Trends in weight management goals and behaviors among 9th-12th grade students: United States, 1999-2009.

To examine trends in weight management goals and behaviors among U.S. high school students during 1999-2009. Data from six biennial cycles (1999-2009) of the national Youth Risk Behavior Survey were analyzed. Cross-sectional, nationally representative samples of 9th-12th grade students (approximately 14,000 students/cycle) completed self-administered questionnaires. Logistic regression models adjusted for grade, race/ethnicity, and obesity were used to test for trends in weight management goals and behaviors among subgroups of students. Combined prevalences and trends differed by sex and by race/ethnicity and weight status within sex. During 1999-2009, the prevalence of female students trying to gain weight decreased (7.6-5.7 %). Among female students trying to lose or stay the same weight, prevalences decreased for eating less (69.6-63.2 %); fasting (23.3-17.6 %); using diet pills/powders/liquids (13.7-7.8 %); and vomiting/laxatives (9.5-6.6 %) for weight control. During 1999-2009, the prevalence of male students trying to lose weight increased (26.1-30.5 %). Among male students trying to lose or stay the same weight, the prevalence of exercising to control weight did not change during 1999-2003 and then increased (74.0-79.1 %) while the prevalence of taking diet pills/powders/liquids for weight control decreased (6.9-5.1 %) during 1999-2009. Weight management goals and behaviors changed during 1999-2009 and differed by subgroup. To combat the use of unhealthy weight control behaviors, efforts may be needed to teach adolescents about recommended weight management strategies and avoiding the risks associated with unhealthy methods.

Disability Within US Public Health School and Program Curricula.

OBJECTIVE: To describe the percentage of US public health schools and programs offering graduate-level courses with disability content as a potential baseline measurement for Healthy People 2020 objective DH-3 and compare the percentage of public health schools that offered disability coursework in 1999 with those in 2011. DESIGN: In 2011, using SurveyMonkey.com, cross-sectional information was collected from the deans, associate deans, directors, or chairpersons of master of public health-granting public health schools and programs that were accredited and listed with the Council on Education for Public Health. Two rounds of follow-up were conducted at 4-month intervals by e-mails and phone calls to program contacts who had not responded. The responses from schools and programs were calculated and compared. RESULTS: There were 78 responses (34 schools and 44 programs) for a response rate of 63%. Fifty percent of public health schools and programs offered some disability content within their graduate-level courses. A greater percentage of schools than programs (71% vs 34%; P = .003) offered some graduate-level disability coursework within their curricula. The percentage of schools that offered disability coursework was similar in 1999 and 2011. CONCLUSION: This assessment provides a potential baseline measurement for Healthy People 2020 objective DH-3. Future assessments should focus on clarifying disability content within courses and identifying capacity to offering disability training within public health schools and programs.

Methodology of the Youth Risk Behavior Surveillance System--2013.

Priority health-risk behaviors (i.e., interrelated and preventable behaviors that contribute to the leading causes of morbidity and mortality among youths and adults) often are established during childhood and adolescence and extend into adulthood. The Youth Risk Behavior Surveillance System (YRBSS), established in 1991, monitors six categories of priority health-risk behaviors among youths and young adults: 1) behaviors that contribute to unintentional injuries and violence; 2) sexual behaviors that contribute to human immunodeficiency virus (HIV) infection, other sexually transmitted diseases, and unintended pregnancy; 3) tobacco use; 4) alcohol and other drug use; 5) unhealthy dietary behaviors; and 6) physical inactivity. In addition, YRBSS monitors the prevalence of obesity and asthma among this population. YRBSS data are obtained from multiple sources including a national school-based survey conducted by CDC as well as schoolbased state, territorial, tribal, and large urban school district surveys conducted by education and health agencies. These surveys have been conducted biennially since 1991 and include representative samples of students in grades 9-12. In 2004, a description of the YRBSS methodology was published (CDC. Methodology of the Youth Risk Behavior Surveillance System. MMWR 2004;53 [No RR-12]). Since 2004, improvements have been made to YRBSS, including increases in coverage and expanded technical assistance.This report describes these changes and updates earlier descriptions of the system, including questionnaire content; operational procedures; sampling, weighting, and response rates; data-collection protocols; data-processing procedures; reports and publications; and data quality. This report also includes results of methods studies that systematically examined how different survey procedures affect prevalence estimates. YRBSS continues to evolve to meet the needs of CDC and other data users through the ongoing revision of the questionnaire, the addition of new populations, and the development of innovative methods for data collection.

Relationships between hours of sleep and health-risk behaviors in US adolescent students.

OBJECTIVE: To examine associations between insufficient sleep (<8h on average school nights) and health-risk behaviors. METHODS: 2007 national Youth Risk Behavior Survey data of U.S. high school students (n=12,154) were analyzed. Associations were examined on weighted data using multivariate logistic regression. RESULTS: Insufficient sleep on an average school night was reported by 68.9% of students. Insufficient sleep was associated with higher odds of current use of cigarettes (age-adjusted odds ratio [AOR], 1.67; 95% confidence interval [CI], 1.45-1.93), marijuana (AOR, 1.52; 95% CI, 1.31-1.76), and alcohol (AOR, 1.64; 95% CI, 1.46-1.84); current sexual activity (AOR, 1.41; 95% CI, 1.25-1.59); seriously considered attempting suicide (AOR, 1.86; 95% CI, 1.60-2.16); feeling sad or hopeless (AOR, 1.62; 95% CI, 1.43-1.84); physical fighting (AOR, 1.40; 95% CI, 1.24-1.60), not being physically active at least 60min ≥ 5days in the past 7days (AOR, 1.16; 95% CI, 1.04-1.29), using the computer ≥3h/day (AOR, 1.58; 95% CI, 1.38-1.80), and drinking soda/pop > 1time/day (AOR, 1.14; 95% CI, 1.03-1.28). CONCLUSION: Two-thirds of adolescent students reported insufficient sleep, which was associated with many health-risk behaviors. Greater awareness of the impact of sleep insufficiency is vital.

Prevalence of health-risk behaviors among Asian American and Pacific Islander high school students in the U.S., 2001-2007.

OBJECTIVES: We provided national prevalence estimates for selected health-risk behaviors for Asian American and Pacific Islander high school students separately, and compared those prevalence estimates with those of white, black, and Hispanic students. METHODS: We analyzed data from the Youth Risk Behavior Surveillance System. To generate a sufficient sample of Asian American and Pacific Islander students, we combined data from four nationally representative surveys of U.S. high school students conducted in 2001, 2003, 2005, and 2007 (total n = 56,773). RESULTS: Asian American students were significantly less likely than Pacific Islander, white, black, or Hispanic students to have drunk alcohol or used marijuana. Asian American students also were the least likely to have carried a weapon, to have been in a physical fight, to have ever had sexual intercourse, or to be currently sexually active. Once sexually active, Asian American students were as likely as most other racial/ethnic groups to have used alcohol or drugs at last sexual intercourse or to have used a condom at last sexual intercourse. Pacific Islander students were significantly more likely than Asian American, white, black, or Hispanic students to have seriously considered or attempted suicide. CONCLUSIONS: The prevalence estimates of health-risk behaviors exhibited by Asian American students and Pacific Islander students are very different and should be reported separately whenever feasible. To address the different health-risk behaviors exhibited by Asian American and Pacific Islander students, prevention programs should use culturally sensitive strategies and materials.

Associations of health risk behaviors with school absenteeism. Does having permission for the absence make a difference?

BACKGROUND: Nearly 10% of students enrolled in US public schools are absent daily. Although previous research has shown associations of school absenteeism with participation in risk behaviors, it is unclear if these associations vary by whether the absence was excused. The purpose of this study was to examine the associations of health risk behaviors with being absent from school with and without permission among high school students. METHODS: During spring 2004, questionnaires similar to the Youth Risk Behavior Survey questionnaire were completed by 4517 ninth- and eleventh-grade students. Responses to items assessing frequency of school absences during the past 30 days for any reason and without permission were combined to create a variable coded as absent on: 0 days; > or =1 day, all with permission (WP); and > or =1 day, at least 1 day without permission (WOP). Logistic regression analyses controlling for gender, grade, and race/ethnicity examined the association of risk behaviors with absenteeism. RESULTS: Controlling for demographic variables, compared to students who were absent 0 days, students who were absent WP had significantly higher odds of engaging in 25 of 55 risk behaviors examined and students who were absent WOP had significantly higher odds of engaging in 43 of the 55 behaviors. Students who were absent WOP also had approximately twice the odds of engaging in risk behaviors compared to students who were absent WP. CONCLUSIONS: School absenteeism, with and without permission, is associated with risk behaviors. Schools should recognize absenteeism for any reason as a warning sign for a variety of risk behaviors.

Prevalence and Correlates of Missing Meals Among High School Students-United States, 2010.

PURPOSE: To determine the prevalence and correlates of missing meals among adolescents. DESIGN: The 2010 National Youth Physical Activity and Nutrition Study, a cross-sectional study. SETTING: School based. PARTICIPANTS: A nationally representative sample of 11 429 high school students. MEASURES: Breakfast, lunch, and dinner consumption; demographics; measured and perceived weight status; physical activity and sedentary behaviors; and fruit, vegetable, milk, sugar-sweetened beverage, and fast-food intake. ANALYSIS: Prevalence estimates for missing breakfast, lunch, or dinner on ≥1 day during the past 7 days were calculated. Associations between demographics and missing meals were tested. Associations of lifestyle and dietary behaviors with missing meals were examined using logistic regression controlling for sex, race/ethnicity, and grade. RESULTS: In 2010, 63.1% of students missed breakfast, 38.2% missed lunch, and 23.3% missed dinner; the prevalence was highest among female and non-Hispanic black students. Being overweight/obese, perceiving oneself to be overweight, and video game/computer use were associated with increased risk of missing meals. Physical activity behaviors were associated with reduced risk of missing meals. Students who missed breakfast were less likely to eat fruits and vegetables and more likely to consume sugar-sweetened beverages and fast food. CONCLUSION: Breakfast was the most frequently missed meal, and missing breakfast was associated with the greatest number of less healthy dietary practices. Intervention and education efforts might prioritize breakfast consumption.

Psychobiology and behavioral strategies. Physical activity, sport participation, and suicidal behavior: U.S. high school students.

PURPOSE: To evaluate the associations of physical activity and sports team participation with suicidal behavior among U.S. high school students. METHODS: Data were from the 2003 Youth Risk Behavior Survey (N = 10,530 respondents). Exposure variables included physical activity (inactive, insufficient, moderately intensive, regular vigorously intensive, and frequent vigorously intensive) and sports team participation. Outcome variables were suicide ideation (seriously considering and/or planning suicide) and suicide attempts. Hierarchical logistic regressions were run, controlling for age, race, smoking, alcohol use, drug use, geographic region, unhealthy weight-control practices, and body mass index/weight perceptions. RESULTS: Compared with inactive students or sports team nonparticipants, the odds of suicide ideation were lower among boys reporting frequent vigorous-intensity physical activity (adjusted odds ratio (AOR) = 0.48; 95% confidence interval (CI) = 0.29, 0.79) and sports team participation, respectively (AOR = 0.65; 95% CI = 0.48, 0.86). The odds of suicide attempts were also lower among frequently vigorously active boys (AOR = 0.44; 95% CI = 0.21, 0.96) and sports team participants (AOR = 0.61; 95% CI = 0.40, 0.93). The odds of suicide attempts were lower for regular vigorously active girls compared with inactive girls (AOR = 0.67; 95% CI = 0.45, 0.99) and sports team participants compared with nonparticipants (AOR = 0.73; 95% CI = 0.57, 0.94). Associations with one exposure variable generally weakened when adjustment was made for the other exposure variable, or for feeling sad and hopeless. CONCLUSIONS: The association of physical activity and sports team participation with suicide ideation and suicide attempts varied by sex. Further research is needed to clarify these different associations.

Faculty and staff health promotion: results from the School Health Policies and Programs Study 2006.

BACKGROUND: US schools employ an estimated 6.7 million workers and are thus an ideal setting for employee wellness programs. This article describes the characteristics of school employee wellness programs in the United States, including state-, district-, and school-level policies and programs. METHODS: The Centers for Disease Control and Prevention conducts the School Health Policies and Programs Study every 6 years. In 2006, computer-assisted telephone interviews or self-administered mail questionnaires were completed by state education agency personnel in 49 states plus the District of Columbia and among a nationally representative sample of school districts (n=445). Computer-assisted personal interviews were conducted with personnel in a nationally representative sample of elementary, middle, and high schools (n=873). RESULTS: During the 2 years preceding the study, 67.3% of states provided assistance to districts or schools on how to develop or implement faculty and staff health promotion activities or services. Although nearly all schools offered at least 1 health promotion service or activity, few schools offered coordinated activities and services within a comprehensive employee wellness program. During the 12 months preceding the study, none of the health screenings were offered by more than one third of schools; only a few of the health promotion activities and services were offered by more than one third of schools; about one third of schools offered physical activity programs, employee assistance programs, and subsidies or discounts for off-site health promotion activities; and only 1 in 10 schools provided health-risk appraisals for faculty and staff. CONCLUSIONS: More schools should implement comprehensive employee wellness programs to improve faculty and staff health behaviors and health status.

Associations of dating violence victimization with lifetime participation, co-occurrence, and early initiation of risk behaviors among U.S. high school students.

This study examined the association of victimization in a physically violent dating relationship with risk behaviors, age of risk behavior initiation, and co-occurrence of risk behaviors among students in grades 9 through 12 in the United States. Data were from the 2003 national Youth Risk Behavior Survey (YRBS). Nearly 9% of students reported experiencing dating violence victimization. Dating violence victimization was associated with alcohol use, marijuana use, and having ever had sexual intercourse among female students and having ever had sexual intercourse among male students. Dating violence victimization also was associated with early initiation of alcohol use among female students. The odds of dating violence victimization increased as the number of risk behaviors increased and as the number of lifetime sexual partners increased. These risk behavior patterns should serve as warning signs of elevated risk for dating violence victimization and may be helpful in identifying adolescents who could benefit from targeted, preventive interventions.

Youth risk behavior surveillance--United States, 2005.

In the United States, 71% of all deaths among persons aged 10-24 years result from 4 causes: motorvehicle crashes, other unintentional injuries, homicide, and suicide. Results from the 2005 national Youth Risk Behavior Survey (YRBS) indicated that during the 30 days preceding the survey, many high school students engaged in behaviors that increased their likelihood of death from these 4 causes: 9.9% had driven a car or other vehicle when they had been drinking alcohol, 18.5% had carried a weapon, 43.3% had drunk alcohol, and 20.2% had used marijuana. In addition, during the 12 months preceding the survey, 35.9% of high school students had been in a physical fight and 8.4% had attempted suicide. Substantial morbidity and social problems among youth also result from unintended pregnancies and sexually transmitted diseases, including human immunodeficiency virus infection. During 2005, a total of 46.8% of high school students had ever had sexual intercourse, 37.2% of sexually active high school students had not used a condom at last sexual intercourse, and 2.1% had ever injected an illegal drug. Among adults aged > or =25 years, 61% of all deaths result from 2 causes: cardiovascular disease and cancer. Results from the 2005 national YRBS indicated that risk behaviors associated with these 2 causes of death were initiated during adolescence. During 2005, a total of 23.0% of high school students had smoked cigarettes during the 30 days preceding the survey, 79.9% had not eaten > or =5 times/day of fruits and vegetables during the 7 days preceding the survey, 67.0% did not attend physical education classes daily, and 13.1% were overweight.

Epidemic Assistance by the Epidemic Intelligence Service, Centers for Disease Control and Prevention, 2005-2014.

BACKGROUND: Epi-Aids, or epidemiologic assistance investigations, are an important mechanism through which Centers for Disease Control and Prevention supports public health organizations. We described the characteristics of Epi-Aids conducted during 2005-2014 and summarized the publication outcome of Epi-Aid related scientific information products. METHODS: We performed a descriptive analysis of all Epi-Aids conducted during January 1, 2005-December 31, 2014; investigations were categorized by health topic and geographic distribution. We highlighted investigations of substantial public health importance, e.g., multistate investigations and investigations of epidemics and pandemics. We identified the Epi-Aid publication outcome by searching PubMed for Epi-Aid related publications, which included Morbidity and Mortality Weekly Reports (MMWRs) and peer-reviewed publications with an Epidemic Intelligence Service Officer (EISO) as a coauthor. We calculated publication timeliness and categorized publications by journal impact factor. RESULTS: During the study period, 698 EISOs and their collaborators participated in 807 Epi-Aids throughout the United States and globally. Approximately 81 Epi-Aids were conducted annually (range, 62-104); 632 (78.3%) were infectious disease-related; 161 (20.0%) were international, supporting 68 countries. As of June 2015, EISOs, in collaboration with partners, published 131 MMWRs and 280 scientific manuscripts on the basis of the 807 Epi-Aids conducted during the study period; 394 (48.8%) Epi-Aids resulted in publications in 80 peer-reviewed journals. CONCLUSIONS: EISOs play a critical role in conducting Epi-Aids, which require qualified field epidemiologists who can rapidly respond to requests for assistance during public health emergencies. Publications based on Epi-Aids share new knowledge with the scientific community, furthering progress of public health science and practice.

Associations of body mass index and perceived weight with suicide ideation and suicide attempts among US high school students.

BACKGROUND: Previous research with adolescents has shown associations of body weight and perceptions of body size with suicide ideation and suicide attempts, but it is unclear whether these associations are direct or whether a mediating effect exists. OBJECTIVES: To determine if body mass index and perceived weight are associated significantly with suicide ideation and suicide attempts, controlling for weight control practices, and if perceived weight mediates the associations of body mass index with suicide ideation and suicide attempts. DESIGN, SETTING, AND PARTICIPANTS: Data were analyzed from the 2001 Youth Risk Behavior Survey, a school-based survey administered to a nationally representative sample of students in grades 9 through 12 (N = 13 601). MAIN OUTCOME MEASURE: Self-reported past-year suicide ideation and suicide attempts, compared by perceived weight and body mass index category, calculated from self-reported height and weight. RESULTS: Body mass index category was associated significantly with suicide ideation (among all students) and suicide attempts (among white and Hispanic students) without perceived weight in the model but not with perceived weight added to the model. In contrast with those who perceive themselves as about the right weight, students who perceived themselves as very underweight (odds ratio [OR], 2.29 [95% confidence interval (CI), 1.46-3.59]), slightly underweight (OR, 1.36 [95% CI, 1.03-1.79]), slightly overweight (OR, 1.33 [95% CI, 1.12-1.58]), and very overweight (OR, 2.50 [95% CI, 1.73-3.60]) had greater adjusted odds of suicide ideation. Among white students, perceiving oneself as very underweight (OR, 3.04 [95% CI, 1.40-6.58]) or very overweight (OR, 2.74 [95% CI, 1.21-6.23]) was associated with greater odds of suicide attempts. Perceiving oneself as very underweight was associated with greater odds for suicide attempts among black (OR, 2.86 [95% CI, 1.10-7.45]) and Hispanic (OR, 3.40 [95% CI, 1.54-7.51]) students. CONCLUSIONS: How adolescents perceive their body weight may be more important than their actual weight in terms of increased likelihood of suicidal behavior. Regardless of body mass index, extreme perceptions of weight appear to be significant risk factors for suicidal behavior; important racial/ethnic differences exist.

The Association of Meal Practices and Other Dietary Correlates With Dietary Intake Among High School Students in the United States, 2010.

PURPOSE: To examine behavioral and environmental factors that may be related to dietary behaviors among U.S. high school students. DESIGN: Data were obtained from the 2010 National Youth Physical Activity and Nutrition Study, a cross-sectional study. SETTING: The study was school-based. SUBJECTS: Study subjects were a nationally representative sample of students in grades 9 to 12 (n = 11,458). MEASURES: Variables of interest included meal practices, in-home snack availability, and intakes of healthful foods/beverages (fruits, vegetables, water, and milk) and less healthful foods/beverages (fried potatoes, pizza, and sugar-sweetened beverages). ANALYSIS: Sex-stratified logistic regression models were used to examine associations of meal practices and snack availability with dietary intake. Odds ratios (ORs) were adjusted for race/ethnicity and grade. RESULTS: Eating breakfast daily, frequent family dinners, and bringing lunch from home were associated with higher odds of consuming at least three healthful foods or beverages. High fast-food intake was associated with lower odds of healthful dietary intake and higher odds of sugar-sweetened beverage intake (female OR = 3.73, male OR = 4.60). Students who mostly/always had fruits and vegetables available at home had increased odds of fruits (female OR = 3.04, male OR = 2.24), vegetables (female OR = 2.12, male OR = 1.65), water (female OR = 1.82, male OR = 1.85), and milk intake (female OR = 1.45, male OR = 1.64). CONCLUSION: Encouraging daily breakfast consumption, frequent family dinners, and fruit and vegetable availability at home may lead to higher intakes of healthful foods among high school students.

Cigarette use in 6th through 10th grade: the Sarasota County Demonstration Project.

OBJECTIVES: To identify factors associated with cigarette smoking in the 6th-grade through 10th-grade youth population of Sarasota County, Florida. METHODS: A closed-ended, quantitative survey was completed by 2004 youth and used to extract population-specific data on the correlates of cigarette use. RESULTS: A range of factors influence cigarette use including self-efficacy to refuse offers of cigarettes, perceived emotional benefits, and perceived maternal disapproval of smoking. CONCLUSIONS: Results underscore the need for multiple-component interventions. This study is unique in that it represents population-specific research in which community partners are using the findings to develop community-specific prevention marketing interventions.

Passive versus active parental permission in school-based survey research: does the type of permission affect prevalence estimates of risk behaviors?

This study investigates whether the type of parental permission affects prevalence estimates for risk behaviors from the national 2001 Youth Risk Behavior Survey. Participants were 13,195 students from 143 schools, of which 65% used passive permission and 35% active permission. Student participation rates were 86.7% in passive permission schools and 77.3% in active permission schools. For 24 of 26 behaviors tested, no significant differences were seen in the prevalence of risk behavior by type of parental permission. As long as high response rates are obtained, type of parental permission does not affect prevalence estimates for risk behaviors that are based on self-report.

Factors related to alcohol use among 6th through 10th graders: the Sarasota County Demonstration Project.

Alcohol consumption by youth can produce negative health outcomes. This study identified correlates of lifetime alcohol use, recent alcohol use, and binge drinking among youth in sixth through 10th grade (n = 2,004) in Sarasota County, Fla. Results from a closed-ended, quantitative survey acknowledged a range of personal, social, and environmental influences. Breadth of these influences supports a need for multifaceted, community-based interventions for effective prevention of youth alcohol use. This study was unique because it represents population-specific research in which community partners are using the findings to develop community-specific social marketing interventions to prevent underage drinking and promote alternative behaviors.

Associations of school violence with physical activity among U.S. high school students.

BACKGROUND: This study investigated associations of violence-related behaviors with physical activity (PA)-related behaviors among U.S. high school students. METHODS: Data from the 2009 national Youth Risk Behavior Survey, a cross-sectional survey of a nationally representative sample of 9th-12th grade students, were analyzed. Sex-stratified, adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated for associations between violence-related behaviors and being physically active for ≥60 minutes daily, sports participation, TV watching for ≥3 hours/day, and video game/computer use for ≥3 hours/day. RESULTS: Among male students, at-school bullying victimization was negatively associated with daily PA (aOR: 0.72; 95% CI: 0.58-0.87) and sports participation; skipping school because of safety concerns was positively associated with video game/computer use (1.42; 1.01-2.00); and physical fighting was positively associated with daily PA. Among female students, at-school bullying victimization and skipping school because of safety concerns were both positively associated with video game/computer use (1.46; 1.19-1.79 and 1.60; 1.09-2.34, respectively), and physical fighting at school was negatively associated with sports participation and positively associated with TV watching. CONCLUSIONS: Bullying victimization emerged as a potentially important risk factor for insufficient PA. Schools should consider the role of violence in initiatives designed to promote PA.

Comparing methods for assessing beverage intake among high school students.

OBJECTIVES: To compare 7 beverage intake survey questions against criterion data from 24-hour dietary recall interviews (24HrDRIs) among adolescents. METHODS: Data were available from 610 US high school students completing a survey and ≥3 24HrDRIs. Analyses compared mean intake (times/day) calculated from the survey to intake (servings/day) from the 24HrDRIs. Proportions of students reporting intake of ≥1 times/day were compared to the 24HrDRI results. RESULTS: Survey data significantly correlated with 24HrDRI data (all corrected r: 0.26-0.49). Survey results differed from 24HrDRI results on reported intake of 5 beverages. CONCLUSION: Intake from these beverage questions should be reported in times/day, which is related to, but not a proxy for, servings/day. These questions are useful for population-level surveillance of beverage intake and monitoring trends over time.

Texting while driving and other risky motor vehicle behaviors among US high school students.

OBJECTIVE: To assess the prevalence of texting/e-mailing while driving (TWD) and association of TWD with other risky motor vehicle (MV) behaviors among US high school students. METHODS: Data were used from the Centers for Disease Control and Prevention's 2011 national Youth Risk Behavior Survey, which assessed TWD during the 30 days before the survey among 8505 students aged ≥16 years from a nationally representative sample of US high school students. TWD frequency was coded into dichotomous and polychotomous variables. Logistic regression assessed the relationship between TWD and other risky driving behaviors, controlling for age, race/ethnicity, and sex. RESULTS: The prevalence of TWD on ≥1 days during the 30 days before the survey was 44.5% (95% confidence interval: 40.8%-48.2%). Students who engaged in TWD were more likely than their non-TWD counterparts to not always wear their seatbelt (prevalence ratio; 95% confidence interval: 1.16; 1.07-1.26), ride with a driver who had been drinking alcohol (1.74; 1.57-1.93), and drink alcohol and drive (5.33; 4.32-6.59). These other risky MV behaviors were most likely to occur among students who frequently engaged in TWD. CONCLUSIONS: Nearly half of US high school students aged ≥16 years report TWD during the past 30 days; these students are more likely to engage in additional risky MV behaviors. This suggests there is a subgroup of students who may place themselves, their passengers, and others on the road at elevated risk for a crash-related injury or fatality by engaging in multiple risky MV behaviors.