Oral health of Dutch primary school children in relation to social and health aspects.

OBJECTIVE: This research investigated the oral health status of Dutch primary school children aged 10-12 years in Utrecht and its association with demographic characteristics, lifestyle factors, general psychosocial health, and dental treatment, to guide targeted interventions to improve children's oral and overall well-being. MATERIALS AND METHODS: A cross-sectional survey was conducted at 49 primary schools in Utrecht in 2017 and 42 schools in 2019. The questionnaire covered background characteristics (7 questions), psychosocial health (14 questions), nutrition and exercise (20 questions), school and leisure time (26 questions), home situation (23 questions), and oral health (4 questions). Associations were analyzed using multivariate logistic regression. RESULTS: Data from 5,426 children were analyzed. Prior to the survey, 11% did not visit a dentist, 23% had a toothache, 22% had a cavity filled, and 8% had a tooth extracted. Independent predictors for increased odds of oral health problems were migration background, poor general health, drinking more than two glasses of soft drinks per day, having ever drunk alcohol, having fear of failure, experiencing problems at home and/or coming from average or low socioeconomic position group. Factors associated with increased odds of dental treatment, such as cavity filled and tooth extracted, were migration background, fear of failure and home problems. CONCLUSIONS: These findings emphasize the need for targeted prevention to improve the oral health of children with a migration background, average or low socioeconomic position and/or with poorer general and psychosocial health, unhealthy diets and problems in the home situation, within a community-based and transdisciplinary approach.

Parental Relationship and School Performance of Children.

Parental relationship with children is the most natural, unique and enduring bond in the world gifted by God. As child's first education begins at home, so the quality of parental relationship with children may have an impact on child's life as well as school performance. The objective of this study was to find out the association between parental relationship and school performance of children. This was a cross sectional study where class six to ten children aged between 11-17 years was participants. Seven secondary schools were selected in Rajshahi city of Bangladesh for data collection. The self-administered questionnaire was used to find out the quality of parental relationship by using the Inventory of Parent and Peer Attachment (IPPA) scale. To asses school performance face to face interview was conducted to the corresponding class teachers as well as exam result and attendance were also taken from official records. The study period was one year from January 2019 to December 2019. Out of total 385 children, 53.5% were girls and 46.5% were boys. The mean age of the children was 13.63±1.289 years. Good quality of relationship with mother was 96.1% and poor-quality relationship was 3.9%. As well as good quality of relationship with father was 93.5% and poor-quality relationship was 6.5%. This study founded boys seemed to establish better relationships with mother compared to girls. Findings also revealed a positive significant association between children's relationship with their mothers and school performance. There was no significant relationship present between all socio-demographic characteristics and parental relationship except gender and occupation of father. This study found statistically significant relationship between parental relationship and school performance of children. Therefore, awareness among parents about parental relationship should be considered as a part of betterment of school performance.

Refractive error and amblyopia among primary school children in remote islands of East Coast of Peninsular Malaysia.

INTRODUCTION: Little is known about the prevalence of refractive errors and amblyopia among school children on the islands of East Coast Malaysia. This study aimed to investigate the prevalence of these conditions and their associated factors in this unique and remote geographical location. MATERIALS AND METHODS: This multicentre cross-sectional school-based study included 480 children aged 7 to 12 year from primary schools on the islands of the East Coast of Malaysia. All children underwent visual acuity assessment, orthoptic evaluation, anterior and posterior segment examinations and manifest refraction. Demographic data, history of parental refractive error, parental education level, duration of digital screen time and time spent outdoors were documented in a questionnaire distributed to the parents. RESULTS: The mean age was 9.53 ± 1.69 years, with an equal distribution of genders. The ethnic composition of the subjects was 99.4% Malay and 0.6% Orang Asli. The overall prevalence of refractive errors was 11.9% (95% CI: 9.1 to 15.1%), with myopia at 7.1% (95% CI: 5.0 to 9.8%), hyperopia at 2.5% (95% CI: 1.3 to 4.3%), astigmatism at 2.3% (95% CI: 1.1 to 4.1%) and amblyopia at 2.5% (95% CI: 1.3 to 4.3%). Older age, an absence of parental history of refractive error and reduced daily outdoor time were significantly associated with refractive errors (p < 0.05). CONCLUSION: The prevalence of refractive error is 11.9% and amblyopia is 2.5% among primary school children on the islands of the East Coast of Peninsular Malaysia. Older age, an absence of parental history of refractive error and reduced daily outdoor time are associated with refractive error.

A Statewide Program to Test and Reduce Lead in Drinking Water at Schools and Child Cares.

A lead testing act was passed in Colorado mandating that all licensed child care facilities and public schools serving fifth grade and lower test all drinking water locations for lead by May 31, 2023. Colorado's Water Quality Control Division created the Test & Fix Water for Kids program to implement this act. Aspects of the program included establishing a database, outreach and education, technical assistance, lead analyses at the Colorado State Laboratory, remediation, and reimbursement. Of a total of 6000 licensed child care providers and public elementary schools, 4500 entities enrolled and tested 53 000 water samples for lead at drinking water fixtures. Testing results showed that 93% (46 000 total) of the fixtures tested were below the 5 parts per billion (ppb) action level. As a result, 7% (3700) of the fixtures tested were above the action level. Of the fixtures that tested above 5 ppb, 47% were classroom faucets. Many of these faucets had not been used since COVID-19 when several schools switched to using bottle fillers. The program identified all fixtures associated with low usage as well as older fixtures to be replaced with lead-free options to reduce lead levels below 5 ppb. Almost 600 000 children have been protected from potential exposure to lead in drinking water through this program. This article outlines the methods of launching a statewide lead testing program and the importance of testing fixtures for lead in drinking water in early childhood education buildings.

Low-Level, Early Life Lead Exposure and School Behavior.

OBJECTIVES: To measure how early childhood exposure to lead affects school behavior from third to eighth grade, measured by the number and days of total school suspensions and out-of-school suspensions (OSS). METHODS: We estimate Poisson models using a cohort of 284 701 students with school records from 2006-2008 in North Carolina. We adjust for demographic and socioeconomic variables and school-grade-year cohort effects, and use coarsened exact matching to ensure similar characteristics across children with blood lead levels (BLLs) 2-10 µg/dL and children in the reference group with BLLs ≤1 µg/dL. RESULTS: BLLs ≥3 µg/dL are positively and significantly associated with all school suspension measures for sixth through eighth graders. The estimated effects on OSS for sixth through eighth graders are larger than the effects on total suspensions. For example, students with BLL = 3 µg/dL receive OSS 16% (95% confidence interval 3.6%-30%) more often and for 22% (95% confidence interval 7.3%-33%) more days than students with BLL ≤1 µg/dL. For third through fifth grade students, we only find a significant effect of lead exposure on suspensions at relatively high BLLs of 8-10 µg/dL. CONCLUSIONS: Our analysis demonstrates that BLL has significant adverse effects on third through eighth grade students' behavior, including at levels below the current Centers for Disease Control and Prevention's blood lead reference value of 3.5 µg/dL. We find that the adverse effects of lead are most strongly associated with more severe disruptive behavior in sixth through eighth graders, as measured by OSS. Our results underscore the long-term benefits of preventing early childhood exposure to lead.

Healthy dietary patterns linked to Brazilian adolescents' school meal adherence.

OBJECTIVE: This study aimed to verify the association between adherence to school meals provided by the National School Feeding Program and dietary patterns in adolescents from Brazilian public schools. METHODS: Data from the 2019 National School Health Survey were used, with a nationally representative sample of Brazilian school adolescents (n=53,477; 13-17 years old). Food consumption of healthy and unhealthy food markers was obtained from a food consumption questionnaire. Regular consumption was considered ≥5 times/week. Latent class analysis was used to identify dietary patterns whose association with adherence to school meals was evaluated by multinomial logistic regression models, with adjustment for sociodemographic and eating behavior variables. RESULTS: Three dietary patterns were identified: "unhealthy" - higher consumption of soft drinks and sweets (9.2% of adolescents); "healthy" - higher consumption of beans, vegetables, and fruits (27.1%); and "monotonous" - higher consumption of beans (63.7%). High adherence to school meals (every day) and unsatisfactory adherence (1-4 times/week) were positively associated with the healthy pattern even after adjustment for possible potential confounders (OR 1.37, 95%CI 1.23-1.52; OR 1.20, 95%CI 1.10-1.30, respectively). CONCLUSION: The results showed that the consumption of school meals offered by the National School Feeding Program can contribute to healthy eating habits among Brazilian adolescents.

An outbreak associated with Escherichia albertii in a junior high school, China.

Escherichia albertii is an emerging foodborne enteropathogen associated with infectious diarrhoea in humans. In February 2023, an outbreak of acute gastroenteric cases was reported in a junior high school located in Hangzhou, Zhejiang province, China. Twenty-two investigated patients presented diarrhoea (22/22, 100%), abdominal pain (21/22, 95.5%), nausea (6/22, 27.3%), and vomiting (3/22, 13.6%). E. albertii strains were successfully isolated from anal swabs collected from six patients. Each isolate was classified as sequence type ST2686, harboured eae-ß gene, and carried both cdtB-I and cdtB-II subtypes, being serotyped as EAOg32:EAHg4 serotype. A comprehensive whole-genome phylogenetic analysis revealed that the six isolates formed a distinct cluster, separate from other strains. These isolates exhibited minimal genetic variation, differing from one another by 0 to 1 single nucleotide polymorphism, suggesting a common origin from a single clone. To the best of our knowledge, this represented the first reported outbreak of gastroenteritis attributed to E. albertii outside of Japan on a global scale.

Overuse injuries among school-going children in Manipur, northeast India: A descriptive cross-sectional study.

Background & objectives Overuse injury is an important public health issue among children and adolescents, which may affect their overall performance. Therefore, the objective is to determine the prevalence and compare overuse injuries among school-going children in hill and valley, rural and urban areas of Manipur and identify factors contributing to overuse injuries. Methods After obtaining approval from school authorities, a cross-sectional study was conducted in three districts of Manipur namely, Imphal West, Bishnupur, and Ukhrul, among 3,600 schoolchildren in the age group of 7-15 yr. An interview schedule using a pretested questionnaire and a proforma was used for data collection. Descriptive statistics were used, such as mean, SD, percentages, etc. Results In this study, 3,600 students participated; the mean age was 13.37 yr. The overall prevalence of overuse injury was 14.39 per cent, which was the highest in Imphal West (50.19%) and among males (53.09%). The commonest overuse injuries were of lower extremities (44.98%) and were observed to be the highest in Bishnupur (49.59%) and among males (45.45%). Back pain was more prevalent in Ukhrul (37.78%) and among females (31.69%). Among lower extremity injuries, the majority had chondromalacia patellae (29.18%) and shin splint (24.03%), and among the upper extremity injuries, 81.25 per cent had neck and arm pain. Interpretation & conclusions The overall prevalence of overuse injuries was 14.39 per cent, and the highest was in Imphal West. We observed a paradigm shift as the students' back, neck and arm pain increased. These are important public health concerns that need immediate attention, as well as the development of innovative interventions, including health education and appropriate regulations.

School Meal Charge Policies Lack Consistency.

This report discusses school meal charge policies nationwide, with an in-depth look at the contents of these policies in North Carolina. The US Department of Agriculture requires school districts to have policies related to unpaid school meal charges; however, there are no specific requirements for what must be included in these policies. School meal charge policies vary across North Carolina and the US. Many policies are vague, and some include provisions that may be harmful to children and families. The implications of these findings, including the suggested direction of future research and potential policy solutions, are discussed.

Positive behavior support in school - a quasi-experimental mixed methods study and a randomized controlled trial.

BACKGROUND: While positive school climate is important for students' well-being and mental health, school personnel may experience challenges in creating a nurturing school climate. School-Wide Positive Behavioral Interventions and Supports (SW-PBIS) has shown positive effects on school climate and children's prosocial behaviors, but fewer studies have been conducted in a European context. AIM: This project aims to investigate the effectiveness of SW-PBIS program for students' social-emotional skills and academic achievement as well as teachers' and students' perceptions of classroom learning environment. Furthermore, the study intends to evaluate how school-level factors mediate or moderate the effects of the intervention. In addition, the study includes a qualitative evaluation of the dynamic interaction processes that occur during program implementation in local school contexts. METHODS: Data on school- and individual-level measures are collected in intervention and control schools. With regard to challenges in retaining control groups over extended time periods, two waves of recruitment are used. In the first wave, an active control group is used and data are collected during three time points. In the second wave, a wait-list control group will be used and data will be collected during two time points during one school year. Hierarchical regression analyses will be conducted to explore the effects of SW-PBIS on the outcomes of the study. An ethno-methodological approach will be applied to provide a detailed examination of the social interactional and meaning-making practices of different school implementation teams, and the negotiation of normative expectations and rules of conduct in peer-teacher-student interactions in different classrooms. DISCUSSION: The study is expected to contribute to knowledge on the effects of the SW-PBIS program and how these effects may be mediated or moderated by school-level factors. Combining quantitative and qualitative methods to explore the significance of school contexts in the implementation of the SW-PBIS program constitutes the strength of the study. The challenge in the study is the extended period of implementation of SW-PBIS, which entails difficulties in retaining a control group over the required time period. Therefore, two waves of recruitment are used, encompassing different procedures of allocation to intervention or control group. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT06270914 on the 22nd of February, 2024 (retrospectively registered).

The effectiveness of secondary-school based interventions on the future physical activity of adolescents in Aotearoa New Zealand: a modelling study.

BACKGROUND: Secondary schools are important settings for promoting varied physical activity (PA) opportunities for adolescents to promote PA throughout life. However, research on the effect of secondary school-based interventions on future PA is limited. This study examined the potential impact of secondary school-based interventions on the determinants of future PA participation of Aotearoa New Zealand (NZ) adolescents using simulated modelling. METHODS: We used data from a nationally representative sample of secondary school students (n = 5035) aged 12-17 between 2017 and 2020 in NZ. We modelled four secondary school-based interventions and their projected impact on five determinants of future PA. Modelled interventions were the technological augmentation of physical education (TAPE), a peer-led PA mentoring programme (PL), physically active learning (PAL) and the inclusion of a natural environment play area (NE). RESULTS: Total weekly PA increased the most from the NE intervention (+ 0.2 h/week), followed by TAPE (+ 0.08 h/week), PAL (+ 0.05 h/week) and PL (-0.06 h/week). Current number of PA settings increased the most in NE (+ 1.75 settings/week), followed by TAPE (+ 1.29 settings/week), PAL (+ 1.21 settings/week) and PL (+ 0.73 settings/week). Current number of PA types increased the most in NE (+ 1.57 types/week), followed by PL (+ 1.05 types/week), TAPE (+ 0.34 types/week) and PAL (+ 0.15 types/week). Physical literacy scores increased the most from PL (+ 3.6%), followed by PAL (+ 3.3%), TAPE (+ 0.43%) and NE (+ 0.12%). Social support scores increased the most from PAL (+ 5%), followed by PL (+ 1.9%), TAPE (+ 1.46%) and NE (+ 0.57%). CONCLUSIONS: On average, all interventions benefitted determinants of future PA participation to a small degree. Results show differing magnitudes of the intervention effect by determinant, indicating the complexities surrounding the promotion of PA adherence. Future interventions could be improved through detailed consultation alongside, and involving, adolescents and stakeholders within schools. Researchers should also prioritise the collection of longitudinal PA data and explore its connection with sociodemographic differences between adolescents.

The effects of school-based hygiene intervention programme: Systematic review and meta-analysis.

Children are susceptible to infections due to frequent participation in school group activities and their often-suboptimal hygiene practices. Frequent infections in children affect school attendance, academic performances, and general health. The effectiveness of school-based hygiene-related intervention programmes need to be informed by updated high-quality synthesised evidence. In this systematic review, we searched PubMed and Cochrane CENTRAL for randomised and non-randomised interventional studies that evaluated school-based hygiene-related interventions. We assessed risk-of-bias (Cochrane risk-of-bias 2 tool), performed random-effect meta-analysis (RevMan 5.4) and rated certainty-of-evidence (GRADE). Thirty-nine trials (41 reports), published from 2011 to 2024 from 22 countries were included. Twenty-three studies contributed data for meta-analysis. All school-based interventions were compared with standard curriculum and demonstrated very low to low certainty-of-evidence due to study methodological limitations and imprecision. Hand-body hygiene interventions may improve knowledge, attitudes and practices (SMD 2.30, 95%CI 1.17 to 3.44, 6 studies, 7301 participants), increase handwashing practices (RR 1.75, 95%CI 1.41 to 2.17, 5 studies, 5479 participants), and reduce infection-related absenteeism (RR 0.74, 95%CI 0.66 to 0.83, 5 studies, 1017852 observations). Genital hygiene interventions may improve attitude (SMD 6.53, 95%CI 2.40 to 10.66, 2 studies, 2644 participants) and practices (RR 2.44, 95%CI 1.28 to 4.68, 1 study, 1201 participants). However, intervention effects on oral hygiene appeared mixed, with worsening of the oral hygiene score (SMD 3.12, 95%CI 1.87 to 4.37, 2 studies, 652 participants) but improved dental hygiene (SMD -0.33, 95%CI -0.53 to -0.13, 3 studies, 4824 participants) and dental caries scores (SMD -0.34, 95%CI -0.52 to -0.16, 4 studies, 2352 participants). Limited evidence suggests that interventions targeting hand-body and genital hygiene practices may improve knowledge, practices, and infection-related absenteeism. However, the effects on oral hygiene intervention appeared mixed. Future research should strengthen randomisation and intervention documentation, and evaluate hygiene-related behaviour, academic performances and health outcomes.

Experiences of Racism in School and Associations with Mental Health, Suicide Risk, and Substance Use Among High School Students - Youth Risk Behavior Survey, United States, 2023.

Racism is a fundamental determinant of health inequities among racial and ethnic groups and is understudied among adolescents. In 2023, the national Youth Risk Behavior Survey questionnaire included an item assessing experiences of racism in the school setting among students in grades 9-12 in the United States. This report estimates the prevalence of students who reported ever having experienced racism in school and compares prevalence by racial and ethnic groups. For each racial and ethnic group, prevalence differences and prevalence ratios were estimated comparing the prevalence of indicators of poor mental health, suicide risk, and substance use among students who reported that they have ever versus never experienced racism in school. In 2023, approximately one in three high school students (31.5%) said that they had ever experienced racism in school. Reported experiences of racism were most prevalent among Asian (56.9%), multiracial (48.8%), and Black or African American (Black) (45.9%) students and least prevalent among White students (17.3%). Black and Hispanic or Latino (Hispanic) students who reported experiencing racism had a higher prevalence of all health risk behaviors and experiences investigated, including indicators of poor mental health, suicide risk, and substance use compared with students of their racial and ethnic group who reported never experiencing racism. Many of these associations were also found among multiracial and White students. Student reports of racism were associated with indicators of mental health and suicide risk among American Indian or Alaska Native (AI/AN) and Asian students. Among students of color, including AI/AN, Asian, Black, Hispanic, and multiracial students, the prevalence of seriously considering and attempting suicide was more than two times higher among students who ever compared with never experienced racism. These findings demonstrate that racism in the school setting is experienced by high school students attending public and private schools and continues to disproportionately affect students of color. Students who reported experiencing racism had a higher prevalence of indicators of poor mental health, suicide risk, and substance use. Schools can incorporate policies and practices to prevent unfair treatment on the basis of race and ethnicity and offer resources to help students cope with these experiences.

Frequent Social Media Use and Experiences with Bullying Victimization, Persistent Feelings of Sadness or Hopelessness, and Suicide Risk Among High School Students - Youth Risk Behavior Survey, United States, 2023.

Social media has become a pervasive presence in everyday life, including among youths. In 2023, for the first time, CDC's nationally representative Youth Risk Behavior Survey included an item assessing U.S. high school students' frequency of social media use. Data from this survey were used to estimate the prevalence of frequent social media use (i.e., used social media at least several times a day) among high school students and associations between frequent social media use and experiences with bullying victimization, persistent feelings of sadness or hopelessness, and suicide risk. All prevalence estimates and measures of association used Taylor series linearization. Prevalence ratios were calculated using logistic regression with predicted marginals. Overall, 77.0% of students reported frequent social media use, with observed differences by sex, sexual identity, and racial and ethnic identity. Frequent social media use was associated with a higher prevalence of bullying victimization at school and electronically, persistent feelings of sadness or hopelessness, and some suicide risk among students (considering attempting suicide and having made a suicide plan), both overall and in stratified models. This analysis characterizes the potential harms of frequent social media use for adolescent health among a nationally representative sample of U.S. high school students. Findings might support multisectoral efforts to create safer digital environments for youths, including decision-making about social media policies, practices, and protections.

Adult Caretaker Engagement and School Connectedness and Association with Substance Use, Indicators of Emotional Well-Being and Suicide Risk, and Experiences with Violence Among American Indian or Alaska Native High School Students - Youth Risk Behavior Survey, United States, 2023.

The strength of American Indian and Alaska Native (AI/AN) communities comes from generations of Indigenous traditions, language, culture, and knowledge. These strengths have been challenged by a complex set of systemic, structural, and social factors related to historical and intergenerational trauma that affects the health of AI/AN communities. Furthermore, AI/AN population health data often are inaccurate because of analytic coding practices that do not account for multiracial and ethnic AI/AN identification and inadequate because of statistical suppression. The 2023 national Youth Risk Behavior Survey included a supplemental sample of AI/AN high school students. Coding of race and ethnicity was inclusive of all AI/AN students, even if they also identified as another race or as Hispanic or Latino, providing comprehensive data on health behaviors and experiences among AI/AN high school students nationwide. Adult caretaker engagement and school connectedness and their association with 13 health behaviors and experiences were examined, including five types of current substance use, four indicators of emotional well-being and suicide risk, and four types of violence. Pairwise t-tests and adjusted prevalence ratios from logistic regression models identified significant associations between exposure and outcome variables. Among AI/AN students, having an adult who always tried to meet their basic needs, high parental monitoring, and high school connectedness were associated with lower prevalence of certain measures of substance use, poor emotional well-being and suicide risk, and violence. Compared with non-AI/AN students, the prevalence of current electronic vapor product use, current marijuana use, attempted suicide, and experience of sexual violence was higher among AI/AN students.This report presents the most comprehensive, up-to-date data on substance use, indicators of emotional well-being and suicide risk, and experiences with violence among AI/AN high school students nationwide. The findings suggest the importance of engaged household adults and school connectedness in promoting emotional well-being and preventing substance use, suicide-related behavior, and experiences of violence among AI/AN students. Understanding the historical context and incorporating Indigenous knowledge when developing interventions focused on AI/AN youths are critical to ensure such interventions are successful in improving AI/AN health and well-being.

Disparities in School Connectedness, Unstable Housing, Experiences of Violence, Mental Health, and Suicidal Thoughts and Behaviors Among Transgender and Cisgender High School Students - Youth Risk Behavior Survey, United States, 2023.

Transgender high school students (those whose gender identity differs from their sex assigned at birth) experience disparate health outcomes and challenges in school, including violence and discrimination, compared with cisgender students (those whose gender identity aligns with their sex assigned at birth). Until recently, population-based data describing the experiences of transgender students and students questioning whether they are transgender (questioning) have been limited. In 2023, the national Youth Risk Behavior Survey assessed transgender identity, providing the first nationally representative data about transgender students. This report describes the demographic characteristics of transgender and questioning high school students and examines differences in the prevalence of experiences of violence, poor mental health, suicidal thoughts and behaviors, school connectedness, and unstable housing among transgender, questioning, and cisgender high school students nationwide. In 2023, 3.3% of U.S. high school students identified as transgender, and 2.2% identified as questioning. Transgender and questioning students experienced a higher prevalence of violence, poor mental health, suicidal thoughts and behaviors, and unstable housing, and a lower prevalence of school connectedness than their cisgender peers. Compared with 8.5% of cisgender male students, 25.3% of transgender students and 26.4% of questioning students skipped school because they felt unsafe. An estimated 40% of transgender and questioning students were bullied at school, and 69% of questioning students and 72% of transgender students experienced persistent feelings of sadness or hopelessness, a marker for experiencing depressive symptoms. Approximately 26% of transgender and questioning students attempted suicide in the past year compared with 5% of cisgender male and 11% of cisgender female students. Intervention opportunities for schools to create safer and more supportive environments for transgender and questioning students can help address these disparities. The findings of this report suggest that more effort is necessary to ensure that the health and well-being of youths who are socially marginalized is prioritized.

Adverse Childhood Experiences and Health Conditions and Risk Behaviors Among High School Students - Youth Risk Behavior Survey, United States, 2023.

Adverse childhood experiences (ACEs) are preventable, potentially traumatic events occurring before age 18 years. Data on ACEs among adolescents in the United States have primarily been collected through parent report and have not included important violence-related ACEs, including physical, sexual, and emotional abuse. This report presents the first national prevalence of self-reported ACEs among U.S. high school students aged <18 years, estimates associations between ACEs and 16 health conditions and risk behaviors, and calculates population-attributable fractions of ACEs with these conditions and behaviors using cross-sectional, nationally representative 2023 Youth Risk Behavior Survey data. Exposures were lifetime prevalence of individual (emotional, physical, and sexual abuse; physical neglect; witnessed intimate partner violence; household substance use; household poor mental health; and incarcerated or detained parent or guardian) ACEs and cumulative ACEs count (zero, one, two or three, or four or more). Health conditions and risk behaviors included violence risk factors, substance use, sexual behaviors, weight and weight perceptions, mental health, and suicidal thoughts and behaviors. Bivariate analyses assessed associations between individual and cumulative ACEs and demographics. Adjusted prevalence ratios assessed associations between cumulative ACEs and health conditions and risk behaviors, accounting for demographics. Population-attributable fractions were calculated to determine the potential reduction in health conditions and risk behaviors associated with preventing ACEs. ACEs were common, with approximately three in four students (76.1%) experiencing one or more ACEs and approximately one in five students (18.5%) experiencing four or more ACEs. The most common ACEs were emotional abuse (61.5%), physical abuse (31.8%), and household poor mental health (28.4%). Students who identified as female; American Indian or Alaska Native; multiracial; or gay or lesbian, bisexual, questioning, or who describe their sexual identity in some other way experienced the highest number of ACEs. Population-attributable fractions associated with experiencing ACEs were highest for suicide attempts (89.4%), seriously considering attempting suicide (85.4%), and prescription opioid misuse (84.3%). ACEs are prevalent among students and contribute substantially to numerous health conditions and risk behaviors in adolescence. Policymakers and public health professionals can use these findings to understand the potential public health impact of ACEs prevention to reduce adolescent suicidal behaviors, substance use, sexual risk behaviors, and other negative health conditions and risk behaviors and to understand current effects of ACEs among U.S. high school students.

Asking for Verbal Sexual Consent and Experiences of Sexual Violence and Sexual Behaviors Among High School Students - Youth Risk Behavior Survey, United States, 2023.

Adolescents' sexual consent behaviors are critical for developing healthy sexual relationships and preventing experiences of sexual violence. This report uses 2023 Youth Risk Behavior Survey data to describe prevalence of asking for sexual consent verbally at last sexual contact among U.S. high school students. Differences in prevalence of asking for sexual consent verbally by sex, age, race and ethnicity, sexual identity, sex of sexual contacts, and gender identity were examined. Differences in asking for sexual consent verbally also were examined by experiences of sexual violence and sexual behaviors. Sex-stratified logistic regression analyses were performed to determine the association between asking for sexual consent verbally with experiences of sexual violence and sexual behaviors. In addition, data were analyzed using adjusted logistic regression models controlling for age, race and ethnicity, and sexual identity. Among high school students who reported ever having sexual contact, 79.8% reported asking for sexual consent verbally at last sexual contact. A lower percentage of female students (74.5%) reported asking for sexual consent verbally than male students (84.6%). In adjusted sex-stratified analyses, female students who asked for sexual consent verbally had higher prevalence of ever having had sexual intercourse. Male students who asked for sexual consent verbally had higher prevalence of ever having had sexual intercourse and being currently sexually active. Female and male students who asked for sexual consent verbally had higher prevalence of having first sexual intercourse before age 13 and using condoms. In addition, female students who asked for sexual consent verbally during last sexual intercourse had lower prevalence of using alcohol or drugs at last sexual intercourse. Public health researchers and practitioners, health care providers, schools, and youth-serving organizations can use these findings to better understand high school students' verbal sexual consent, improve complex measurement of consent-seeking behaviors, and guide multicomponent sexual health and violence prevention efforts across various settings.

Mental Health and Suicide Risk Among High School Students and Protective Factors - Youth Risk Behavior Survey, United States, 2023.

Adolescent mental health and suicide risk remain substantial public health concerns. High pre-COVID rates of poor mental health and suicide-related behaviors have continued to rise, highlighting the need to identify factors that might foster positive mental health outcomes and reduce suicide-related behaviors at population levels. Using CDC's 2023 Youth Risk Behavior Survey, CDC analyzed the prevalence of mental health and suicide risk indicators and their associations with individual-, family-, and school- or community-level protective factors. Prevalence estimates were calculated for each of the mental health and suicide risk indicators by demographic characteristic. Prevalence ratios adjusted for sex, sexual identity, grade, and race and ethnicity were calculated to examine the association between protective factors and mental health and suicide risk indicators. Overall, 39.7% of students experienced persistent feelings of sadness and hopelessness, 28.5% experienced poor mental health, 20.4% seriously considered attempting suicide, and 9.5% had attempted suicide. Mental health and suicide risk indicators differed by sex, sexual identity, grade, and race and ethnicity. All protective factors were associated with lower prevalence of one or more risk indicators. Findings from this report can serve as a foundation for the advancement of research on protective factors and for the development and implementation of programs, practices, and policies that protect and promote mental health and emotional well-being among youth.

Report of Unfair Discipline at School and Associations with Health Risk Behaviors and Experiences - Youth Risk Behavior Survey, United States, 2023.

Relatively little is known about the association between school discipline and student health and well-being. Using CDC's 2023 Youth Risk Behavior Survey, CDC analyzed the prevalence of report of unfair discipline at school and associations with experiences at school, mental health, suicidal thoughts and behaviors, and health risk behaviors among high school students overall and stratified by race and ethnicity. Prevalence estimates, prevalence differences, and prevalence ratios adjusted for race (in overall models), grade, and sex were calculated. Overall, 19.3% of students reported receiving unfair discipline during the previous 12 months; Black or African American students had a higher prevalence (23.1%) compared with Hispanic or Latino students (18.4%) and White students (18.1%). Unfair discipline was reported among a majority of students who describe their sexual identity in some other way (besides gay, heterosexual, lesbian, bisexual, or questioning) for American Indian or Alaska Native (81.7%) and multiracial (57.1%) subgroups. Overall, report of unfair discipline was associated with every health risk behavior and experience examined, including being bullied at school or electronically, skipping school due to feeling unsafe, carrying a weapon at school, prescription opioid misuse, poor mental health, persistent feelings of sadness or hopelessness, seriously considered attempting suicide, and attempted suicide. This pattern of association was similar among most student groups in models stratified by race and ethnicity. This analysis is the first to demonstrate, among a nationally representative sample of high school students, that reports of unfair discipline are associated with various health risk behaviors and experiences. With these findings, public health and education practitioners can create interventions that equitably promote safe, supportive, and inclusive school environments for student health.