Timing of alcohol and other drug use and sexual risk behaviors among unmarried adolescents and young adults.

CONTEXT: Although alcohol and drug use by young people has been associated with sexual risk behavior in some research, detailed data are lacking on the timing of substance use in relationship to sexual risk-taking. METHODOLOGY: Cross-sectional data on 7,441 unmarried young people aged 14-22 from the 1992 Youth Risk Behavior Survey (household supplement) were used in the analysis. Alcohol and other drug use at last sexual intercourse, substance use in the past 30 days (recent use), the number of different substances ever used (lifetime use) and age at initiation of alcohol use are examined here. The outcome variables assessed through multivariate regression analyses were condom use at last intercourse and more than one sexual partner in the past three months. RESULTS: Failure to use a condom was strongly associated with the lifetime substance-use scale or, alternatively, with age at initiation of alcohol. Once the number of substances ever used was controlled for, neither substance use at last sexual intercourse nor recent use was associated with the likelihood of using a condom at last coitus. Among young men and women, recent substance use and use of either alcohol or drugs at last intercourse were both strongly associated with having had more than one sexual partner in the past three months. For females only, lifetime use also increased the probability of recent multiple partners. CONCLUSIONS: The relationships between alcohol and other drug use and two sexual behaviors--condom use and multiple partners-suggest distinct mechanisms of influence and the need for different prevention strategies.

Binge drinking among undergraduate college students in the United States: implications for other substance use.

The authors examined the relationship between binge drinking and other substance use among US college students, using nationally representative data from the 1995 National College Health Risk Behavior Survey implemented by the Centers for Disease Control and Prevention. Compared with nonbinge drinkers, current binge drinkers were significantly more likely to report "ever" using and current use of cigarettes, marijuana, cocaine, and other illegal drugs. The researchers also found that the more often students binge drank, the more likely they were to have ever used cigarettes, marijuana, cocaine, and other drugs, and the more likely they were to report current use of cigarettes and marijuana. Those who design programs to prevent binge drinking and use of other substances should take into account the reality that many students use more than one substance and that the more frequently students report binge drinking, the more likely they are to be using other substances as well.

US college students' reports of receiving health information on college campuses.

Institutions of higher education are in a unique position to promote healthy behaviors by providing health education to students, but little information exists about the proportion of students reached by such efforts. The authors used data from a nationally representative sample of college students to describe the extent to which students reported receiving health information from their colleges and universities, to examine the characteristics of students who received such information, and to determine specific sources of health information. Approximately three quarters of college students reported they received information on at least one health topic, and 6% received information on all of the topics examined. Those who reported receiving health information from their colleges or universities were likely to be "traditional" college students. To achieve relevant national health objectives, health educators must increase the proportion of students they reach and the number of health topics they cover.

Substance use on school property among students attending alternative high schools in the United States.

We analyzed nationally representative data from the 1998 National Alternative High School Youth Risk Behavior Survey, conducted by the Centers for Disease Control and Prevention, to determine the prevalence of substance use on school property among alternative high school students in the United States, to describe the characteristics of students who use substances on school property, and to examine the interrelationships of substance-use behaviors. During the 30 days preceding the survey, nearly 48 percent of students used at least one substance on school property and 17 percent used more than one substance on school property. Males were more likely than females and white students were more likely than black or Hispanic students to have used substances on school property. The results of this and other studies suggest that school administrators, public health practitioners, and policy makers should work to improve strategies for reducing substance use in this heterogeneous, hard-to-reach population.

The association of sexual behaviors with socioeconomic status, family structure, and race/ethnicity among US adolescents.

OBJECTIVES: This study assessed the relation of socioeconomic status (SES), family structure, and race/ethnicity to adolescent sexual behaviors that are key determinants of pregnancy and sexually transmitted diseases (STDs). METHODS: The 1992 Youth Risk Behavior Survey/Supplement to the National Health Interview Survey provided family data from household adults and behavioral data from adolescents. RESULTS: Among male and female adolescents, greater parental education, living in a 2-parent family, and White race were independently associated with never having had sexual intercourse. Parental education did not show a linear association with other behaviors. Household income was not linearly related to any sexual behavior. Adjustment for SES and family structure had a limited effect on the association between race/ethnicity and sexual behaviors. CONCLUSIONS: Differences in adolescent sexual behavior by race and SES were not large enough to fully explain differences in rates of pregnancy and STD infection. This suggests that other factors, including access to health services and community prevalence of STDs, may be important mediating variables between SES and STD transmission and pregnancy among adolescents.

Contextual influences on school provision of health services.

PURPOSE: To examine contextual factors that may facilitate or impede the provision of school health services. METHODS: Using a composite database derived primarily from the National Longitudinal Study of Adolescent Health, we used logistic regression to examine how selected characteristics of communities, schools, and state-level policies are related to the provision of specific health services by high schools. RESULTS: Schools whose students experienced more health risks were generally more likely to provide related services than schools whose students experienced fewer risks. State policies and requirements for health-related programs and services were associated with greater school-based provision of services. Availability of health care services within the community was associated with a reduced likelihood that schools provided similar services on-site; however, for some health services, the reverse was true. In general, more affluent communities were more likely to provide school health services than less affluent communities. Public schools were more likely to offer health services than private schools. CONCLUSIONS: Certain characteristics of communities, schools, and state-level policies are associated with the provision of school health services. These contextual factors appear to operate by creating a demand for services and by creating the opportunity for schools to provide health services.

Suicide ideation among US college students. Associations with other injury risk behaviors.

Suicide, the endpoint of a continuum that begins with suicide ideation, is the third leading cause of death among the US college-aged population. The first and second leading causes of death among this age group, unintentional injury and homicide, may also be linked to suicide ideation. We used data from the National College Health Risk Behavior Survey to examine the association between suicide ideation and injury-related behaviors among 18- to 24-year-old college students. Students who reported suicide ideation were significantly more likely than students who did not report considering suicide to carry a weapon, engage in a physical fight, boat or swim after drinking alcohol, ride with a driver who had been drinking alcohol, drive after drinking alcohol, and rarely or never used seat belts. Given this clustering of injury-related risk behaviors, college prevention programs should aim to reduce risks for injuries comprehensively, rather than addressing each risk behavior separately.

Trends in suicide ideation and suicidal behavior among high school students in the United States, 1991-1997.

To examine trends in suicide ideation and behavior over time, the authors analyze data from nationally representative samples of between 10,904 and 16,296 students participating in the 1991, 1993, 1995, and 1997 Youth Risk Behavior Surveys. These data describe the proportion of United States students in grades 9 through 12 that reported having (1) seriously considered attempting suicide, (2) made a plan to attempt suicide, (3) attempted suicide, and (4) made an injurious suicide attempt. From 1991 to 1997, the percentage of students seriously considering suicide and the percentage that made a suicide plan showed significant linear decreases. However, the percentage of students that made an injurious suicide attempt showed a significant linear increase. These trends make it unlikely that relevant national health objectives for the year 2000 will be met. Additional efforts are needed to identify and disseminate strategies that effectively reduce suicidal thoughts and behaviors among adolescents.

Suicidal ideation among college students in the United States.

This study analyzed data from the 1995 National College Health Risk Behavior Survey (NCHRBS) to assess the prevalence of suicidal ideation among college students in the United States and to examine the association between suicidal ideation and substance use in this population. The NCHRBS used a mail questionnaire to assess health-risk behaviors in a nationally representative sample of undergraduate students. During the 12 months preceding the survey, 10% of the students had seriously considered attempting suicide. When controlling for demographic characteristics, the analysis showed that students who had considered suicide were at increased odds of using tobacco, alcohol, and illegal drugs. These results suggest that colleges and universities should establish suicide prevention programs that also address the related problem of substance use.

Recent trends in violence-related behaviors among high school students in the United States.

CONTEXT: Violence-related behaviors such as fighting and weapon carrying are associated with serious physical and psychosocial consequences for adolescents. OBJECTIVE: To measure trends in nonfatal violent behaviors among adolescents in the United States between 1991 and 1997. DESIGN, SETTING, AND PARTICIPANTS: Nationally representative data from the 1991, 1993, 1995, and 1997 Youth Risk Behavior Surveys were analyzed to describe the percentage of students in grades 9 through 12 who engaged in behaviors related to violence. Overall response rates for each of these years were 68%, 70%, 60%, and 69%, respectively. To assess the statistical significance of time trends for these variables, logistic regression analyses were conducted that controlled for sex, grade, and race or ethnicity and simultaneously assessed linear and higher-order effects. MAIN OUTCOME MEASURES: Self-reported weapon carrying, physical fighting, fighting-related injuries, feeling unsafe, and damaged or stolen property. RESULTS: Between 1991 and 1997, the percentage of students in a physical fight decreased 14%, from 42.5% (95% confidence interval [CI], 40.1%-44.9%) to 36.6% (95% CI, 34.6%-38.6%); the percentage of students injured in a physical fight decreased 20%, from 4.4% (95% CI, 3.6%-5.2%) to 3.5% (95% CI, 2.9%-4.1%); and the percentage of students who carried a weapon decreased 30%, from 26.1% (95% CI, 23.8%-28.4%) to 18.3% (95% CI, 16.5%-20.1%). Between 1993 and 1997, the percentage of students who carried a gun decreased 25%, from 7.9% (95% CI, 6.6%-9.2%) to 5.9% (95% CI, 5.1%-6.7%); the percentage of students in a physical fight on school property decreased 9%, from 16.2% (95% CI, 15.0%-17.4%) to 14.8% (95% CI, 13.5%-16.1 %); and the percentage of students who carried a weapon on school property decreased 28%, from 11.8% (95% CI, 10.4%-13.2%) to 8.5% (95% CI, 7.0%-10.0%). All of these changes represent significant linear decreases. CONCLUSIONS: Declines in fighting and weapon carrying among US adolescents between 1991 and 1997 are encouraging and consistent with declines in homicide, nonfatal victimization, and school crime rates. Further research should explore why behaviors related to interpersonal violence are decreasing and what types of interventions are most effective.

Forced sexual intercourse and associated health-risk behaviors among female college students in the United States.

This study analyzed data from the 1995 National College Health Risk Behavior Survey (NCHRBS) to assess the prevalence of lifetime rape among female college students and to examine the association between rape and health-risk behaviors. The NCHRBS used a mail questionnaire to assess health-risk behaviors among a nationally representative sample of undergraduate students. Twenty percent of female students reported ever having been forced to have sexual intercourse, most often during adolescence. When analyses controlled for demographic characteristics, female students who had ever been raped were significantly more likely than those who had not to report a wide range of health-risk behaviors. These results highlight a need to improve rape prevention and treatment programs for female adolescents.

The impact of condom availability [correction of distribution] in Seattle schools on sexual behavior and condom use.

OBJECTIVES: Ten Seattle high schools made condoms available through vending machines, baskets in school clinics, or both. This study measured the number of condoms that students obtained and subsequent changes in sexual behavior and condom use. METHODS: Schoolwide surveys were administered in spring 1993 and in spring 1995, before and during the condom availability program. These data were compared with data from nationally representative surveys administered at the same time. RESULTS: Seattle students obtained an average of 4.6 condoms per year, the vast majority from baskets and very few from vending machines. Relative to the national samples, the percentage of Seattle students who had ever had sex remained stable after the program began; current sexual activity decreased significantly; and the percentage of sexually experienced students who used a condom the last time they had sex decreased significantly, particularly in the 5 schools with baskets of condoms in clinics. CONCLUSIONS: Making condoms available in Seattle schools enabled students to obtain relatively large numbers of condoms but did not lead to increases in either sexual activity or condom use.