) students, and higher among white male (32.9%) and black male (31.5%) than Hispanic male (24.8%) students. The prevalence of having drunk soda or pop one or more times per day was higher among 9th-grade students (29.3%) than 10th-grade (25.4%) and 12th-grade (26.0%) students and higher among 9th-grade male (32.0%) than 10th-grade male (27.6%) students.

During 2007–2013, a significant linear decrease occurred overall in the prevalence of having drunk soda or pop one or more times per day (33.8%–27.0%). A significant quadratic trend was not identified. The prevalence of having drunk soda or pop one or more times per day did not change significantly from 2011 (27.8%) to 2013 (27.0%).

Across 38 states, the prevalence of having drunk soda or pop one or more times per day ranged from 12.2% to 38.0% (median: 21.8%) (Table 90). Across 21 large urban school districts, the prevalence ranged from 9.7% to 29.6% (median: 20.7%).

Drank Soda or Pop Two or More Times per Day

Nationwide, 19.4% of students had drunk a can, bottle, or glass of soda or pop (not counting diet soda or diet pop) two or more times per day during the 7 days before the survey (Table 91). The prevalence of having drunk soda or pop two or more times per day was higher among male (22.2%) than female (16.6%) students; higher among white male (23.5%) and Hispanic male (18.4%) than white female (16.4%) and Hispanic female (13.5%) students, respectively; and higher among 9th-grade male (23.2%), 10th-grade male (20.8%), 11th-grade male (23.0%), and 12th-grade male (21.6%) than 9th-grade female (19.0%), 10th-grade female (15.9%), 11th-grade female (15.0%), and 12th-grade female (15.8%) students, respectively. The prevalence of having drunk soda or pop two or more times per day was higher among black (24.7%) than Hispanic (15.9%) students, higher among black female (22.8%) than white female (16.4%) and Hispanic female (13.5%) students, and higher among black male (26.5%) than Hispanic male (18.4%) students. The prevalence of having drunk soda or pop two or more times per day was higher among 9th-grade (21.1%) than 11th-grade (18.9%) and 12th-grade (18.7%) students and higher among 9th-grade female (19.0%) than 11th-grade female (15.0%) students.

During 2007–2013, a significant linear decrease occurred overall in the prevalence of having drunk soda or pop two or more times per day (24.4%–19.4%). A significant quadratic trend was not identified. The prevalence of having drunk soda or pop two or more times per day did not change significantly from 2011 (19.0%) to 2013 (19.4%).

Across 38 states, the prevalence of having drunk soda or pop two or more times per day ranged from 7.1% to 29.5% (median: 13.8%) (Table 92). Across 21 large urban school districts, the prevalence ranged from 5.5% to 23.0% (median: 15.0%).

Drank Soda or Pop Three or More Times per Day

Nationwide, 11.2% of students had drunk a can, bottle, or glass of soda or pop (not counting diet soda or diet pop) three or more times per day during the 7 days before the survey (Table 91). The prevalence of having drunk soda or pop three or more times per day was higher among male (13.0%) than female (9.4%) students; higher among white male (13.5%) than white female (8.5%) students; and higher among 11th-grade male (14.6%) and 12th-grade male (12.5%) than 11th-grade female (8.3%) and 12th-grade female (8.5%) students, respectively. The prevalence of having drunk soda or pop three or more times per day was higher among black (17.1%) than white (11.0%) and Hispanic (9.6%) students, higher among black female (16.0%) than white female (8.5%) and Hispanic female (8.6%) students, and higher among black male (18.1%) than white male (13.5%) and Hispanic male (10.6%) students. The prevalence of having drunk soda or pop three or more times per day was higher among 9th-grade female (11.2%) than 11th-grade female (8.3%) students.

During 2007–2013, a significant linear decrease occurred overall in the prevalence of having drunk soda or pop three or more times per day (14.4%–11.2%). A significant quadratic trend was not identified. The prevalence of having drunk soda or pop three or more times per day did not change significantly from 2011 (11.3%) to 2013 (11.2%).

Across 38 states, the prevalence of having drunk soda or pop three or more times per day ranged from 4.0% to 18.7% (median: 7.2%) (Table 92). Across 21 large urban school districts, the prevalence ranged from 2.9% to 15.4% (median: 8.3%).

Did Not Eat Breakfast

Nationwide, 13.7% of students had not eaten breakfast during the 7 days before the survey (Table 93). The prevalence of having not eaten breakfast was higher among 9th-grade female (16.9%) than 9th-grade male (12.3%) students and higher among 12th-grade male (14.8%) than 12th-grade female (11.4%) students. The prevalence of having not eaten breakfast was higher among black (16.0%) and Hispanic (17.4%) than white (11.5%) students, higher among black female (16.0%) and Hispanic female (17.7%) than white female (11.6%) students, and higher among black male (15.8%) and Hispanic male (17.0%) than white male (11.3%) students. The prevalence of having not eaten breakfast was higher among 9th-grade female (16.9%) than 10th-grade female (11.7%) and 12th-grade female (11.4%) students.

Because this question was asked for the first time in 2011, linear and quadratic trends are not available. The prevalence of having not eaten breakfast did not change significantly from 2011 (13.1%) to 2013 (13.7%).

Across 37 states, the prevalence of having not eaten breakfast ranged from 9.5% to 17.6% (median: 13.3%) (Table 94). Across 19 large urban school districts, the prevalence ranged from 10.9% to 21.4% (median: 15.3%).

Ate Breakfast on All 7 Days

Nationwide, 38.1% of students had eaten breakfast on all 7 days before the survey (Table 93). The prevalence of having eaten breakfast on all 7 days was higher among male (42.4%) than female (33.8%) students; higher among white male (44.9%), black male (35.7%), and Hispanic male (39.6%) than white female (37.0%), black female (24.9%), and Hispanic female (32.1%) students, respectively; and higher among 9th-grade male (48.9%), 10th-grade male (41.8%), and 11th-grade male (39.6%) than 9th-grade female (32.5%), 10th-grade female (34.4%), and 11th-grade female (34.8%) students, respectively. The prevalence of having eaten breakfast on all 7 days was higher among white (41.0%) than black (30.1%) and Hispanic (35.8%) students, higher among Hispanic (35.8%) than black (30.1%) students, higher among white female (37.0%) than black female (24.9%) and Hispanic female (32.1%) students, higher among Hispanic female (32.1%) than black female (24.9%) students, and higher among white male (44.9%) than black male (35.7%) and Hispanic male (39.6%) students. The prevalence of having eaten breakfast on all 7 days was higher among 9th-grade (40.7%) than 11th-grade (37.2%) and 12th-grade (35.7%) students and higher among 9th-grade male (48.9%) than 10th-grade male (41.8%), 11th-grade male (39.6%), and 12th-grade male (37.7%) students.

Because this question was asked for the first time in 2011, linear and quadratic trends are not available. The prevalence of having eaten breakfast on all 7 days did not change significantly from 2011 (37.7%) to 2013 (38.1%).

Across 37 states, the prevalence of having eaten breakfast on all 7 days ranged from 31.4% to 41.9% (median: 37.1%) (Table 94). Across 19 large urban school districts, the prevalence ranged from 20.2% to 44.0% (median: 34.0%).

Physical Activity

Did Not Participate in at Least 60 Minutes of Physical Activity on at Least 1 Day

Nationwide, 15.2% of students had not participated in at least 60 minutes of any kind of physical activity that increased their heart rate and made them breathe hard some of the time on at least 1 day during the 7 days before the survey (i.e., did not participate in at least 60 minutes of physical activity on at least 1 day) (Table 95). The prevalence of not having participated in at least 60 minutes of physical activity on at least 1 day was higher among female (19.2%) than male (11.2%) students; higher among white female (16.1%), black female (27.3%), and Hispanic female (20.3%) than white male (9.2%), black male (15.2%), and Hispanic male (12.1%) students, respectively; and higher among 9th-grade female (15.5%), 10th-grade female (17.6%), 11th-grade female (21.4%), and 12th-grade female (22.6%) than 9th-grade male (9.2%), 10th-grade male (11.2%), 11th-grade male (11.7%), and 12th-grade male (13.0%) students, respectively. The prevalence of not having participated in at least 60 minutes of physical activity on at least 1 day was higher among black (21.5%) than white (12.7%) and Hispanic (16.2%) students, higher among Hispanic (16.2%) than white (12.7%) students, higher among black female (27.3%) than white female (16.1%) and Hispanic female (20.3%) students, higher among Hispanic female (20.3%) than white female (16.1%) students, higher among black male (15.2%) than white male (9.2%) and Hispanic male (12.1%) students, and higher among Hispanic male (12.1%) than white male (9.2%) students. The prevalence of not having participated in at least 60 minutes of physical activity on at least 1 day was higher among 11th-grade (16.7%) and 12th-grade (17.8%) than 9th-grade (12.3%) students, higher among 12th-grade (17.8%) than 10th-grade (14.4%) students, higher among 11th-grade female (21.4%) and 12th-grade female (22.6%) than 9th-grade female (15.5%) and 10th-grade female (17.6%) students, and higher among 12th-grade male (13.0%) than 9th-grade male (9.2%) students.

Because of changes in question context starting in 2011, national YRBS prevalence estimates derived from the 60 minutes of physical activity question in 2011 and 2013 are not comparable to those reported in 2009 or earlier. On the 2005–2009 national YRBS questionnaire, physical activity was assessed with three questions (in the following order) that asked the number of days students participated in 1) at least 20 minutes of vigorous physical activity; 2) at least 30 minutes of moderate physical activity; and 3) at least 60 minutes of aerobic (moderate and vigorous) physical activity. On the 2011 and 2013 national YRBS questionnaire, only the 60 minutes of aerobic physical activity question was included. Consequently, linear and quadratic trends are not available. The prevalence of not having participated in at least 60 minutes of physical activity on at least 1 day did not change significantly from 2011 (13.8%) to 2013 (15.2%).

Across 41 states, the prevalence of not having participated in at least 60 minutes of physical activity on at least 1 day ranged from 10.0% to 22.8% (median: 15.0%) (Table 96). Across 21 large urban school districts, the prevalence ranged from 14.2% to 28.9% (median: 21.3%).

Physically Active at Least 60 Minutes per Day on 5 or More Days

Nationwide, 47.3% of students had been physically active doing any kind of physical activity that increased their heart rate and made them breathe hard some of the time for a total of at least 60 minutes per day on 5 or more days during the 7 days before the survey (i.e., physically active at least 60 minutes per day on 5 or more days) (Table 95). The prevalence of having been physically active at least 60 minutes per day on 5 or more days was higher among male (57.3%) than female (37.3%) students; higher among white male (59.6%), black male (53.3%), and Hispanic male (54.4%) than white female (40.5%), black female (29.3%), and Hispanic female (35.4%) students, respectively; and higher among 9th-grade male (60.5%), 10th-grade male (57.2%), 11th-grade male (56.8%), and 12th-grade male (53.9%) than 9th-grade female (40.7%), 10th-grade female (40.7%), 11th-grade female (33.1%), and 12th-grade female (34.1%) students, respectively. The prevalence of having been physically active at least 60 minutes per day on 5 or more days was higher among white (50.1%) than black (41.0%) and Hispanic (44.7%) students, higher among white female (40.5%) and Hispanic female (35.4%) than black female (29.3%) students, and higher among white male (59.6%) than black male (53.3%) and Hispanic male (54.4%) students. The prevalence of having been physically active at least 60 minutes per day on 5 or more days was higher among 9th-grade (50.6%) and 10th-grade (49.1%) than 11th-grade (44.7%) and 12th-grade (43.9%) students, higher among 9th-grade female (40.7%) and 10th-grade female (40.7%) than 11th-grade female (33.1%) and 12th-grade female (34.1%) students, and higher among 9th-grade male (60.5%) than 12th-grade male (53.9%) students.

Linear and quadratic trends are not available. The prevalence of having been physically active at least 60 minutes per day on 5 or more days did not change significantly from 2011 (49.5%) to 2013 (47.3%).

Across 41 states, the prevalence of having been physically active at least 60 minutes per day on 5 or more days ranged from 39.8% to 57.6% (median: 46.5%) (Table 96). Across 21 large urban school districts, the prevalence ranged from 24.5% to 49.3% (median: 36.4%).

Physically Active at Least 60 Minutes per Day on All 7 Days

Nationwide, 27.1% of students had been physically active doing any kind of physical activity that increased their heart rate and made them breathe hard some of the time for a total of at least 60 minutes per day on each of the 7 days before the survey (i.e., physically active at least 60 minutes per day on all 7 days) (Table 97). The prevalence of having been physically active at least 60 minutes per day on all 7 days was higher among male (36.6%) than female (17.7%) students; higher among white male (37.5%), black male (37.2%), and Hispanic male (33.9%) than white female (18.7%), black female (16.0%), and Hispanic female (17.4%) students, respectively; and higher among 9th-grade male (40.5%), 10th-grade male (34.6%), 11th-grade male (37.0%), and 12th-grade male (33.5%) than 9th-grade female (20.1%), 10th-grade female (20.5%), 11th-grade female (14.4%), and 12th-grade female (15.3%) students, respectively. The prevalence of having been physically active at least 60 minutes per day on all 7 days was higher among 9th-grade (30.4%) than 11th-grade (25.5%) and 12th-grade (24.3%) students, higher among 10th-grade (27.6%) than 12th-grade (24.3%) students, higher among 9th-grade female (20.1%) and 10th-grade female (20.5%) than 11th-grade female (14.4%) and 12th-grade female (15.3%) students, and higher among 9th-grade male (40.5%) than 10th-grade male (34.6%) and 12th-grade male (33.5%) students.

Linear and quadratic trends are not available. The prevalence of having been physically active at least 60 minutes per day on all 7 days did not change significantly from 2011 (28.7%) to 2013 (27.1%).

Across 41 states, the prevalence of having been physically active at least 60 minutes per day on all 7 days ranged from 19.7% to 38.5% (median: 25.4%) (Table 98). Across 21 large urban school districts, the prevalence ranged from 13.3% to 26.9% (median: 19.6%).

Participated in Muscle Strengthening Activities on 3 or More Days

Nationwide, 51.7% of students had participated in muscle strengthening exercises (e.g., push-ups, sit-ups, or weightlifting) on 3 or more days during the 7 days before the survey (Table 97). The prevalence of having participated in muscle strengthening exercises on 3 or more days was higher among male (61.8%) than female (41.6%) students; higher among white male (61.7%), black male (64.1%), and Hispanic male (62.6%) than white female (42.8%), black female (34.7%), and Hispanic female (44.4%) students, respectively; and higher among 9th-grade male (65.1%), 10th-grade male (61.9%), 11th-grade male (61.2%), and 12th-grade male (58.6%) than 9th-grade female (44.3%), 10th-grade female (46.1%), 11th-grade female (38.4%), and 12th-grade female (36.9%) students, respectively. The prevalence of having participated in muscle strengthening exercises on 3 or more days was higher among Hispanic (53.3%) than black (48.8%) students and higher among white female (42.8%) and Hispanic female (44.4%) than black female (34.7%) students. The prevalence of having participated in muscle strengthening exercises on 3 or more days was higher among 9th-grade (54.8%) than 11th-grade (49.5%) and 12th-grade (47.7%) students, higher among 10th-grade (54.0%) than 12th-grade (47.7%) students, higher among 9th-grade female (44.3%) than 12th-grade female (36.9%) students, higher among 10th-grade female (46.1%) than 11th-grade female (38.4%) and 12th-grade female (36.9%) students, and higher among 9th-grade male (65.1%) than 12th-grade male (58.6%) students.

During 1991-2013, a significant linear increase occurred overall in the prevalence of having participated in muscle strengthening exercises on 3 or more days (47.8%-51.7%). A significant quadratic trend was not identified. The prevalence of having participated in muscle strengthening exercises on 3 or more days decreased from 2011 (55.6%) to 2013 (51.7%).

Used Computers 3 or More Hours per Day

Nationwide, 41.3% of students played video or computer games or used a computer for something that was not school work for 3 or more hours per day on an average school day (i.e., used computers 3 or more hours per day) (Table 99). The prevalence of having used computers 3 or more hours per day was higher among black male (51.9%) than black female (46.6%) students and higher among 9th-grade female (46.5%) than 9th-grade male (43.0%) students. The prevalence of having used computers 3 or more hours per day was higher among black (49.1%) than white (37.4%) and Hispanic (43.4%) students, higher among Hispanic (43.4%) than white (37.4%) students, higher among black female (46.6%) and Hispanic female (44.8%) than white female (35.6%) students, and higher among black male (51.9%) than white male (39.1%) and Hispanic male (42.0%) students. The prevalence of having used computers 3 or more hours per day was higher among 9th-grade (44.8%) than 11th-grade (40.0%) and 12th-grade (36.9%) students; higher among 10th-grade (42.9%) than 12th-grade (36.9%) students; higher among 9th-grade female (46.5%) than 10th-grade female (41.0%), 11th-grade female (37.6%), and 12th-grade female (35.4%) students; higher among 10th-grade female (41.0%) than 12th-grade female (35.4%) students; higher among 9th-grade male (43.0%) and 10th-grade male (44.9%) than 12th-grade male (38.4%) students.

During 2003–2013, a significant linear increase occurred overall in the prevalence of having used computers 3 or more hours per day (22.1%–41.3%). A significant quadratic trend also was identified. The prevalence of having used computers 3 or more hours per day increased from 2003–2009 (22.1%–24.9%) and then increased more rapidly from 2009–2013 (24.9%–41.3%). The prevalence of having used computers 3 or more hours per day also increased from 2011 (31.1%) to 2013 (41.3%).

Across 40 states, the prevalence of having used computers 3 or more hours per day ranged from 25.1% to 46.2% (median: 36.6%) (Table 100). Across 21 large urban school districts, the prevalence ranged from 29.1% to 46.7% (median: 40.2%).

Watched Television 3 or More Hours per Day

Nationwide, 32.5% of students watched television 3 or more hours per day on an average school day (Table 99). The prevalence of having watched television 3 or more hours per day was higher among black (53.7%) than white (25.0%) and Hispanic (37.8%) students, higher among Hispanic (37.8%) than white (25.0%) students, higher among black female (52.2%) than white female (24.3%) and Hispanic female (39.0%) students, higher among Hispanic female (39.0%) than white female (24.3%) students, higher among black male (55.3%) than white male (25.7%) and Hispanic male (36.5%) students, and higher among Hispanic male (36.5%) than white male (25.7%) students. The prevalence of having watched television 3 or more hours per day was higher among 9th-grade (34.9%) than 11th-grade (31.3%) and 12th-grade (31.3%) students and higher among 9th-grade female (35.3%) than 12th-grade female (30.6%) students.

During 1999–2013, a significant linear decrease occurred overall in the prevalence of having watched television 3 or more hours per day (42.8%–32.5%). A significant quadratic trend was not identified. The prevalence of having watched television 3 or more hours per day did not change from 2011 (32.4%) to 2013 (32.5%).

Across 40 states, the prevalence of having watched television 3 or more hours per day ranged from 14.9% to 39.5% (median: 27.8%) (Table 100). Across 21 large urban school districts, the prevalence ranged from 19.3% to 47.5% (median: 34.8%).

Attended Physical Education Classes

Nationwide, 48.0% of students went to physical education (PE) classes on 1 or more days in an average week when they were in school (i.e., attended PE classes) (Table 101). The prevalence of having attended PE classes was higher among male (53.3%) than female (42.8%) students; higher among white male (49.5%), black male (57.0%), and Hispanic male (61.2%) than white female (36.6%), black female (44.7%), and Hispanic female (54.0%) students, respectively; and higher among 9th-grade male (67.8%), 10th-grade male (55.3%), 11th-grade male (46.9%), and 12th-grade male (40.6%) than 9th-grade female (60.8%), 10th-grade female (45.5%), 11th-grade female (32.6%), and 12th-grade female (29.9%) students, respectively. The prevalence of having attended PE classes was higher among Hispanic (57.5%) than white (43.1%) students, higher among Hispanic female (54.0%) than white female (36.6%) and black female (44.7%) students, and higher among Hispanic male (61.2%) than white male (49.5%) students. The prevalence of having attended PE classes was higher among 9th-grade (64.3%) than 10th-grade (50.5%), 11th-grade (39.6%), and 12th-grade (35.2%) students; higher among 10th-grade (50.5%) than 11th-grade (39.6%) and 12th-grade (35.2%) students; higher among 9th-grade female (60.8%) than 10th-grade female (45.5%), 11th-grade female (32.6%), and 12th-grade female (29.9%) students; higher among 10th-grade female (45.5%) than 11th-grade female (32.6%) and 12th-grade female (29.9%) students; higher among 9th-grade male (67.8%) than 10th-grade male (55.3%), 11th-grade male (46.9%), and 12th-grade male (40.6%) students; higher among 10th-grade male (55.3%) than 11th-grade male (46.9%) and 12th-grade male (40.6%) students; and higher among 11th-grade male (46.9%) than 12th-grade male (40.6%) students.

During 1991–2013, significant linear and quadratic trends were not identified in the prevalence of having attended PE classes. The prevalence of having attended PE classes did not change significantly from 2011 (51.8%) to 2013 (48.0%).

Across 37 states, the prevalence of having attended PE classes ranged from 30.7% to 92.7% (median: 47.3%) (Table 102). Across 19 large urban school districts, the prevalence ranged from 28.4% to 85.0% (median: 45.8%).

Attended Physical Education Classes Daily

Nationwide, 29.4% of students went to physical education (PE) classes on all 5 days in an average week when they were in school (i.e., attended PE classes daily) (Table 101). The prevalence of having attended PE classes daily was higher among male (34.9%) than female (24.0%) students; higher among white male (33.3%), black male (32.4%), and Hispanic male (42.7%) than white female (20.9%), black female (21.3%), and Hispanic female (32.8%) students, respectively; and higher among 9th-grade male (47.8%), 10th-grade male (35.6%), 11th-grade male (29.6%), and 12th-grade male (24.4%) than 9th-grade female (36.5%), 10th-grade female (26.5%), 11th-grade female (15.4%), and 12th-grade female (16.1%) students, respectively. The prevalence of having attended PE classes daily was higher among Hispanic (37.7%) than white (27.1%) and black (26.6%) students, higher among Hispanic female (32.8%) than white female (20.9%) and black female (21.3%) students, and higher among Hispanic male (42.7%) than white male (33.3%) and black male (32.4%) students. The prevalence of having attended PE classes daily was higher among 9th-grade (42.2%) than 10th-grade (31.1%), 11th-grade (22.3%), and 12th-grade (20.2%) students; higher among 10th-grade (31.1%) than 11th-grade (22.3%) and 12th-grade (20.2%) students; higher among 9th-grade female (36.5%) than 10th-grade female (26.5%), 11th-grade female (15.4%), and 12th-grade female (16.1%) students; higher among 10th-grade female (26.5%) than 11th-grade female (15.4%) and 12th-grade female (16.1%) students; higher among 9th-grade male (47.8%) than 10th-grade male (35.6%), 11th-grade male (29.6%), and 12th-grade male (24.4%) students; and higher among 10th-grade male (35.6%) and 11th-grade male (29.6%) than 12th-grade male (24.4%) students.

During 1991–2013, a significant linear trend was not identified in the prevalence of having attended PE classes daily. A significant quadratic trend was identified. The prevalence of having attended PE classes daily decreased from 1991–1995 (41.6%–25.4%) and then did not change significantly from 1995–2013 (25.4%–29.4%). The prevalence of having attended PE classes did not change significantly from 2011 (31.5%) to 2013 (29.4%).

Across 37 states, the prevalence of having attended PE classes daily ranged from 4.5% to 63.6% (median: 24.2%) (Table 102). Across 19 large urban school districts, the prevalence ranged from 7.8% to 40.9% (median: 21.7%).

Played on at Least One Sports Team

Nationwide, 54.0% of students had played on at least one sports team (run by their school or community groups) during the 12 months before the survey (Table 103). The prevalence of having played on at least one sports team was higher among male (59.6%) than female (48.5%) students; higher among white male (59.3%), black male (65.6%), and Hispanic male (57.7%) than white female (51.1%), black female (45.2%), and Hispanic female (44.9%) students, respectively; and higher among 9th-grade male (61.6%), 10th-grade male (61.3%), 11th-grade male (59.5%), and 12th-grade male (55.5%) than 9th-grade female (51.2%), 10th-grade female (55.4%), 11th-grade female (44.7%), and 12th-grade female (41.7%) students, respectively. The prevalence of having played on at least one sports team was higher among white female (51.1%) than black female (45.2%) and Hispanic female (44.9%) students and higher among black male (65.6%) than white male (59.3%) and Hispanic male (57.7%) students. The prevalence of having played on at least one sports team was higher among 9th-grade (56.4%) and 10th-grade (58.4%) than 11th-grade (51.9%) and 12th-grade (48.5%) students, higher among 9th-grade female (51.2%) and 10th-grade female (55.4%) than 11th-grade female (44.7%) and 12th-grade female (41.7%) students, and higher among 9th-grade male (61.6%) than 12th-grade male (55.5%) students.

During 1999–2013, significant linear and quadratic trends were not identified in the prevalence of having played on at least one sports team. The prevalence of having played on at least one sports team decreased from 2011 (58.4%) to 2013 (54.0%).

Across 29 states, the prevalence of having played on at least one sports team ranged from 50.5% to 65.2% (median: 55.7%) (Table 104). Across 17 large urban school districts, the prevalence ranged from 43.9% to 57.9% (median: 49.7%).

Obesity, Overweight, and Weight Control

Obese

Nationwide, 13.7% of students were obese (Table 105). The prevalence of obesity was higher among male (16.6%) than female (10.8%) students; higher among white male (16.5%) and Hispanic male (19.0%) than white female (9.7%) and Hispanic female (11.2%) students, respectively; and higher among 9th-grade male (16.2%), 10th-grade male (17.2%), and 11th-grade male (17.6%) than 9th-grade female (10.2%), 10th-grade female (10.1%), and 11th-grade female (11.4%) students, respectively. The prevalence of obesity was higher among black female (16.7%) than white female (9.7%) and Hispanic female (11.2%) students and higher among Hispanic male (19.0%) than black male (14.8%) students.

During 1999–2013, a significant linear increase occurred overall in the prevalence of obesity (10.6%–13.7%). A significant quadratic trend was not identified. The prevalence of obesity did not change significantly from 2011 (13.0%) to 2013 (13.7%).

Across 42 states, the prevalence of obesity ranged from 6.4% to 18.0% (median: 12.4%) (Table 106). Across 21 large urban school districts, the prevalence ranged from 7.7% to 22.9% (median: 13.6%).

Overweight

Nationwide, 16.6% of students were overweight (Table 105). The prevalence of overweight was higher among white male (16.9%) than white female (14.3%) students and higher among black female (22.8%) than black male (15.2%) students. The prevalence of overweight was higher among black (19.1%) and Hispanic (18.3%) than white (15.6%) students, higher among black female (22.8%) than white female (14.3%) and Hispanic female (19.2%) students, and higher among Hispanic female (19.2%) than white female (14.3%) students. The prevalence of overweight was higher among 9th-grade (18.2%) than 11th-grade (15.6%) students.

During 1999–2013, a significant linear increase occurred overall in the prevalence of overweight (14.1%–16.6%). A significant quadratic trend was not identified. The prevalence of obesity did not change significantly from 2011 (15.2%) to 2013 (16.6%).

Across 42 states, the prevalence of overweight ranged from 11.0% to 17.1% (median: 14.9%) (Table 106). Across 21 large urban school districts, the prevalence ranged from 12.2% to 22.8% (median: 16.3%).

Described Themselves as Overweight

Nationwide, 31.1% of students described themselves as slightly or very overweight (Table 107). The prevalence of students describing themselves as overweight was higher among female (36.3%) than male (25.9%) students; higher among white female (35.8%), black female (33.4%), and Hispanic female (40.3%) than white male (27.8%), black male (18.3%), and Hispanic male (27.1%) students, respectively; and higher among 9th-grade female (34.5%), 10th-grade female (34.3%), 11th-grade female (39.3%), and 12th-grade female (37.5%) than 9th-grade male (26.1%), 10th-grade male (26.7%), 11th-grade male (25.4%), and 12th-grade male (25.4%) students, respectively. The prevalence of students describing themselves as overweight was higher among white (31.8%) and Hispanic (33.8%) than black (26.0%) students, higher among Hispanic female (40.3%) than white female (35.8%) and black female (33.4%) students, and higher among white male (27.8%) and Hispanic male (27.1%) than black male (18.3) students. The prevalence of students describing themselves as overweight was higher among 11th-grade female (39.3%) than 10th-grade female (34.3%) students.

During 1991–2013, a significant linear decrease occurred overall in the prevalence of students describing themselves as overweight (31.8%–31.1%). A significant quadratic trend also was identified. The prevalence of students describing themselves as overweight decreased from 1991–1995 (31.8%–27.6%) and then did not change significantly during 1995–2013 (27.6%–31.1%). The prevalence of students describing themselves as overweight increased from 2011 (29.2%) to 2013 (31.1%).

Across 34 states, the prevalence of students describing themselves as overweight ranged from 24.8% to 35.6% (median: 29.3%) (Table 108). Across 20 large urban school districts, the prevalence ranged from 19.6% to 36.0% (median: 27.6%).

Were Trying to Lose Weight

Nationwide, 47.7% of students were trying to lose weight (Table 107). The prevalence of trying to lose weight was higher among female (62.6%) than male (33.0%) students; higher among white female (63.1%), black female (54.9%), and Hispanic female (66.9%) than white male (31.4%), black male (26.3%), and Hispanic male (41.8%) students, respectively; and higher among 9th-grade female (60.5%), 10th-grade female (62.8%), 11th-grade female (64.7%), and 12th-grade female (62.6%) than 9th-grade male (37.1%), 10th-grade male (31.2%), 11th-grade male (32.1%), and 12th-grade male (31.2%) students, respectively. The prevalence of trying to lose weight was higher among Hispanic (54.5%) than white (47.1%) and black (40.9%) students, higher among white (47.1%) than black (40.9%) students, higher among Hispanic female (66.9%) than white female (63.1%) and black female (54.9%) students, higher among white female (63.1%) than black female (54.9%) students, higher among Hispanic male (41.8%) than white male (31.4%) and black male (26.3%) students, and higher among white male (31.4%) than black male (26.3%) students. The prevalence of trying to lose weight was higher among 11th-grade female (64.7%) than 9th-grade female (60.5%) students and higher among 9th-grade male (37.1%) than 10th-grade male (31.2%), 11th-grade male (32.1%), and 12th-grade male (31.2%) students.

During 1991–2013, a significant linear increase occurred overall in the prevalence of trying to lose weight (41.8%–47.7%). A significant quadratic trend was not identified. The prevalence of trying to lose weight did not change significantly from 2011 (46.0%) to 2013 (47.7%).

Across 35 states, the prevalence of trying to lose weight ranged from 39.5% to 50.1% (median: 45.2%) (Table 108). Across 21 large urban school districts, the prevalence ranged from 37.2% to 53.3% (median: 44.6%).

Did Not Eat for ≥24 Hours to Lose Weight or to Keep from Gaining Weight

Nationwide, 13.0% of students had not eaten for 24 or more hours to lose weight or to keep from gaining weight during the 30 days before the survey (Table 109). The prevalence of having not eaten for 24 or more hours to lose weight or to keep from gaining weight was higher among female (18.7%) than male (7.4%) students; higher among white female (18.2%), black female (16.6%), and Hispanic female (22.8%) than white male (5.6%), black male (9.8%), and Hispanic male (9.5%) students, respectively; and higher among 9th-grade female (20.9%), 10th-grade female (20.5%), 11th-grade female (17.2%), and 12th-grade female (15.8%) than 9th-grade male (7.2%), 10th-grade male (7.1%), 11th-grade male (7.7%), and 12th-grade male (7.5%) students, respectively. The prevalence of having not eaten for 24 or more hours to lose weight or to keep from gaining weight was higher among Hispanic (16.2%) than white (11.8%) and black (13.3%) students, higher among Hispanic female (22.8%) than white female (18.2%) and black female (16.6%) students, and higher among black male (9.8%) and Hispanic male (9.5%) than white male (5.6%) students. The prevalence of having not eaten for 24 or more hours to lose weight or to keep from gaining weight was higher among 9th-grade (14.0%) than 12th-grade (11.7%) students and higher among 9th-grade female (20.9%) and 10th-grade female (20.5%) than 12th-grade female (15.8%) students.

During 1999-2013, significant linear and quadratic tends were not identified in the prevalence of having not eaten for 24 or more hours to lose weight or to keep from gaining weight. The prevalence of having not eaten for 24 or more hours to lose weight or to keep from gaining weight did not change significantly from 2011 (12.2%) to 2013 (13.0%).

Across 28 states, the prevalence of having not eaten for 24 or more hours to lose weight or to keep from gaining weight ranged from 9.6% to 16.7% (median: 12.8%) (Table 110). Across 18 large urban school districts, the prevalence ranged from 9.9% to 17.9% (median: 12.8%).

Took Diet Pills, Powders, or Liquids to Lose Weight or to Keep from Gaining Weight

Nationwide, 5.0% of students had taken diet pills, powders, or liquids without a doctor's advice to lose weight or to keep from gaining weight during the 30 days before the survey (Table 109). The prevalence of having taken diet pills, powders, or liquids without a doctor's advice to lose weight or to keep from gaining weight was higher among female (6.6%) than male (3.4%) students; higher among white female (6.1%) and Hispanic female (10.0%) than white male (3.0%) and Hispanic male (4.1%) students, respectively; and higher among 9th-grade female (4.8%), 10th-grade female (6.8%), 11th-grade female (6.6%), and 12th-grade female (8.6%) than 9th-grade male (2.1%), 10th-grade male (2.5%), 11th-grade male (4.3%), and 12th-grade male (5.1%) students, respectively. The prevalence of having taken diet pills, powders, or liquids without a doctor's advice to lose weight or to keep from gaining weight was higher among Hispanic (7.1%) than white (4.6%) and black (3.8%) students and higher among Hispanic female (10.0%) than white female (6.1%) and black female (4.7%) students. The prevalence of having taken diet pills, powders, or liquids without a doctor's advice to lose weight or to keep from gaining weight was higher among 11th-grade (5.5%) and 12th-grade (6.8%) than 9th-grade (3.4%) students, higher among 12th-grade (6.8%) than 10th-grade (4.6%) students, higher among 12th-grade female (8.6%) than 9th-grade female (4.8%) students, and higher among 11th-grade male (4.3%) and 12th-grade male (5.1%) than 9th-grade male (2.1%) and 10th-grade male (2.5%) students.

During 1999–2013, a significant linear decrease occurred overall in the prevalence of having taken diet pills, powders, or liquids without a doctor's advice to lose weight or to keep from gaining weight (7.6%–5.0%). A significant quadratic trend was not identified. The prevalence of having taken diet pills, powders, or liquids without a doctor's advice to lose weight or to keep from gaining weight did not change significantly from 2011 (5.1%) to 2013 (5.0%).

Across 31 states, the prevalence of having taken diet pills, powders, or liquids without a doctor's advice to lose weight or to keep from gaining weight ranged from 3.4% to 10.3% (median: 6.0%) (Table 110). Across 17 large urban school districts, the prevalence ranged from 4.3% to 9.8% (median: 6.0%).

Vomited or Took Laxatives to Lose Weight or to Keep from Gaining Weight

Nationwide, 4.4% of students had vomited or taken laxatives to lose weight or to keep from gaining weight during the 30 days before the survey (Table 111). The prevalence of having vomited or taken laxatives to lose weight or to keep from gaining weight was higher among female (6.6%) than male (2.2%) students; higher among white female (6.1%) and Hispanic female (10.3%) than white male (1.3%) and Hispanic male (3.0%) students, respectively; and higher among 9th-grade female (6.7%), 10th-grade female (6.4%), 11th-grade female (6.1%), and 12th-grade female (6.9%) than 9th-grade male (1.7%), 10th-grade male (2.2%), 11th-grade male (2.0%), and 12th-grade male (2.7%) students, respectively. The prevalence of having vomited or taken laxatives to lose weight or to keep from gaining weight was higher among Hispanic (6.7%) than white (3.7%) and black (3.7%) students, higher among Hispanic female (10.3%) than white female (6.1%) and black female (4.1%) students, and higher among black male (3.2%) and Hispanic male (3.0%) than white male (1.3%) students.

During 1995–2013, a significant linear decrease occurred overall in the prevalence of having vomited or taken laxatives to lose weight or to keep from gaining weight (4.8%–4.4%). A significant quadratic trend was not identified. The prevalence of having vomited or taken laxatives to lose weight or to keep from gaining weight did not change significantly from 2011 (4.3%) to 2013 (4.4%).

Across 32 states, the prevalence of having vomited or taken laxatives ranged from 3.6% to 9.0% (median: 5.2%) (Table 112). Across 19 large urban school districts, the prevalence ranged from 3.4% to 8.6% (median: 6.0%).

Other Health-Related Topics

Ever Had Asthma

Nationwide, 21.0% of students had ever been told by a doctor or nurse that they had asthma (i.e., ever had asthma) (Table 113). The prevalence of having ever had asthma was higher among black (26.0%) than white (19.9%) and Hispanic (20.3%) students, higher among black female (25.2%) than white female (20.5%) and Hispanic female (20.1%) students, and higher among black male (26.9%) than white male (19.4%) and Hispanic male (20.4%) students.

During 2003–2013, a significant linear increase occurred overall in the prevalence of having ever had asthma (18.9%–21.0%). A significant quadratic trend also was identified. The prevalence of having ever had asthma increased from 2003–2009 (18.9%–22.0%) and then did not change significantly from 2009–2013 (22.0%–21.0%). The prevalence of having ever had asthma decreased from 2011 (23.0%) to 2013 (21.0%).

Across 34 states, the prevalence of having ever had asthma ranged from 16.9% to 30.1% (median: 23.3%) (Table 114). Across 19 large urban school districts, the prevalence ranged from 18.3% to 33.3% (median: 22.7%).

Routine Sunscreen Use

Nationwide, 10.1% of students most of the time or always wore sunscreen with an SPF of 15 or higher when outside for more than 1 hour on a sunny day (i.e., routine sunscreen use) (Table 115). The prevalence of routine sunscreen use was higher among female (13.2%) than male (6.9%) students; higher among white female (15.1%), black female (6.0%), and Hispanic female (11.7%) than white male (7.9%), black male (3.3%), and Hispanic male (6.2%) students, respectively; and higher among 9th-grade female (12.6%), 10th-grade female (13.9%), 11th-grade female (12.6%), and 12th-grade female (13.8%) than 9th-grade male (6.7%), 10th-grade male (7.1%), 11th-grade male (5.4%), and 12th-grade male (8.4%) students, respectively. The prevalence of routine sunscreen use was higher among white (11.5%) than black (4.7%) and Hispanic (9.0%) students, higher among Hispanic (9.0%) than black (4.7%) students, higher among white female (15.1%) than black female (6.0%) and Hispanic female (11.7%) students, higher among Hispanic female (11.7%) than black female (6.0%) students, and higher among white male (7.9%) and Hispanic male (6.2%) than black male (3.3%) students. The prevalence of routine sunscreen use was higher among 12th-grade (11.1%) than 11th-grade (9.1%) students and higher among 12th-grade male (8.4%) than 11th-grade male (5.4%) students.

During 2005-2013, significant linear and quadratic trends were not identified in the prevalence of routine sunscreen use. The prevalence of routine sunscreen use did not change significantly from 2011 (10.8%) to 2013 (10.1%).

Indoor Tanning Device Use

Nationwide, 12.8% of students had used an indoor tanning device, such as a sunlamp, sunbed, or tanning booth (not including getting a spray-on tan), one or more times during the 12 months before the survey (i.e., indoor tanning device use) (Table 115). The prevalence of indoor tanning device use was higher among female (20.2%) than male (5.3%) students; higher among white female (30.7%) than white male (6.1%) students; and higher among 9th-grade female (12.9%), 10th-grade female (19.0%), 11th-grade female (23.0%), and 12th-grade female (27.2%) than 9th-grade male (3.9%), 10th-grade male (4.3%), 11th-grade male (4.2%), and 12th-grade male (9.1%) students, respectively. The prevalence of indoor tanning device use was higher among white (18.3%) than black (2.8%) and Hispanic (6.2%) students, higher among Hispanic (6.2%) than black (2.8%) students, higher among white female (30.7%) than black female (2.5%) and Hispanic female (7.9%) students, higher among Hispanic female (7.9%) than black female (2.5%) students, and higher among white male (6.1%) than black male (3.2%) students. The prevalence of indoor tanning device use was higher among 10th-grade (11.7%), 11th-grade (13.9%), and 12th-grade (18.2%) than 9th-grade (8.4%) students; higher among 12th-grade (18.2%) than 10th-grade (11.7%) and 11th-grade (13.9%) students; higher among 10th-grade female (19.0%), 11th-grade female (23.0%), and 12th-grade female (27.2%) than 9th-grade female (12.9%) students; higher among 12th-grade female (27.2%) than 10th-grade female (19.0%) students; and higher among 12th-grade male (9.1%) than 9th-grade male (3.9%), 10th-grade male (4.3%), and 11th-grade male (4.2%) students.

During 2009-2013, a significant linear decrease occurred overall in the prevalence of indoor tanning device use (15.6%–12.8%). A significant quadratic trend was not identified. The prevalence of indoor tanning device use did not change significantly from 2011 (13.3%) to 2013 (12.8%).

Eight or More Hours of Sleep

Nationwide, 31.7% of students got 8 or more hours of sleep on an average school night (Table 116). The prevalence of getting 8 or more hours of sleep was higher among male (34.5%) than female (28.9%) students; higher among white male (35.4%) and Hispanic male (35.4%) than white female (29.4%) and Hispanic female (30.2%) students, respectively; and higher among 9th-grade male (45.0%) and 10th-grade male (37.1%) than 9th-grade female (34.8%) and 10th-grade female (29.9%) students, respectively. The prevalence of getting 8 or more hours of sleep was higher among white (32.5%) and Hispanic (32.7%) than black (28.2%) students and higher among white male (35.4%) and Hispanic male (35.4%) than black male (28.8%) students. The prevalence of getting 8 or more hours of sleep was higher among 9th-grade (39.9%) than 10th-grade (33.5%), 11th-grade (28.5%), and 12th-grade (23.3%) students; higher among 10th-grade (33.5%) than 11th-grade (28.5%) and 12th-grade (23.3%) students; higher among 11th-grade (28.5%) than 12th-grade (23.3%) students; higher among 9th-grade female (34.8%) than 10th-grade female (29.9%), 11th-grade female (27.6%), and 12th-grade female (22.4%) students; higher among 10th-grade female (29.9%) and 11th-grade female (27.6%) than 12th-grade female (22.4%) students; higher among 9th-grade male (45.0%) than 10th-grade male (37.1%), 11th-grade male (29.4), and 12th-grade male (24.3%) students; higher among 10th-grade male (37.1%) than 11th-grade male (29.4%) and 12th-grade male (24.3%) students; and higher among 11th-grade male (29.4%) than 12th-grade male (24.3%) students.

During 2007-2013, significant linear and quadratic trends were not identified in the prevalence of getting 8 or more hours of sleep. The prevalence of getting 8 or more hours of sleep did not change significantly from 2011 (31.4%) to 2013 (31.7%).

Discussion

YRBSS is the largest public health surveillance system in the United States monitoring a broad range of health-risk behaviors among high school students. YRBSS data are used widely to compare the prevalence of health-risk behaviors among subpopulations of students; assess trends in health-risk behaviors over time; monitor progress toward achieving national health objectives; provide comparable state and large urban school district data; and help develop, assess, and improve school and community policies, programs, and practices designed to decrease health-risk behaviors and improve health outcomes among youth. Because of its broad scope, YRBSS also allows analysis of the inter-relationships among health-risk behaviors (e.g., how alcohol and other drug use is associated with behaviors that contribute to violence) and a more complete understanding of how health-risk behaviors cluster among various subpopulations of students (e.g., whether tobacco use or sexual behaviors are more likely to occur among males than females or in certain regions of the country). Although these analyses are beyond the scope of this report, they are a particular strength of YRBSS as compared with more narrowly focused surveys.

Compare Health-Risk Behavior Prevalence Among Subpopulations of Students

YRBSS is designed to identify how health-risk behaviors vary by subpopulations of high school students defined by sex and race/ethnicity. Understanding of these variations (or lack of variation) in health-risk behaviors might help design, target, and identify the impact of school and community policies, programs, and practices. However, YRBSS data cannot isolate the effects of sex and race/ethnicity from the effects of socioeconomic status (SES) or culture on the prevalence of health risk behaviors. In a national study, the likelihood of behavioral cardiovascular disease risks, including obesity, sedentary behaviors, and tobacco exposure, increased among adolescents aged 12–17 years as the SES based on poverty-income ratio decreased (14).

Variations by Sex

On the basis of the 2013 national YRBS data, prevalence estimates for many health-risk behaviors are different between male and female students. For example, male students were more likely than female students to report three of the five health-risk behaviors that contribute to unintentional injuries (never or rarely wearing a bicycle helmet, never or rarely wearing a seat belt, and driving when drinking alcohol). However, male and female students were equally likely to report two health-risk behaviors that contribute to unintentional injuries (riding with a driver who had been drinking alcohol and texting or e-mailing while driving).

Male students also were more likely than female students to report seven violence-related behaviors (carrying a weapon, carrying a gun, carrying a weapon on school property, being threatened or injured with a weapon on school property, being in a physical fight, being injured in a physical fight, and being in a physical fight on school property). However, female students were more likely than male students to report not going to school because of safety concerns, being electronically bullied, being bullied on school property, being forced to have sexual intercourse, experiencing physical dating violence, and experiencing sexual dating violence. Female students also were more likely than male students to report all five suicide-related behaviors (feeling sad or hopeless, seriously considering attempting suicide, making a suicide plan, attempting suicide, and making a suicide attempt that resulted in an injury, poisoning, or overdose that had to be treated by a doctor or nurse).

Male students were more likely than female students to report seven of the 13 tobacco use behaviors (ever smoking cigarettes, smoking a whole cigarette before age 13 years, smoking more than 10 cigarettes per day, buying cigarettes in a store or gas station, current smokeless tobacco use, current cigar use, and current tobacco use). Trying to quit smoking cigarettes was the only tobacco use behavior more likely to be reported by female students than male students. However, five tobacco use behaviors did not vary by sex (current cigarette use, current frequent cigarette use, smoking cigarettes on school property, ever smoking cigarettes daily, and currently smoking cigarettes daily).

Male students were more likely than female students to report 12 of the 19 alcohol and other drug use behaviors (drinking alcohol before age 13 years; having 10 or more as the largest number of drinks in a row; ever using marijuana; trying marijuana before age 13 years; current marijuana use; ever using cocaine; ever using hallucinogenic drugs; ever using ecstasy; ever using heroin; ever taking steroids without a doctor's prescription; ever injecting any illegal drug; and being offered, sold, or given an illegal drug on school property). In contrast, female students were more likely than male students to report only three of the 19 alcohol and other drug use behaviors (ever drinking alcohol, drinking alcohol before age 13 years, and ever using inhalants).

Male students were more likely than female students to report three sexual behaviors that increase risk for unintended pregnancy and sexually transmitted infections, including HIV infection (having sexual intercourse before age 13 years, having sexual intercourse with four or more persons during their life, and drinking alcohol or using drugs before last sexual intercourse). Male students were more likely than female students to report one behavior (using a condom) that reduces risk for unintended pregnancy and sexually transmitted infections, including HIV infection. However, female students were more likely than male students to report five other behaviors that reduce risk (using birth control pills; using a shot, patch, or birth control ring; using birth control pills, an IUD or implant, or a shot, patch, or birth control ring; using a condom and birth control pills, an IUD or implant, or a shot, patch, or birth control ring; and being tested for HIV) and one behavior that increases risk (not using any method to prevent pregnancy).

Male students were more likely than female students to report 14 of 18 dietary behaviors (eating fruit or drinking 100% fruit juices zero, one or more, two or more, and three or more times per day; eating vegetables zero, two or more, and three or more times per day; drinking one or more, two or more, and three or more glasses per day of milk; drinking soda or pop one or more, two or more, and three or more times per day; and eating breakfast on all 7 days before the survey). Female students were more likely than male students to report two dietary behaviors (not drinking milk and not drinking soda or pop during the 7 days before the survey).

Male students were more likely than female students to report six behaviors that increase overall physical activity (being physically active at least 60 minutes per day on 5 or more days, being physically active at least 60 minutes per day on all 7 days, participating in muscle strengthening activities on 3 or more days; attending physical education classes, attending physical education classes daily, and playing on at least one sports team). However, female students were more likely than male students to not participate in at least 60 minutes of physical activity on any day. Playing video or computer games or using computers and watching television 3 or more hours per day did not vary by sex.

Although male students were more likely than female students to be obese, female students were more likely than male students to report all three unsafe weight loss behaviors (not eating for ≥24 hours to lose weight or to keep from gaining weight; taking diet pills, powders, or liquids to lose weight or to keep from gaining weight; and vomiting or taking laxatives to lose weight or to keep from gaining weight).

Variations by Race/Ethnicity

On the basis of the 2013 national YRBS data, prevalence estimates for many health-risk behaviors vary by race/ethnicity. White students were more likely than black and Hispanic students to report 23 behaviors, black students were more likely than white and Hispanic students to report 14 behaviors, and Hispanic students were more likely than white and black students to report 19 behaviors. Fourteen behaviors did not vary by race/ethnicity.

More specifically, white students were more likely than black and Hispanic students to report one behavior that contributes to unintentional injuries (texting or emailing while driving); three violence-related behaviors (carrying a weapon, being electronically bullied, and being bullied on school property); eight tobacco use behaviors (current cigarette use, current frequent cigarette use, smoking more than 10 cigarettes per day, smoking cigarettes on school property, ever smoking cigarettes daily, currently smoking cigarettes daily, current smokeless tobacco use, and current tobacco use); three sexual behaviors (using birth control pills; using birth control pills, an IUD or implant, or a shot, patch, or birth control ring; and using a condom and birth control pills, an IUD or implant, or a shot, patch, or birth control ring); five dietary behaviors (eating vegetables one or more times per day; drinking one or more, two or more, and three or more glasses per day of milk; and eating breakfast all 7 days); one physical activity behavior (being physically active at least 60 minutes per day on 5 or more days); and two other behaviors (using sunscreen routinely and using indoor tanning devices).

Black students were more likely than white and Hispanic students to report two violence-related behaviors (being in a physical fight and being in a physical fight on school property); one tobacco use behavior (trying to quit smoking cigarettes); six sexual behaviors (ever having sexual intercourse, having sexual intercourse before age 13 years, having sexual intercourse with four or more persons during their life, current sexual activity, using a condom, and being tested for HIV); three dietary behaviors (not eating fruit or drinking 100% fruit juices, not drinking milk, and drinking soda or pop three or more times per day); and one physical activity behavior (not participating in at least 60 minutes of physical activity on any day) and ever having asthma.

Hispanic students were more likely than white and black students to report one behavior that contributes to unintentional injuries (riding with a driver who had been drinking alcohol); all five suicide-related behaviors (feeling sad or hopeless; seriously considering attempting suicide; making a suicide plan; attempting suicide; and making a suicide attempt that resulted in an injury, poisoning, or overdose that had to be treated by a doctor or nurse); eight alcohol and other drug use behaviors (ever drinking alcohol; ever using cocaine; ever using inhalants; ever using ecstasy; ever using heroin; ever using methamphetamines; ever taking steroids without a doctor's prescription; and being offered, sold, or given an illegal drug on school property); one physical activity behavior (attending physical education classes); and four weight control behaviors (trying to lose weight, not eating for ≥24 hours to lose weight or to keep from gaining weight; taking diet pills, powders, or liquids to lose weight or to keep from gaining weight; and vomiting or taking laxatives to lose weight or to keep from gaining weight).

White, black, and Hispanic students were equally likely to report three violence-related behaviors (carrying a gun, experiencing physical dating violence, and experiencing sexual dating violence); two tobacco use behaviors (buying cigarettes in a store or gas station and current cigar use); one alcohol and other drug use behavior (ever injecting any illegal drug); three sexual behaviors (using an IUD or implant; using a shot, patch, or birth control ring; and drinking alcohol or using drugs before last sexual intercourse); two dietary behaviors (eating vegetables two or more time per day and not drinking soda or pop); and two physical activity variables (being physically active at least 60 minutes per day on all 7 days and playing on at least one sports team) and being obese.

Assess Trends in Health-Risk Behaviors Over Time

YRBSS data can be used to assess long term trends and more recent changes in health-risk behaviors. This report identifies many linear increases and decreases that reflect long term reductions in risk behaviors and potential improvements in health outcomes. Quadratic trends might reflect more recent changes.

More specifically, linear decreases occurred for all three behaviors (for which trend data were available) that contribute to unintentional injuries (never or rarely wearing a bicycle helmet, never or rarely wearing a seat belt, and riding with a driver who had been drinking alcohol). Linear decreases also occurred for seven of the 11 violence-related behaviors (for which trend data were available) (carrying a weapon, carrying a gun, carrying a weapon on school property, being threatened or injured with a weapon on school property, being in a physical fight, being injured in a physical fight, and being in a physical fight on school property) and three of the five behaviors related to suicide (seriously considering attempting suicide, making a suicide plan, and attempting suicide) and a linear increase occurred for one violence-related behavior (not going to school because of safety concerns). Unfortunately, quadratic trends indicate that weapon carrying and gun carrying leveled off more recently and never or rarely wearing a bicycle helmet, seriously considering attempting suicide, and making a suicide plan increased more recently.

Linear decreases occurred for 11 of the 13 tobacco use behaviors (ever smoking cigarettes, smoking a whole cigarette before age 13 years, current cigarette use, current frequent cigarette use, smoking more than 10 cigarettes per day, smoking cigarettes on school property, buying cigarettes in a store or gas station, ever smoking cigarettes daily, currently smoking cigarettes daily, current cigar use, and current tobacco use). Quadratic trends indicated that eight of these behaviors (ever smoking cigarettes, smoking a whole cigarette before age 13 years, current cigarette use, current frequent cigarette use, smoking cigarettes on school property, currently smoking cigarettes daily, current cigar use, and current tobacco use) also decreased more recently.

Linear decreases occurred for four of the five alcohol use behaviors (for which trend data were available) (ever drinking alcohol, drinking alcohol before age 13 years, current alcohol use, and drinking five or more drinks of alcohol in a row) and quadratic trends indicated more recent decreases as well in these same behaviors. Linear decreases occurred for five of the 13 other drug use behaviors (ever using hallucinogenic drugs; ever using inhalants; ever using ecstasy; ever using methamphetamines; and ever using prescription drugs without a doctor's prescription and being offered, sold, or given an illegal drug on school property), but quadratic trends for two of these behaviors (ever using hallucinogenic drugs and ever using ecstasy) indicated they had leveled off more recently. In addition, although a linear increase occurred for current marijuana use and ever taking steroids without a doctor's prescription, quadratic trends indicated that since 1995 current marijuana use and since 2001 ever taking steroids both decreased.

Across the 12 sexual behaviors (for which trend data were available), linear decreases occurred for five risk behaviors (ever having sexual intercourse, having sexual intercourse before age 13 years, having sexual intercourse with four or more persons during their life, being currently sexually active, and not using any method to prevent pregnancy), while a linear increase occurred for condom use. However, quadratic trends indicated no change more recently for two of the risk behaviors (ever having sexual intercourse and having sexual intercourse with four or more persons during their life) and a decrease in condom use.

Linear decreases that occurred for four dietary behaviors (not eating fruit or drink 100% fruit juices and drinking soda or pop one or more, two or more, and three or more times per day) and linear increases that occurred for two other dietary behaviors (eating vegetables three or more times per day and not drinking or soda or pop) are positive changes. However, linear increases for two dietary behaviors (not eating vegetables and not drinking milk) and linear decreases for drinking one or more, two or more, and three or more glasses of milk per day are negative changes. Similarly, although a decrease occurred for participating in muscle strengthening activities and a linear increase occurred for using computers 3 or more times per day, a linear decrease occurred for watching television 3 or more hours per day. The negative changes in dietary behaviors and physical activity might have contributed to linear increases in obesity and overweight. Linear decreases occurred for two unhealthy weight loss behaviors (taking diet pills, powders, or liquids to lose weight or to keep from gaining weight and vomiting or taking laxatives to lose weight or to keep from gaining weight).

Monitor Progress Toward Achieving National Health Objectives

The national YRBS is the primary source of data to measure 20 Healthy People 2020 objectives, including one leading health indicator (15). The Healthy People 2020 objectives provide a comprehensive agenda for improving the health of all persons in the United States during 2011-2020. This report provides the Healthy People 2020 targets and data from the 2013 national YRBS for 20 objectives (Table 117). The data indicates that, as of 2013, four of the 20 Healthy People 2020 objectives have been achieved. Healthy People 2020 objective C-20.3 is to reduce the proportion of adolescents in grades 9–12 who report using artificial sources of ultraviolet light for tanning to ≤14.0%. During 2013, 12.8% of high school students nationwide had used an indoor tanning device (e.g., sunlamp, sunbed, or tanning booth) one or more times during the 12 months before the survey. Healthy People 2020 objective IVP-34 is to reduce physical fighting among adolescents to ≤28.4%. In 2013, 24.7% of high school students nationwide had been in a physical fight one or more times during the 12 months before the survey. Healthy People 2020 objective SA-1 is to reduce the proportion of adolescents who report that they rode, during the previous 30 days, with a driver who had been drinking alcohol to ≤25.5%. During 2013, 21.9% of high school students nationwide had rode in a car or other vehicle driven by someone who had been drinking alcohol one or more times during the 30 days before the survey. Healthy People 2020 objective TU-2.2 is to reduce the proportion of adolescents who use cigarettes during the past 30 days to ≤16.0%. During 2013, 15.7% of high school students smoked cigarettes on at least one day during the 30 days before the survey. Although the table indicates that Healthy People 2020 objective PA-3.1 to increase the proportion of adolescents who meet current federal physical activity guidelines for aerobic activity has been met, the 2013 YRBS prevalence estimate for aerobic physical activity is not comparable to the baseline prevalence estimate upon which the target was set because of a change in the context of the question starting with the 2011 national YRBS questionnaire.

To obtain additional Healthy People 2020 objectives, positive changes in school and community policies, programs, and practices might be needed. For example, Healthy People 2020 objective PA-5 is to increase the proportion of adolescents who participate in daily school physical education to ≥36.6%. During 2013, only 29.4% of high school students nationwide met this objective. Similarly, Healthy People 2020 objective PA-8.3.3 is to increase the proportion of adolescents in grades 9–12 who use a computer or play computer games outside of school (for non-school work) for no more than 2 hours a day to ≥82.6%. During 2013, only 58.7% of high school students nationwide met this objective.

Provide Comparable State and Large Urban School District Data

One of the strengths of YRBSS is that it provides not just national, but state and large urban school district data. These data are more likely to be used to develop, improve, and evaluate state and local policies, programs, and practices because they reflect a more relevant population. It is also possible to compare data from the state and large urban school district surveys because they share similar sample designs, questionnaires, data collection procedures, and data processing procedures.

Across states, a range of 25 or more percentage points or a fivefold variation or greater was identified for the following 25 health-risk behaviors:

• never or rarely wore a bicycle helmet (minimum: 60.0%; maximum: 93.2%);
• drove when drinking alcohol (minimum: 2.5%; maximum: 12.6%);
• texted or e-mailed while driving (minimum: 32.3%; maximum: 61.3%);
• ever smoked cigarettes (minimum: 18.3%; maximum: 52.1%);
• current frequent cigarette use (minimum: 1.3%; maximum: 8.9%);
• smoked more than 10 cigarettes per day (minimum: 2.4%; maximum: 15.7%);
• bought cigarettes in a store or gas station (minimum: 4.5%; maximum: 28.7%);
• ever smoked cigarettes daily (minimum: 2.6%; maximum: 13.9%);
• currently smoked cigarettes daily (minimum: 0.9%; maximum: 6.7%);
• current smokeless tobacco use (minimum: 2.6%; maximum: 15.9%);
• current tobacco use (minimum: 5.6%; maximum: 29.7%);
• ever drank alcohol (minimum: 30.7%; maximum: 70.5%);
• current alcohol use (minimum: 11.0%; maximum: 39.3%);
• largest number of drinks in a row was 10 or more (minimum: 1.2%; maximum: 9.0%);
• ever used marijuana (minimum: 16.8%; maximum: 43.3%);
• ever used heroin (minimum: 1.1%; maximum: 7.8%);
• ever used methamphetamines (minimum: 1.6%; maximum: 8.9%);
• ever took steroids without a doctor's prescription (minimum: 1.5%; maximum: 8.8%);
• IUD or implant use (minimum: 0.3%; maximum: 5.0%);
• shot, patch, or birth control ring use (minimum: 1.3%; maximum: 9.5%);
• drank one or more glasses per day of milk (minimum: 26.0%; maximum: 56.4%);
• drank two or more glasses per day of milk (minimum: 14.0%; maximum: 42.4%);
• drank soda or pop one or more times per day (minimum: 12.2%; maximum: 38.0%);
• attended physical education classes (minimum: 30.7%; maximum: 92.7%); and
• attended physical education classes daily (minimum: 4.5%; maximum: 63.6%).

Across large urban school districts, a range of 25 or more percentage points or a fivefold variation or greater was identified for the following 14 health-risk behaviors:

• never or rarely wore a seat belt (minimum: 4.7%; maximum: 25.0%);
• currently smoked cigarettes daily (minimum: 0.4%; maximum: 2.5%);
• ever use marijuana (minimum: 28.2%; maximum: 54.4%);
• ever had sexual intercourse (minimum: 25.8%; maximum: 59.7%);
• IUD or implant use (minimum: 0.3%; maximum: 7.8%);
• shot, patch, or birth control ring use (minimum: 0.5%; maximum: 11.2%);
• birth control pill; IUD or implant; or shot, patch, or birth control ring use (minimum: 10.2%; maximum: 41.4%);
• condom use and birth control pill; IUD or implant; or shot, patch, or birth control ring use (minimum: 2.4%; maximum: 15.7%);
• did not drink milk (minimum: 17.4%; maximum: 42.6%);
• drank one or more glasses per day of milk (minimum: 13.5%; maximum: 39.6%);
• drank soda or pop three or more times per day (minimum: 2.9%; maximum: 15.4%);
• watched television 3 or more hours per day (minimum: 19.3%; maximum: 47.5%);
• attended physical education classes (minimum: 28.4%; maximum: 85.0%); and
• attended physical education classes daily (minimum: 7.8%; maximum: 40.9%).

Across the states, 32% (n = eight) of the health-risk behaviors with a range of 25 or more percentage points or a fivefold variation or greater were related to tobacco use and an additional 28% (n = seven) were related to alcohol and other drug use. Across the large urban school districts, 43% (n = six) of the health-risk behaviors with a range of 25 or more percentage points or a fivefold variation or greater were related to dietary behaviors and physical activity and an additional 36% (n = five) were related to sexual behaviors that contribute to unintended pregnancy and sexually transmitted infections. All of these variations reflect differences in state and local laws and policies, enforcement practices, access to drugs, availability of effective school and community interventions, prevailing behavioral and social norms, demographic characteristics of the population, and adult practices and health-risk behaviors and also highlight how changes in one or more of these factors might contribute to reductions in health-risk behaviors among high school students.

Develop, Assess, and Improve Health-Related Policies, Programs, and Practices

CDC and other federal agencies use national YRBS data to assess the contributions of HIV and other STD prevention and chronic disease prevention efforts designed to reduce health-risk behaviors among youth and, in a variety of reports and publications, to stimulate support for and improvements in public health interventions. At the state and local level, agencies and nongovernmental organizations use YRBS data in a variety of ways to improve health-related policies, programs, and practices. For example, the San Diego Unified School District used YRBS data to identify symptoms of an unhealthy school environment, including feeling unsafe at school or on the way to or from school, feeling sad or hopeless, considering or planning suicide, or having attempted suicide among all students including sexual minority students. This spurred development of a district-wide Bullying, Harassment, and Intimidation Prohibition Policy that complies with federal and state laws and extensively delineates the types of protections addressed. In Kentucky, after reviewing YRBS data on fruit and vegetable consumption, physical activity, and obesity, the Coordinated School Health Program and Kentucky Action for Healthy Kids collaborated to create Students Taking Charge projects in high schools around the state. This initiative trains high school students to assess their school's nutritional and physical activity environment, develop an action plan to improve it, implement their plan using minigrants, and learn how to advocate for healthier school environments and policies. In Philadelphia, YRBS data on sexual behaviors were cited along with data on the prevalence of chlamydia and gonorrhea to help persuade the Philadelphia Department of Health and the School District of Philadelphia to set up an in-school STD screening program to educate students about STDs and identify and treat chlamydia and gonorrhea among high school students.

Limitations

The findings in this report are subject to at least four limitations. First, these data apply only to youth who attend school and, therefore, are not representative of all persons in this age group. Nationwide, in 2009, of persons aged 16–17 years, approximately 4% were not enrolled in a high school program and had not completed high school (16). Second, the extent of underreporting or overreporting of behaviors cannot be determined, although the survey questions demonstrate good test-retest reliability (8). Third, BMI is calculated on the basis of self-reported height and weight, and, therefore, tends to underestimate the prevalence of obesity and overweight (17). Fourth, not all states and large urban school districts include all of the standard questions on their YRBS questionnaire. For example, four states (Georgia, Louisiana, Utah, and Virginia) do not ask any questions on sexual risk behaviors.

Conclusions

YRBSS is an ongoing source of high-quality data at the national, state, and large urban school district levels for monitoring health-risk behaviors that contribute to the leading causes of mortality and morbidity among youth and adults in the United States. In 2013, in addition to the national data, 42 states and 21 large urban school districts obtained data representative of high school students in their jurisdiction. These data have been an important tool for planning, implementing, and evaluating public health policies, programs, and practices in schools and communities. Ongoing support for YRBSS, enhanced training and technical assistance for participating state and local health and education agencies, an increase in the number of states with representative data, more substate surveys at the large urban school district and county- or school-district level, and more universal use of all standard questions on YRBSS will help sustain the surveillance system and the quality of the data it produces and ensure that it continues to inform future efforts designed to protect and promote the health of youth nationwide.

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