Initiation of nonmedical use of prescription opioids among high school students.

Background: Nonmedical use of prescription opioids (NUPO) is associated with heroin use and other adverse outcomes among adolescents. To inform the timing of substance use prevention activities and which substances to target, we examined age at NUPO initiation, associations between substance use initiation and current (past 30-day) NUPO, and order of NUPO initiation relative to other substances. Methods: Data from 2,834 students aged 15 or older participating in the 2017 Virginia Youth Survey, the first Youth Risk Behavior Surveillance System survey to assess age at NUPO initiation and current NUPO, were analyzed in 2019. Students reported current NUPO and ages at initiation for cigarettes, alcohol, marijuana, and NUPO (categorized as 12 or younger, 13 or 14, 15 or older, or never). Associations between age at substance use initiation and current NUPO were examined using adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs). Results: Overall, 12% of students reported lifetime NUPO, with 2.4%, 4.0%, and 5.6% initiating at 12 or younger, 13 or 14, and 15 or older, respectively; 5.3% reported current NUPO. Initiating cigarettes, alcohol, and marijuana at each age category (compared with never) was associated with an increased prevalence of current NUPO after adjusting for demographics and initiation of other substances. Among students initiating NUPO, initiating NUPO at 12 or younger (compared with 15 or older) was associated with an increased prevalence of current NUPO after adjusting for demographics (aPR = 1.54, 95% CI: 1.10-2.16), but not after further adjustment for initiation of other substances (aPR = 1.38, 95% CI = 0.97-1.97). Among students initiating NUPO, 45.4% initiated NUPO before or during the same age as other substances. Conclusions: More than 6% of students initiated NUPO at 14 or younger. Younger substance use initiation was associated with current NUPO, suggesting that some students may benefit from prevention activities during early adolescence that address multiple substances.

Sexual Minority Youth at Risk of Early and Persistent Alcohol, Tobacco, and Marijuana Use.

The current study sought to examine substance use disparities among sexual minority youth. The current subsample of 348,175 students participated in the Youth Risk Behavior Surveillance System (YRBSS) study from years 2005 to 2015 (biennially) in jurisdictions that asked at least one question about sexual minority status. Latent class analysis was used to identify implicit classes of sexual minority youth, based on respondents' sexual identity and sexual behavior. Sex-stratified regression models were run to determine the association between class membership and age of onset and persistent use of alcohol, tobacco, and marijuana. Findings showed that sexual minority female subgroups were primarily distinguished by sexual identity (e.g., "lesbian," "bisexual"), whereas sexual minority male subgroups were primarily distinguished by sexual behavior. Female lesbian and bisexual youth were at risk of initiating substance use at younger ages and, among lifetime users, were more likely to persist in their tobacco and marijuana use over time, relative to sexually active female heterosexual youth. Among lifetime users, male youth with partners of both sexes were at greater risk of persistent use of alcohol, tobacco, and marijuana over time and earlier ages of first use. Recommendations for intervention and prevention programs geared toward reducing sexual minority youth substance use are provided.

Unhealthy weight control behaviors and health risk behaviors in American youth: a repeated cross-sectional study.

BACKGROUND: Unhealthy weight control behaviors (UWCBs) involve weight control strategies to reduce or maintain weight, such as fasting, taking diet pills, and vomiting or taking laxatives. UWCBs in teenagers can escalate into severe health issues such as eating disorders. Understanding the trends of UWCBs and their association with risk behaviors in teenagers is crucial, as early intervention and prevention strategies are pivotal. METHODS: This study utilized eight waves of the youth risk behavior surveillance system (YRBSS) data from 1999 to 2013. Our primary outcome was UWCBs engagement. We used multinomial logistic models to analyze the association between UWCBs and risk behaviors among adolescents including driving after alcohol consumption, suicide attempts, smoking, alcohol use, and sexual intercourse. RESULTS: Among 109,023 participants, UWCBs prevalence was 16.64%. Body Mass Index (BMI) was significantly associated with UWCBs risk. In addition, we found the intention of weight management confounded the relationship between BMI and UWCBs. The unadjusted logistic regression indicated a monotone-increasing association between BMI and the risk of UWCBs. In contrast, the adjusted logistic regression indicated a U-shaped curve with the lowest (BMI < 17 kg/m2) and highest (BMI > 30 kg/m2) BMI groups having significantly higher odds of engaging in UWCBs compared to the reference BMI group (18.5 ≤ BMI ≤ 24.9 kg/m2). CONCLUSIONS: The intention of weight management confounded the relationship between Body Mass Index (BMI) and the risk of UWCBs. These findings suggest that healthcare interventions for weight management behaviors should be tailored to adolescents with BMI ≥ 25 and BMI < 18.5.

This study looked at unhealthy weight control behaviors (UWCBs) in American teenagers, such as fasting, taking diet pills, or vomiting to control weight. These behaviors can lead to serious health problems, including eating disorders. The research analyzed data from over 100,000 teenagers between 1999 and 2013 to understand the connection between UWCBs and other risky behaviors like drinking alcohol, smoking, and attempting suicide. While previous research suggested that teens with higher body weight were more likely to engage in UWCBs, our findings showed a shift in this relationship after considering the teens' intentions to manage weight. Specifically, teens with very low body weight (BMI < 17) and a strong desire to lose weight had an increased risk of UWCBs. This highlights the need for healthcare providers to focus on the mental health and weight management goals of these teens to prevent harmful behaviors. Additionally, reconsidering the removal of UWCB-related questions from national surveys like YRBSS is important to continue monitoring these behaviors.

Lifestyle Behaviors and Suicide-Related Behaviors in Adolescents: Cross-Sectional Study Using the 2019 YRBS Data.

Objective: The purpose of this research was to investigate the prevalence of lifestyle behaviors and suicide-related behaviors and the association between them using a nationally representative sample of adolescents from the USA. Methods: 13,677 high school students aged 14-18 years were included in this cross-sectional study. The research data were retrieved from the Youth Risk Behavior Surveillance System Survey in 2019. All data on age, sex, grade, race, physical activity, television time, fruit intake, and suicide-related behavior were self-reported by students. Logistic regression models were adopted to examine the association between lifestyle behaviors and the suicide-related behaviors. Results: Students who played video/computer games for ≥2 h had higher risk of suicide attempt (OR = 1.55, 95%CI: 1.30-1.85). Daily sleep duration of ≤8 h was positively associated with considering a suicide attempt (OR = 1.99, 95%CI: 1.62-2.43). In addition, participants who did not engage in any sport team were more likely to report considering a suicide attempt (OR = 1.50, 95%CI: 1.24-1.81). Conclusion: This research suggests that some lifestyle behaviors (e.g., time for video or computer use, sleep duration, sports team participation, regular breakfast intake, and substance use) are associated with increased risk of suicidal behavior and ideation in high school students. To identify the specific effect of multiple lifestyle factors in influencing the risk of suicide-related behaviors in high school students, longitudinal studies are warranted in future.

Indoor tanning and poor mental health among adolescents in New York City (2015).

This study explored relationships between mental health and indoor tanning among high school students in New York City using 2015 data from the Youth Risk Behavior Surveillance System. Those more likely to use indoor tanning were females (odds ratio = 6.26, 95% confidence interval = 6.08-6.45) and non-Hispanic White (odds ratio = 1.10, 95% confidence interval = 1.06-1.14). Being bullied on school property (odds ratio = 1.30, 95% confidence interval = 1.25-1.34), having attempted suicide (odds ratio = 2.08, 95% confidence interval = 1.99-2.18), and having sought counseling (odds ratio = 1.22, 95% confidence interval = 1.18-1.26) were significantly associated with indoor tanning. This study indicates that engaging in indoor tanning is associated with a number of mental health factors.

Digital media use and suicidal behavior in U.S. adolescents, 2009-2017.

U.S. adolescent suicidal behavior and digital media use prevalence have contemporaneously increased this decade in population-level ecological analyses. The purpose of this study was to determine whether these two trends are directly associated by using multi-year person-level data to test whether the association of year with suicidal behavior was mediated by digital media use. Data were from the Youth Risk Behavior Surveillance System (2009-2017), a nationally-representative biennial cross-sectional self-report survey of U.S. students (N = 72,942). Mediation analysis was used to estimate the proportion of cross-year changes in suicidal behavior that were mediated by concurrent changes in leisure-time digital media use. Past-year suicidal behavior in 2011 (19.6%), 2013 (20.4%), 2015 (21.7%), and 2017 (20.5%) increased relative to 2009 (17.1%). Hours of daily digital media use in 2011 (mean[SD] = 2.65[1.86]), 2013 (mean[SD] = 3.02[2.08]), 2015 (mean[SD] = 2.97[2.12]), and 2017 (mean[SD] = 3.01[2.18) increased vs. 2009 (mean[SD] = 2.31[1.81]). The association of survey year with suicidal behavior was mediated by digital media use-20.5%(95%CI = 16.2, 24.8), 34.3%(95%CI = 24.5, 44.1), 22.8%(95%CI = 17.3, 28.0), and 41.4%(95%CI = 33.9, 49.5) of cross-year suicidal behavior prevalence increases (vs. 2009) for 2011, 2013, 2015, and 2017, respectively, were mediated by concurrent digital media use increases. Therefore, small proportions of the 2009-2017 increases in U.S. adolescent suicidal behavior are associated with concurrent increasing digital media use trends. Further exploration of these trends is warranted.

The Implementation of Mental Health Policies and Practices in Schools: An Examination of School and State Factors.

BACKGROUND: Poor mental health outcomes persist among adolescent youth. Secondary schools play a critical role in fostering positive mental health by implementing policies and practices grounded in evidence. The factors associated with implementation, however, are unclear. This study examines which school- and state-level factors are associated with improved implementation of mental health policies and practices at secondary schools across the United States. METHODS: US Centers for Disease Control and Prevention data stemming from 3 datasets (School Health Policies and Practices, School Health Profiles, and Youth Risk Behavior Surveillance System) surveys were integrated and analyzed. RESULTS: Health educator certification, school use of data during school improvement planning, presence of a health/safety coordinator, presence of a health council and state-provided health educator professional development in mental health and suicide prevention were each significantly positively associated with schools' implementation of mental health policies and practices. CONCLUSIONS: To promote improved implementation of mental health policies and practices in schools and provide better support for youth mental health outcomes, the use of certified health educators and health-related supports should be considered. State health and education agencies should undertake evaluations of its mental health practices to ensure the assistance they offer to schools is evidence based.

Adherence to sleep guidelines reduces risk of overweight/obesity in addition to 8-5-2-1-0 guidelines among a large sample of adolescents in the United States.

OBJECTIVES: To examine whether adherence to US sleep, dietary, screen time, and physical activity (8-5-2-1-0) guidelines is associated with reduced risk of overweight/obesity in adolescents. DESIGN: Multivariable log-binomial regressions were estimated using the 2017 Youth Risk Behavior Surveillance System data. RESULTS: Of the 8194 adolescents aged 13 years and older, only 0.6% (49) met all guidelines. Meeting the recommended 8 hours of sleep per day was associated with reduced risk of overweight/obesity (risk ratio [RR]: 0.90; confidence interval [CI]: 0.81-0.99). Having ≤2 hours of screen time per day was associated with reduced risks of overweight/obesity (RR: 0.85; CI: 0.77-0.95). One hour of daily physical activity was associated with reduced risk of overweight/obesity (RR: 0.80; CI: 0.73-0.87). No significant associations were found between daily consumption of ≥5 fruits and vegetables or consumption of zero sugar-sweetened beverages and overweight/obesity. The 8-5-2-1-0 constitutes an improved prediction model to explain the risk of overweight/obesity among adolescents compared with the 5-2-1-0 model (F1,36 = 4.80; P = .035). CONCLUSIONS: Findings from this study suggest that meeting recommendations for sleep, screen time, and physical activity is associated with decreased risk of overweight/obesity in a large sample of adolescents. These are important factors to consider in the prevention and treatment of overweight/obesity in adolescents.

Pediatric herniated lumbar disc: a population-based risk factor analysis.

OBJECTIVE: Surgical treatment of herniated lumbar disc (HLD) remains rare in children. The purpose of this study was to evaluate for potential disease risk factors leading to surgery based on a large single-center experience. METHODS: Data for all patients who had undergone surgical treatment for HLD between December 2008 and December 2016 at a single pediatric tertiary care referral center were collected and compared to data for a healthy control population obtained through a Youth Risk Behavior Surveillance System (YRBSS) survey in order to determine relevant disease risk factors. Univariate and multivariate logistic regression were used to determine the effect of potential risk factors. RESULTS: Twenty-seven patients in the disease cohort and 5212 healthy controls from the general population were included in the risk factor analysis. The mean body mass index was significantly higher in the disease population (30.2 vs 24.0 kg/m2, p < 0.0001). Children who had undergone microdiscectomy were more likely to be obese (OR 7.4, 95% CI 3.46-15.8, p < 0.001). No association was found between lumbar microdiscectomy and sports participation (OR 1.0, 95% CI -0.002 to 0.005, p = 0.37). CONCLUSIONS: Microdiscectomy remains a viable and safe option in the setting of failed conservative management for pediatric HLD. Childhood obesity is a risk factor for HLD and many other diseases, which increases its importance as a public health priority.

Reciprocal associations between screen time and emotional disorder symptoms during adolescence.

Screen-based sedentary behaviors and emotional disorders are associated with one another in youth. Yet, the direction of the association is unclear, as is whether specific types of screen-based sedentary behaviors and emotional disorder symptoms are more closely linked. This study estimated the bi-directional associations between two types of screen-based sedentary behaviors and four types of self-reported emotional disorder symptoms, and tested whether physical activity buffered these associations in a Los Angeles high school student cohort (N = 2525, baseline Mage = 14.6 years). Participants completed baseline (9th Grade, 2013) and 12-month follow-up (10th grade, 2014) surveys reporting on: television viewing and computer/videogame use (≥4 h/day; yes/no), physical activity (≥60 min/day for ≥5 days/week), and Major Depressive Disorder (MDD), Generalized Anxiety Disorder (GAD), Panic Disorder (PD), and Social Phobia (SP) symptoms (meet/exceed [sub]clinical symptom threshold; yes/no). After adjusting for baseline screen-based sedentary behavior and covariates, students with (sub)clinical baseline MDD and GAD were at increased odds of high computer/videogame use one year later (OR = 1.36[95%CI, 1.07-1.73]; OR = 1.36[95%CI,1.09-1.71], respectively). Baseline SP was marginally related to increased computer/videogame use at follow-up (OR = 1.33[95%CI,1.04-1.69]). Greater baseline computer/videogame use was associated with increased odds of (sub)clinical GAD (OR = 1.54[95%CI,1.23-1.94]) and (sub)clinical SP (OR = 1.64[95%CI 1.27-2.12]) at follow-up; these associations were suppressed among baseline physically active students. Television viewing was unrelated to emotional disorder symptoms and PD was not associated with screen-based sedentary behaviors. Thus, only reciprocal associations between computer/videogame use, SP, and GAD during a one-year period of adolescence were observed. Interventions reducing computer/videogame use and increasing physical activity may improve adolescent emotional health.

The relationships between sexual risk behaviors and general health risk behaviors among unmarried youth in Thailand.

OBJECTIVES: The prevalence and correlates of sexual risk behaviors among unmarried youth in Thailand are poorly documented. The objectives of this study were to compare the differences in sexual behaviors across age groups and gender and to identify the relationships between sexual risk behaviors and general health risk behaviors among unmarried Thai youth. METHODS: A population-based, nationally representative, cross-sectional survey was conducted between January and March 2013. The Thai version of the Youth Risk Behavior Survey questionnaire was used to collect data from 800 unmarried Thai youth. RESULTS: Majority of the respondents (65.9%) had not engaged in any sexual risk behavior, 18.7% had engaged in 2-3 sexual risk behaviors, and only 5.5% had engaged in a single sexual risk behavior. Current sexually active youth had higher risk of participating in physical fights (odds ratio = 3.41, 95% confidence interval = 1.53-7.57), smoking cigarette (odds ratio = 4.05, 95% confidence interval = 1.89-8.67), and drinking alcohol (odds ratio = 2.17, 95% confidence interval = 1.08-4.36). CONCLUSION: Thai youth were more likely to be involved in multiple sexual risk behaviors than a single sexual risk behavior. Physical fighting was the strongest general health risk behavior associated with the sexual risk behaviors, followed by substance abuse.

Association of Youth Characteristics and Recent Utilization of Dental Services in the United States.

Background: Oral health is important for overall health of youth, although dental service utilization is lower than national goals. The purpose of the study was to identify sociodemographic and health behavioral characteristics of youth in the United States who reported having at least one dental visit in the past 12 months. Methods: Secondary data analysis was conducted using the 2015 Youth Risk Behavior Survey (YRBS) to examine factors associated with dental care utilization using Andersen's theory-based Behavioral Model of Health Care Utilization. Results: Among 5,814 youth, nearly 78 percent reported visiting a dentist in the past 12 months. After adjusting for potential confounders, characteristics significantly associated with higher likelihood of dental care utilization were: predisposing factors of non-Hispanic white ethnicity and health behavior characteristics of not using tobacco, not using illegal substances, not drinking soda, and wearing a seat belt; enabling factor of speaking English well; and perceived health of not being overweight. Discussion: Use of the Healthcare Utilization Model identified significant factors classified as predisposing, enabling, and need-related factors associated with youth's utilization of dental care services. Findings from the theory-based population-based study informs healthcare providers of factors to consider when promoting dental care among youth.

Health risk behavior among Thai youth: national survey 2013.

This study aims to establish the prevalence of risky health behaviors among Thai youth and to characterize the prevalence of these behaviors by gender, age group, educational status, and region. We analyzed data from a population-based, nationally representative, cross-sectional survey of 938 youth aged between 13 and 24 years, sampled from Bangkok and 4 regions of Thailand. The 2011 Youth Risk Behavior Surveillance System questionnaire was used to measure youth risk behaviors. This study finds that 15.9% of respondents had engaged in physical fights, and 8.1% had been cyber bullied. The prevalence of current cigarette smoking, alcohol, and marijuana use were 22.3%, 27.9%, and 2.3%, respectively. The prevalence of risky behaviors among Thai youth were found to be high, including behaviors that contribute to unintentional injuries and violence, unsafe sexual behaviors, and cigarette and alcohol consumption.

Trends in Physical Dating Violence Victimization Among U.S. High School Students, 1999-2011.

Dating violence is a serious form of violence that places students at risk for injury, death, and negative mental health sequelae. The current analysis presents data on the prevalence of dating violence over a 12-year period among a nationally representative sample of high school-attending youth in the United States, stratified by race and gender. Data from the national Youth Risk Behavior Surveillance System (YRBSS) 1999-2011 revealed that physical dating violence victimization rates are similar for males and females; the 12-year prevalence rate of physical dating violence victimization was 9.4% for males and 9.2% for females. Black and Multiracial students were at increased risk for dating violence victimization in comparison to their White, Asian, and Hispanic counterparts. There were no changes in the reported rate of dating violence victimization over the 12-year period.

Substance use and sexual risk behaviors among american Indian and alaska native high school students.

BACKGROUND: We describe the prevalence of behaviors that put American Indian and Alaska Native (AI/AN) high school students at risk for teen pregnancy and sexually transmitted infections (STIs) and the relationships among race/ethnicity and these behaviors. METHODS: We analyzed merged 2007 and 2009 data from the national Youth Risk Behavior Survey, a biennial, self-administered, school-based survey of US students in grades 9-12 (N = 27,912). Prevalence estimates and logistic regression, controlling for sex and grade, were used to examine the associations between race/ethnicity, and substance use, and sexual risk behaviors. RESULTS: Of the 26 variables studied, the adjusted odds ratios (AOR) were higher among AI/AN than White students for 18 variables (ranging from 1.4 to 2.3), higher among AI/AN than Black students for 13 variables (ranging from 1.4 to 4.2), and higher among AI/AN than Hispanic students for 5 variables (ranging from 1.4 to 1.5). Odds were lower among AI/AN than Black students for many of the sexual risk-related behaviors. CONCLUSIONS: The data suggest it is necessary to develop targeted, adolescent-specific interventions aimed at reducing behaviors that put AI/AN high school students at risk for teen pregnancy, STI/HIV, and other health conditions.

Gender differences in risk behaviors among high school youth.

The US Centers for Disease Control and Prevention's (CDC) Youth Risk Behavior Surveillance System (YRBSS) demonstrates that American youth engage in a wide variety of risky behaviors.(1) The frequency and type of these behaviors often differ by a number of factors, such as socioeconomic status, race, and ethnicity. For example, results of the 2011 YRBSS revealed that white high school students were most likely to have texted or e-mailed while driving or been bullied on school property, while black high school students were most likely to have engaged in risky sexual behaviors, to have been physically inactive, and to be obese.(1) Conversely, Hispanic high school students were most likely to have ridden with a driver who had been drinking alcohol; to have ever used cocaine, inhalants, or ecstasy; and to have failed to use protection to prevent pregnancy during last sexual intercourse.(1) However, it is difficult to discern whether differences in risk-taking behaviors between and among ethnic groups can actually be attributed to differences in group norms, socioeconomic status, or cultural beliefs regarding acceptance or rejection of such behaviors,(1) suggesting a need for more comprehensive regional investigations.

Association of smokeless tobacco use and smoking in adolescents in the United States: an analysis of data from the Youth Risk Behavior Surveillance System survey, 2011.

BACKGROUND: Using smokeless tobacco and smoking are behaviors that increase the risk of developing oral cancer, soft-tissue lesions, caries, periodontal disease and other oral conditions. The author conducted a study to examine use of smokeless tobacco and smoking by adolescents. METHODS: The study was a cross-sectional analysis of participants with complete data regarding smoking, smokeless tobacco use and other variables of interest from the 2011 national Youth Risk Behavior Surveillance System survey (n = 9,655). The author performed descriptive analysis and multivariable logistic regression analyses. RESULTS: The unadjusted odds ratio for smokeless tobacco use and smoking was 9.68 (95 percent confidence interval [CI], 7.72-12.13; P < .0001), and the adjusted odds ratio was 3.92 (95 percent CI, 2.89-5.31; P < .0001). Adolescents who used smokeless tobacco were more likely to be male, to smoke and to have engaged in binge drinking. CONCLUSION: Adolescents who were using smokeless tobacco were more likely to be engaging in concomitant smoking and to be participating in other risk-taking behaviors. Practical Implications. Dentists are involved in helping patients with tobacco-use cessation. The association of smoking with using smokeless tobacco needs to be considered in the design of tobacco-use cessation programs for adolescents.