Changes in Illicit Drug Use Among High School Students in Southeastern U.S. States-2009 to 2019.

To determine if decreasing lifetime use of methamphetamines, cocaine, ecstasy, and inhalants among high school students occurring from 2009 to 2019 in the U.S. also occurred in five southeastern states, Youth Risk Behavior Survey data representative of high school students in grades 9-12 in 2009 and 2019 were analyzed. In a classroom setting, lifetime use of methamphetamines, cocaine, ecstasy, and inhalants were self-reported. Students nationwide (n = 30,087) were compared to students in Alabama, Georgia, Louisiana, Mississippi, and South Carolina (n = 18,237). Lifetime methamphetamine use significantly increased from 4.8% in 2009 to 6.2% in 2019 in the southeast but decreased from 4.1 to 2.2% nationwide. Use of cocaine, ecstasy, and inhalants remained stable in the southeast while decreasing significantly nationwide from 2009 to 2019. During a period when use of methamphetamines, cocaine, ecstasy, and inhalants among high school students in the U.S. decreased, use in southeastern states did not change. Culturally specific programs and interventions may be needed to prevent illicit drug use in communities of southeastern states where youth remain at risk.

Reliability of the 2021 National Youth Risk Behavior Survey Questionnaire.

PURPOSE: The Youth Risk Behavior Survey (YRBS) monitors behaviors, experiences, and conditions affecting the health of high school students nationwide. This study examined the test-retest reliability of the 2021 national YRBS questionnaire. DESIGN: Respondents completed a Time 1 and Time 2 paper-and-pencil questionnaire approximately 2 weeks apart during February to May 2022. Data were linked in such a way as to preserve anonymity. SETTING: Convenience sample of high schools. SUBJECTS: High school students (N = 588). MEASURES: Health risk behaviors and experiences assessed on the 2021 national YRBS questionnaire. ANALYSIS: Time 1 and Time 2 responses were compared for each questionnaire item using the McNemar's test. Then, Cohen's kappa coefficients tested the agreement between Time 1 and Time 2 responses overall, and by sex, grade, and Black, White, and Hispanic race and ethnicity. RESULTS: Among the 74 items analyzed, 96% had at least moderate reliability, and 73% had substantial or almost perfect reliability. The mean Cohen's kappa was .68. McNemar's test findings showed Time 1 and Time 2 data significantly differed (P < .01) for 9 items (12%). CONCLUSION: Reliable health behavior measures are important in the development of youth-focused public health programs and policies. Findings suggest the national YRBS questionnaire is a reliable instrument. Such findings lend support to relying on adolescent self-reported data when monitoring health behaviors using the YRBS.

Reliability of the 2020 School Health Profiles Principal and Lead Health Education Teacher Questionnaires.

BACKGROUND: School Health Profiles assesses school health policies and practices among US secondary schools. METHODS: The 2020 School Health Profiles principal and teacher questionnaires were used for a test-retest reliability study. Cohen's kappa coefficients tested the agreement in dichotomous responses to each questionnaire variable at 2 time points. The aggregate prevalence estimates between time 1 and time 2 were compared for each questionnaire item via overlapping 95% confidence intervals. Chi-square tests examined whether the prevalence at time 2 differed between paper and web administration for both questionnaires. RESULTS: For the principal (N = 50) and teacher (N = 34) data, there were no significant differences in the prevalence of any items between time 1 and time 2. For the principal survey, the mean kappa for 191 variables was 0.49. For the teacher survey, the mean kappa for 260 variables was 0.65. Overall, 60.7% of principal and 91.1% of teacher questionnaire items had at least "moderate" reliability. CONCLUSIONS: School Health Profiles offers education and health agencies a reliable tool to monitor school policies and practices.

Associations Between Verbal and Physical Abuse in the Home and Mental Health Indicators Among Heterosexual and Lesbian, Gay, Bisexual, and Questioning High School Students in the US-Adolescent Behaviors and Experiences Survey, 2021.

PURPOSE: A number of factors may contribute to disparities in mental health and suicidality for lesbian, gay, bisexual, and questioning (LGBQ) students, including parental abuse. METHODS: The Centers for Disease Control and Prevention's (CDC) Adolescent Behaviors and Experiences Survey included a nationally representative sample of US high school students during the COVID-19 pandemic. The current analyses examined experiences of verbal and physical abuse in the home with mental health and suicidality among LGBQ students compared to heterosexual students. RESULTS: The relationship between abuse and mental health and suicidality was significant for all students; however, LGBQ students experienced substantially more abuse and had significantly poorer mental health and greater suicidality than heterosexual students. DISCUSSION: Experiencing verbal or physical abuse in the home is strongly associated with poor mental health and suicidality among youth, regardless of sexual identity; however, among LGBQ students who experienced abuse, the prevalence of poor mental health and suicidality reached crisis levels.

Overview and Methods for the Youth Risk Behavior Surveillance System - United States, 2021.

The Youth Risk Behavior Surveillance System (YRBSS) is the largest public health surveillance system in the United States, monitoring a broad range of health-related behaviors among high school students. The system includes a nationally representative Youth Risk Behavior Survey (YRBS) and separate school-based YRBSs conducted by states, tribes, territories, and local school districts. In 2021, these surveys were conducted during the COVID-19 pandemic. The pandemic underscored the importance of data in understanding changes in youth risk behaviors and addressing the multifaceted public health needs of youths. This overview report describes 2021 YRBSS survey methodology, including sampling, data collection procedures, response rates, data processing, weighting, and analyses. The 2021 YRBS participation map, survey response rates, and a detailed examination of student demographic characteristics are included in this report. During 2021, in addition to the national YRBS, a total of 78 surveys were administered to high school students across the United States, representing the national population, 45 states, two tribal governments, three territories, and 28 local school districts. YRBSS data from 2021 provided the first opportunity since the onset of the COVID-19 pandemic to compare youth health behaviors using long-term public health surveillance. Approximately half of all student respondents represented racial and ethnic minority groups, and approximately one in four identified as lesbian, gay, bisexual, questioning, or other (a sexual identity other than heterosexual) (LGBQ+). These findings reflect shifts in youth demographics, with increased percentages of racial and ethnic minority and LGBQ+ youths compared with previous YRBSS cycles. Educators, parents, local decision makers, and other partners use YRBSS data to monitor health behavior trends, guide school health programs, and develop local and state policy. These and future data can be used in developing health equity strategies to address long-term disparities so that all youths can thrive in safe and supportive environments. This overview and methods report is one of 11 featured in this MMWR supplement. Each report is based on data collected using methods presented in this overview. A full description of YRBSS results and downloadable data are available (https://www.cdc.gov/healthyyouth/data/yrbs/index.htm).

Dietary and Physical Activity Behaviors in 2021 and Changes from 2019 to 2021 Among High School Students - Youth Risk Behavior Survey, United States, 2021.

The fall of 2021 was the first school semester to begin with widespread in-person learning since the COVID-19 pandemic began. Understanding dietary and physical activity behaviors of adolescents during this time can provide insight into potential health equity gaps and programmatic needs in schools and communities. This report uses data from the 2021 national Youth Risk Behavior Survey conducted among a nationally representative sample of U.S. public and private school students in grades 9-12 to update estimates of dietary and physical activity behaviors among U.S. high school students overall and by sex and race and ethnicity. In addition, 2-year comparisons (2019 versus 2021) of these behaviors were examined. In 2021, daily consumption of fruits, vegetables, and breakfast during the past 7 days remained low and decreased overall with specific disparities by sex and race and ethnicity from 2019 to 2021. The overall prevalence of students attending physical education classes daily, exercising to strengthen muscles on ≥3 days/week (i.e., met the guideline for muscle-strengthening activity), and playing on at least one sports team decreased from 2019 to 2021; whereas being physically active for ≥60 minutes/day on all 7 days (i.e., met the guideline for aerobic activity) and meeting both aerobic and muscle-strengthening guidelines remained low but did not change. These findings underscore the need for strategies to increase healthy dietary and physical activity behaviors both in the recovery phase of COVID-19 and longer term.

Electronic Vapor Product Use Among High School Students - Youth Risk Behavior Survey, United States, 2021.

Commercial tobacco use is the leading cause of preventable disease and death in the United States. Despite declines in overall tobacco product use among youths, disparities persist. This report uses biennial data from the 2015-2021 cycles of the nationally representative Youth Risk Behavior Survey to assess prevalence and trends in electronic vapor product (EVP) use among high school students, including ever use, current use (past 30 days), and daily use. Data from 2021 also included usual source of EVPs among students who currently used EVPs. Overall, in 2021, 36.2% had ever used EVPs, 18.0% currently used EVPs, and 5.0% used EVPs daily, with variation in prevalence by demographic characteristics. Prevalence of ever use and current use of EVPs was higher among female students than male students. Prevalence of ever use, current use, and daily use of EVPs was lower among Asian students than Black or African American (Black), Hispanic, Native Hawaiian or other Pacific Islander, White, and multiracial students. Prevalence of ever use, current use, and daily use of EVPs was higher among bisexual students than among students who were not bisexual. During 2015-2021, although ever use of EVPs decreased overall (from 44.9% to 36.2%) and current use of EVPs was stable overall, daily EVP use increased overall (from 2.0 to 5.0%) and among female (from 1.1% to 5.6%), male (from 2.8% to 4.5%), Black (from 1.1% to 3.1%), Hispanic (from 2.6% to 3.4%), multiracial (from 2.8% to 5.3%) and White (from 1.9% to 6.5%) students. Among students who currently use EVPs, 54.1% usually got or bought EVPs from a friend, family member, or someone else. Continued surveillance of EVP and other tobacco product use is necessary to document and understand youth tobacco product usage. These findings can be used to inform youth-focused tobacco prevention and control strategies at the local, state, tribal, and national levels.

Sports-Related Concussions and Adverse Health Behaviors Among Middle and High School Students.

BACKGROUND: Concussions affect millions of youths in the United States each year, and there is concern about long-term health effects from this injury. PURPOSE: To examine the association between sports- or physical activity-related concussion and health risk behaviors among middle and high school students in 9 states. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Data from the 2019 middle school and high school Youth Risk Behavior Survey were used for this analysis. Nine states were identified that included the same question on concussion and similar questions on health risk behaviors in their 2019 Youth Risk Behavior Survey. Students were asked to self-report whether they had ≥1 sports- or physical activity-related concussions during the 12 months preceding the survey. Self-reported concussion was the primary outcome of interest. Other variables included sex, race/ethnicity, played on a sports team, were physically active 5 or more days/week, ever tried cigarette smoking, ever used an electronic vapor product, academic grades, drank alcohol, were in a physical fight, seriously considered attempting suicide, made a suicide plan, and attempted suicide. RESULTS: Among the 9 states, 18.2% of middle school students and 14.3% of high school students self-reported ≥1 sports- or physical activity-related concussions. Among both middle school and high school students, the prevalence of ≥1 sports- or physical activity-related concussions was higher among students who played on a sports team, were physically active 5 or more days per week, had ever tried cigarette smoking, had ever used an electronic vapor product, had seriously considered attempting suicide, had made a suicide plan, and had attempted suicide compared with those who had not engaged in those behaviors. The prevalence of sports- or physical activity-related concussion was consistently higher among middle school students than high school students across sex, race/ethnicity, and adverse health behaviors. CONCLUSION: Middle school students with a history of concussion warrant attention as an at-risk population for concussions and adverse health behaviors. Health care providers may consider screening students for adverse health behaviors during preparticipation examinations and concussion evaluations.

Family Economics and Mental Health Among High-School Students During COVID-19.

INTRODUCTION: The COVID-19 pandemic has had unprecedented socioeconomic and health impacts in the U.S. This study examined racial/ethnic and school poverty status differences in the relationship between parent job loss, experiences with hunger, and indicators of mental health problems among public high-school students nationwide during the COVID-19 pandemic. METHODS: The study analyzed data from the Adolescent Behaviors and Experiences Survey, conducted in January-June 2021. The Adolescent Behaviors and Experiences Survey was a 1-time, cross-sectional, online survey that used a stratified, 3-stage cluster sample to obtain a nationally representative sample of high-school students in the U.S. This study was limited to public-school students (n=7,379). RESULTS: Among public high-school students nationwide, 36.9% experienced poor mental health during the pandemic, and during the past year, 43.9% experienced persistent feelings of sadness or hopelessness, 19.8% seriously considered attempting suicide, and 9.1% attempted suicide. Parent job loss and having gone hungry were associated with indicators of mental health problems overall and across racial/ethnic groups and school poverty status levels. CONCLUSIONS: Students who experience parent job loss and hunger are likely to also experience poor mental health and may be at higher risk for suicide.

Implications for Coding Race and Ethnicity for American Indian and Alaska Native High School Students in a National Survey.

OBJECTIVES: To examine the impact of racial/ethnic coding strategies on the estimated prevalence of risk behaviors among American Indian/Alaska Native (AI/AN) high school students. METHODS: Data from the national Youth Risk Behavior Survey (2017 and 2019) were analyzed (N=28,422). Racial/ethnic data were coded to identify "Multiracial/ethnic AI/AN students" and "AI/AN alone students." The prevalence of persistent feelings of sadness or hopelessness, suicidality, and violence victimization were compared across the coding schemes and with non-Hispanic White students. RESULTS: Of students who selfidentified as AI/AN, one in six (18%) were AI/AN alone. The prevalence of many health risk behaviors was significantly higher among AI/AN students than non-Hispanic/Latino White students. The precision of the risk behavior prevalence estimates, however, varied considerably. CONCLUSION: How racial/ethnic data were coded affected the precision of calculations of risk behavior prevalence among AI/AN students, who are often multiracial and of Hispanic/Latino ethnicity.

Mental Health, Suicidality, and Connectedness Among High School Students During the COVID-19 Pandemic - Adolescent Behaviors and Experiences Survey, United States, January-June 2021.

Disruptions and consequences related to the COVID-19 pandemic, including school closures, social isolation, family economic hardship, family loss or illness, and reduced access to health care, raise concerns about their effects on the mental health and well-being of youths. This report uses data from the 2021 Adolescent Behaviors and Experiences Survey, an online survey of a probability-based, nationally representative sample of U.S. public- and private-school students in grades 9-12 (N = 7,705), to assess U.S. high school students' mental health and suicidality during the COVID-19 pandemic. The study also examines whether mental health and suicidality are associated with feeling close to persons at school and being virtually connected to others during the pandemic. Overall, 37.1% of students experienced poor mental health during the pandemic, and 31.1% experienced poor mental health during the preceding 30 days. In addition, during the 12 months before the survey, 44.2% experienced persistent feelings of sadness or hopelessness, 19.9% had seriously considered attempting suicide, and 9.0% had attempted suicide. Compared with those who did not feel close to persons at school, students who felt close to persons at school had a significantly lower prevalence of poor mental health during the pandemic (28.4% versus 45.2%) and during the past 30 days (23.5% versus 37.8%), persistent feelings of sadness or hopelessness (35.4% versus 52.9%), having seriously considered attempting suicide (14.0% versus 25.6%), and having attempted suicide (5.8% versus 11.9%). The same pattern was observed among students who were virtually connected to others during the pandemic (i.e., with family, friends, or other groups by using a computer, telephone, or other device) versus those who were not. Comprehensive strategies that improve feelings of connectedness with others in the family, in the community, and at school might foster improved mental health among youths during and after the COVID-19 pandemic.

Mental Health Surveillance Among Children - United States, 2013-2019.

Mental health encompasses a range of mental, emotional, social, and behavioral functioning and occurs along a continuum from good to poor. Previous research has documented that mental health among children and adolescents is associated with immediate and long-term physical health and chronic disease, health risk behaviors, social relationships, education, and employment. Public health surveillance of children's mental health can be used to monitor trends in prevalence across populations, increase knowledge about demographic and geographic differences, and support decision-making about prevention and intervention. Numerous federal data systems collect data on various indicators of children's mental health, particularly mental disorders. The 2013-2019 data from these data systems show that mental disorders begin in early childhood and affect children with a range of sociodemographic characteristics. During this period, the most prevalent disorders diagnosed among U.S. children and adolescents aged 3-17 years were attention-deficit/hyperactivity disorder and anxiety, each affecting approximately one in 11 (9.4%-9.8%) children. Among children and adolescents aged 12-17 years, one fifth (20.9%) had ever experienced a major depressive episode. Among high school students in 2019, 36.7% reported persistently feeling sad or hopeless in the past year, and 18.8% had seriously considered attempting suicide. Approximately seven in 100,000 persons aged 10-19 years died by suicide in 2018 and 2019. Among children and adolescents aged 3-17 years, 9.6%-10.1% had received mental health services, and 7.8% of all children and adolescents aged 3-17 years had taken medication for mental health problems during the past year, based on parent report. Approximately one in four children and adolescents aged 12-17 years reported having received mental health services during the past year. In federal data systems, data on positive indicators of mental health (e.g., resilience) are limited. Although no comprehensive surveillance system for children's mental health exists and no single indicator can be used to define the mental health of children or to identify the overall number of children with mental disorders, these data confirm that mental disorders among children continue to be a substantial public health concern. These findings can be used by public health professionals, health care providers, state health officials, policymakers, and educators to understand the prevalence of specific mental disorders and other indicators of mental health and the challenges related to mental health surveillance.

Substance Use and Sports- or Physical Activity-Related Concussions Among High School Students.

History of concussion is associated with substance use. Data from the 2017 National Youth Risk Behavior Survey (N = 14,765) were used in this study to examine associations between sports- or physical activity-related concussions and current cigarette, alcohol, and marijuana use among high school students, and whether other factors moderate those associations. In addition to having played on a sports team, potential moderators examined included persistent feelings of sadness or hopelessness, hours of sleep, and serious difficulty concentrating, remembering, or making decisions. The association between sports- or physical activity-related concussions and current cigarette, alcohol, and marijuana use was significant when controlling for sex, grade, and race/ethnicity and the potential moderators with the exception of cigarette smoking while controlling for hours of sleep. Those involved in the care of high school students after a concussion may consider assessing current cigarette, alcohol, and marijuana use.

Prevalence of Concussion-Related Policies and Practices Among Public School Districts in the United States, 2012 and 2016.

BACKGROUND: Beginning in 2009, there was an increase in the number of states with laws addressing 3 different components of youth sports-related concussion prevention and management: concussion education, removal from play, and medical clearance requirements before allowing an athlete to return to play. Schools are an important setting to implement policies and practices related to concussions, as many youth participate in organized sports through school venues. OBJECTIVE: To examine whether the prevalence of concussion-related policies and practices adopted by school districts changed from 2012 to 2016. METHODS: This study used nationally representative data from the 2012 and 2016 School Health Policies and Practices Study to examine whether the prevalence of 4 concussion-related policies and practices changed during 2012 and 2016 and whether comprehensive policies changed during the same time frame. Comprehensive policies were defined as those that address removal from play after injury, medical clearance before returning to play, and concussion-related educational materials and sessions for parents and student athletes. RESULTS: Among school districts nationwide, the prevalence of each of the 4 concussion-related policies and practices significantly increased during 2012 and 2016. The prevalence of comprehensive policies significantly increased from 51.6% in 2012 to 66.7% in 2016. While these findings are promising, it is important to note that one-third of districts still lacked comprehensive policies in 2016 and only 71% of districts provided educational sessions in 2016. CONCLUSIONS: The findings in this study highlight improvements in school districts nationwide in adopting concussion-related policies and practices. Policies such as requiring educational sessions allow parents and student athletes to learn about concussions and understand the importance of reporting a concussion or concussion symptoms.

Sports- or Physical Activity-Related Concussions and Feelings of Sadness or Hopelessness Among U.S. High School Students: Results From the 2017 Youth Behavior Risk Survey.

For this study, we explored the association between high school students' reported history of sport- or physical activity-related concussions and persistent feelings of sadness or hopelessness. Data from the 2017 national Youth Risk Behavior Survey (YRBS; N = 14,765) was used for this analysis. YRBS is administered to high school students throughout the country every 2 years. Findings from this study demonstrate that the prevalence of persistent feelings of sadness or hopelessness was 36.4% among students who reported sustaining one or more concussions. Compared to students who did not report having sustained a concussion, the odds of persistent feelings of sadness or hopelessness were significantly higher among students who had sustained one or more concussions (AOR = 1.41). These findings support the need for continued efforts by school nurses and other health care providers to identify students with a history of concussion and assess their mental health needs.

Assessment of US Public School District Policies for Pandemic Preparedness and Implications for COVID-19 Response Activities.

OBJECTIVES: To describe school district preparedness for school closures and other relevant strategies before the coronavirus disease 2019 (COVID-19) pandemic. METHODS: A stratified random sample of 957 public school districts from the 50 US states and the District of Columbia were surveyed between October 2015 and August 2016. The response rates for the questionnaires were as follows: Healthy and Safe School Environment, Crisis Preparedness Module (60%; N = 572), Nutrition Services (63%; N = 599), and Health Services (64%; N = 613). Data were analyzed using descriptive and regression techniques. RESULTS: Most school districts had procedures that would facilitate the implementation of school closures (88.7%). Fewer districts had plans for ensuring continuity of education (43.0%) or feeding students during closure (33.8%). The prevalence of continuity of education plans was lower in the Midwest than the Northeast (adjusted prevalence ratio [aPR] = 0.68; 95% confidence interval [CI]: 0.51-0.90). Presence of plans for feeding students was higher in high-poverty than low-poverty districts (aPR = 1.41; 95% CI: 1.01-1.99) and in large districts than small districts (aPR = 2.06; 95% CI: 1.37-3.09). CONCLUSIONS: Understanding factors associated with having comprehensive emergency plans could help decision makers to target assistance during the current COVID-19 pandemic and for future planning purposes.

Does geographic location matter for transportation risk behaviors among U.S. public high school students?

Introduction: Teen motor vehicle crash fatality rates differ by geographic location. Studies assessing teen transportation risk behaviors by location are inconclusive. Therefore, we explored the role of census region and metropolitan status for driving prevalence and four transportation risk behaviors among U.S. public high school students. Methods: Data from 2015 and 2017 national Youth Risk Behavior Surveys were combined and analyzed. Multivariable models controlled for sex, age, race/ethnicity, grades in school, and school socioeconomic status. Results: Overall, 41% of students did not always wear a seat belt. Students attending schools in the Northeast were 40% more likely than those in the Midwest to not always wear a seat belt. Among the 75% of students aged ≥16 years who had driven during the past 30 days, 47% texted/e-mailed while driving. Students in the Northeast were 20% less likely than those in the Midwest to text/e-mail while driving, and students attending suburban or town schools were more likely to text/e-mail while driving (20% and 30%, respectively) than students attending urban schools. Nineteen percent of students rode with a driver who had been drinking alcohol, and 7% of drivers aged ≥16 years drove when they had been drinking alcohol, with no significant differences by location for either alcohol-related behavior. Conclusions: We found few differences in teen transportation risk behaviors by census region or metropolitan status. Age at licensure, time since licensure, driving experience, and the policy and physical driving environment might contribute more to variation in teen fatal crashes by location than differences in transportation risk behaviors. Regardless of location, teen transportation risk behaviors remain high. Future research could address developing effective strategies to reduce teen cell phone use while driving and enhancing community implementation of existing, effective strategies to improve seat belt use and reduce alcohol consumption and driving after drinking alcohol.

The Association Between Sports- or Physical Activity-Related Concussions and Suicidality Among US High School Students, 2017.

BACKGROUND: This study examined the association between sports- or physical activity-related concussions and having seriously considered attempting suicide, made a suicide plan, or attempted suicide (ie, suicidality), and tested potential moderators of the association. HYPOTHESIS: Risk factors such as persistent feelings of sadness or hopelessness, low academic grades, few hours of sleep, and current alcohol or marijuana use will increase the odds of suicidality among those who self-reported sports- or physical activity-related concussions, while protective factors such as physical activity and having played on a sports team will decrease the odds. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 4. METHODS: This study used data from the 2017 Youth Risk Behavior Survey, a biennial, school-based, nationally representative survey of US students in grade levels 9 to 12 (N = 14,765). Logistic regression models examined associations between self-reported sports- or physical activity-related concussions and suicidality among the students, and whether physical activity, having played on a sports team, persistent feelings of sadness or hopelessness, academic grades, hours of sleep, or current alcohol or marijuana use moderated those associations. RESULTS: Sports- or physical activity-related concussions were found to be associated with suicidality. The associations remained significant in models that adjusted for demographic characteristics, and they did not appear to be moderated by physical activity, having played on sports team, academic grades, or sleep. CONCLUSIONS: Given the findings of this study and others, health care providers are advised to ask students who have experienced a concussion about their emotional well-being as part of their symptom-based assessment, using validated, age- appropriate concussion symptom scales. Comprehensively assessing students who have experienced a sports- or physical activity-related concussion for persistent feelings of sadness or hopelessness may alert providers to thoughts of suicidal ideation and will allow for earlier intervention. CLINICAL RELEVANCE: If thoughts of suicide are discovered among adolescents with a concussion, or if other risk factors are observed, referrals to medical and mental health providers for a more comprehensive assessment may be warranted.

Dietary and Physical Activity Behaviors Among High School Students - Youth Risk Behavior Survey, United States, 2019.

Establishing healthy dietary and physical activity patterns among youths is an important public health strategy for improving health and preventing chronic diseases; however, few adolescents meet U.S. government recommendations for dietary or physical activity behaviors, and disparities by sex and race/ethnicity exist. CDC analyzed data from the 2019 Youth Risk Behavior Survey to update estimates of dietary and physical activity behaviors among U.S. high school students overall and by sex and race/ethnicity. In addition, 2-year comparisons (2017 and 2019) and trends in prevalence of these behaviors during 2009-2019 were examined. In 2019, overall, during the 7 days before the survey, 41.8% of students had eaten fruit or drunk 100% fruit juices <1 time/day; 40.7% had eaten vegetables <1 time/day; and 16.7% had not eaten breakfast on all 7 days. Moreover, although 57.4% of students had played on ≥1 sports team during the 12 months before the survey, less than half of students had been physically active for ≥60 minutes/day on all 7 days (23.2%), had exercised to strengthen or tone their muscles on ≥3 days/week (49.5%), had met both aerobic and muscle-strengthening physical activity guidelines (16.5%), or had attended physical education classes on all 5 days in an average school week (25.9%). Trend data indicate limited progress in shifting dietary and physical activity behaviors. That is, with the exception of decreases in the percentage of students who had consumed soda ≥1 time/day (2009: 29.2%; 2019: 15.1%), sports drinks ≥1 time/day (2015: 13.8%; 2019: 10.6%), and <3 glasses/day of plain water (2015: 50.5%; 2019: 44.6%), high school students' dietary and physical activity behaviors have not improved and, in certain cases, have worsened. These findings support the need for multicomponent approaches, including policy and environmental changes, and opportunities for adolescents to learn about and practice making healthy choices.

Overview and Methods for the Youth Risk Behavior Surveillance System - United States, 2019.

Health risk behaviors practiced during adolescence often persist into adulthood and contribute to the leading causes of morbidity and mortality in the United States. Youth health behavior data at the national, state, territorial, tribal, and local levels help monitor the effectiveness of public health interventions designed to promote adolescent health. The Youth Risk Behavior Surveillance System (YRBSS) is the largest public health surveillance system in the United States, monitoring a broad range of health-related behaviors among high school students. YRBSS includes a nationally representative Youth Risk Behavior Survey (YRBS) and separate state, local school district, territorial, and tribal school-based YRBSs. This overview report describes the surveillance system and the 2019 survey methodology, including sampling, data collection procedures, response rates, data processing, weighting, and analyses presented in this MMWR Supplement. A 2019 YRBS participation map, survey response rates, and student demographic characteristics are included. In 2019, a total of 78 YRBSs were administered to high school student populations across the United States (national and 44 states, 28 local school districts, three territories, and two tribal governments), the greatest number of participating sites with representative data since the surveillance system was established in 1991. The nine reports in this MMWR Supplement are based on national YRBS data collected during August 2018-June 2019. A full description of 2019 YRBS results and downloadable data are available (https://www.cdc.gov/healthyyouth/data/yrbs/index.htm).Efforts to improve YRBSS and related data are ongoing and include updating reliability testing for the national questionnaire, transitioning to electronic survey administration (e.g., pilot testing for a tablet platform), and exploring innovative analytic methods to stratify data by school-level socioeconomic status and geographic location. Stakeholders and public health practitioners can use YRBS data (comparable across national, state, tribal, territorial, and local jurisdictions) to estimate the prevalence of health-related behaviors among different student groups, identify student risk behaviors, monitor health behavior trends, guide public health interventions, and track progress toward national health objectives.