Alcohol and Other Substance Use Before and During the COVID-19 Pandemic Among High School Students - Youth Risk Behavior Survey, United States, 2021.

Adolescence is a critical phase of development and is frequently a period of initiating and engaging in risky behaviors, including alcohol and other substance use. The COVID-19 pandemic and associated stressors might have affected adolescent involvement in these behaviors. To examine substance use patterns and understand how substance use among high school students changed before and during the COVID-19 pandemic, CDC analyzed data from the nationally representative Youth Risk Behavior Survey. This report presents estimated prevalences among high school students of current (i.e., previous 30 days) alcohol use, marijuana use, binge drinking, and prescription opioid misuse and lifetime alcohol, marijuana, synthetic marijuana, inhalants, ecstasy, cocaine, methamphetamine, heroin, and injection drug use and prescription opioid misuse. Trends during 2009-2021 were assessed using logistic regression and joinpoint regression analyses. Changes in substance use from 2019 to 2021 were assessed using prevalence differences and prevalence ratios, stratified by demographic characteristics. Prevalence of substance use measures by sexual identity and current co-occurring substance use were estimated using 2021 data. Substance use prevalence declined during 2009-2021. From 2019 to 2021, the prevalence of current alcohol use, marijuana use, and binge drinking and lifetime use of alcohol, marijuana, and cocaine and prescription opioid misuse decreased; lifetime inhalant use increased. In 2021, substance use varied by sex, race and ethnicity, and sexual identity. Approximately one third of students (29%) reported current use of alcohol or marijuana or prescription opioid misuse; among those reporting current substance use, approximately 34% used two or more substances. Widespread implementation of tailored evidence-based policies, programs, and practices likely to reduce risk factors for adolescent substance use and promote protective factors might further decrease substance use among U.S. high school students and is urgently needed in the context of the changing marketplaces for alcohol beverage products and other drugs (e.g., release of high-alcohol beverage products and increased availability of counterfeit pills containing fentanyl).

Prescription Opioid Misuse and Use of Alcohol and Other Substances Among High School Students - Youth Risk Behavior Survey, United States, 2019.

Adolescence is an important period of risk for substance use initiation and substance use-related adverse outcomes. To examine youth substance use trends and patterns, CDC analyzed data from the 2009-2019 Youth Risk Behavior Survey. This report presents estimated prevalence of current (i.e., previous 30-days) marijuana use, prescription opioid misuse, alcohol use, and binge drinking and lifetime prevalence of marijuana, synthetic marijuana, cocaine, methamphetamine, heroin, injection drug use, and prescription opioid misuse among U.S. high school students. Logistic regression and Joinpoint analyses were used to assess 2009-2019 trends. Prevalence of current and lifetime substance use by demographics, frequency of use, and prevalence of co-occurrence of selected substances among students reporting current prescription opioid misuse are estimated using 2019 data. Multivariable logistic regression analysis was used to determine demographic and substance use correlates of current prescription opioid misuse. Current alcohol, lifetime cocaine, methamphetamine, heroin, and injection drug use decreased during 2009-2019. Lifetime use of synthetic marijuana (also called synthetic cannabinoids) decreased during 2015-2019. Lifetime marijuana use increased during 2009-2013 and then decreased during 2013-2019. In 2019, 29.2% reported current alcohol use, 21.7% current marijuana use, 13.7% current binge drinking, and 7.2% current prescription opioid misuse. Substance use varied by sex, race/ethnicity, grade, and sexual minority status (lesbian, gay, or bisexual). Use of other substances, particularly current use of alcohol (59.4%) and marijuana (43.5%), was common among students currently misusing prescription opioids. Findings highlight opportunities for expanding evidence-based prevention policies, programs, and practices that aim to reduce risk factors and strengthen protective factors related to youth substance use, in conjunction with ongoing initiatives for combating the opioid crisis.

Association Between Bullying Victimization and Health Risk Behaviors Among High School Students in the United States.

BACKGROUND: Childhood exposure to adverse experiences has been associated with adult asthma, smoking, sexually transmitted disease, obesity, substance use, depression, and sleep disturbances. Conceptualizing bullying as an adverse childhood experience, 2011 Youth Risk Behavior Survey (YRBS) data were used to examine the relationship between in-person and electronic bullying victimization among US high school students and health risk behaviors and conditions related to violence, substance use, sexual risk, overweight and physical activity, sleep, and asthma. METHODS: Data were from the 2011 national YRBS among students who answered questions about in-person and electronic bullying (N = 13,846). The YRBS is a biennial, nationally representative survey of students in grades 9-12 (overall response rate = 71%). Logistic regression analyses, stratified by sex and controlling for race/ethnicity and grade, examined the association between bullying victimization and health risk behaviors or conditions. RESULTS: Rates of victimization varied; 9.4% of students reported being bullied in-person and electronically, 10.8% only bullied in-person, 6.8% only electronically bullied, and 73.0% uninvolved. Bullying was associated with nearly all health risk behaviors and conditions studied. CONCLUSION: Assessing the broad functioning and behaviors of victims of bullying could enable educators and health practitioners to intervene early and promote the long-term health of youth.

Healthy People 2010 objectives for unintentional injury and violence among adolescents. Trends from the National Youth Risk Behavior Survey, 1999-2009.

BACKGROUND: In 2000, the USDHHS released Healthy People 2010 (HP2010), a series of disease prevention and health promotion objectives for the nation. Thirty-nine of these objectives were dedicated to injury prevention and six of these objectives related to adolescents, who were tracked through CDC's National Youth Risk Behavior Survey (YRBS). PURPOSE: This paper uses national YRBS data from 1999 to 2009 to analyze overall and subgroup trends and determine progress toward targets for the following HP2010 objectives: seatbelt use (HP2010 objective 15-19); motorcycle helmet use (15-21); riding with a driver who had been drinking alcohol (26-6); physical fighting (15-38); weapon carrying on school property (15-39); and suicide attempts requiring medical attention (18-2). METHODS: The CDC conducted the national YRBS biennially from 1999 to 2009 and used similar three-stage cluster-sample designs to obtain representative samples of high school students in the U.S. This study was conducted in 2010 and used linear and quadratic time variables simultaneously in logistic regression models while controlling for gender, race/ethnicity, and grade to test for secular trends over time. RESULTS: Only two objectives met their HP2010 targets: riding with a driver who had been drinking alcohol (26-6) and physical fighting (15-38). Progress was seen for four additional objectives and within some subgroups. CONCLUSIONS: Substantial policy and practice changes must occur if the recently released Healthy People 2020 targets are to be met. School-, community-, and state-level policies and programs may be effective tools to prevent injuries and victimizations.

Associations between Electronic Media Use and Involvement in Violence, Alcohol and Drug Use among United States High School Students.

OBJECTIVE: We identified associations between time spent watching television and time spent playing video or computer games or using computers and involvement in interpersonal violence, alcohol and drug use in a nationally representative sample of United States high school students. METHODS: We analyzed data from the 2007 national Youth Risk Behavior Survey. Exposure variables were time spent watching television and time spent playing computer or video games or using computers (hereafter denoted as "computer/video game use") on an average school day; outcome variables included multiple measures assessing involvement in violence and alcohol or drug use. Chi-square tests were used to identify statistically significant associations between each exposure variable and each of the outcome variables. We used logistic regression to obtain crude odds ratios for outcome variables with a significant chi-square p-value and to obtain adjusted odds ratios controlling for sex, race, and grade in school. RESULTS: Overall, 35.4% (95% CI=33.1%-37.7%) of students reported frequent television (TV) use and 24.9% (95% CI=22.9%-27.0%) reported frequent computer/video game use. A number of risk behaviors, including involvement in physical fights and initiation of alcohol use before age 13, were significantly associated with frequent TV use or frequent computer/video game use, even after controlling for sex, race/ethnicity and grade. CONCLUSION: Findings highlight the need for additional research to better understand the mechanisms by which electronic media exposure and health-risk behaviors are associated and for the development of strategies that seek to understand how the content and context (e.g., watching with peers, having computer in common area) of media use influence risk behaviors among youth.

Partnerships for preventing violence: a locally-led satellite training model.

Local face-to-face provider training has the benefit of enabling participants to network with people in their communities who are working on similar issues, to engage in interactive discussions, and to learn from local experts and local program examples. However, face-to-face training has considerable costs (labor and expense) and provides limited exposure to national experts. In recent years, technology has allowed training methods to expand to include distance learning methods (satellite and web-based). The newer methods can decrease per-person training costs, provide exposure to national experts, and result in wide dissemination of information. Yet these distance learning methods often limit the ability of participants to interact and network with each other and substantially reduce opportunities to apply the learning objectives to local circumstances. To maximize the benefits of both models, the Harvard School of Public Health, the Prevention Institute, and the Education Development Center developed, implemented, and evaluated Partnerships for Preventing Violence (PPV), an innovative six-part satellite training series on the public health approach to preventing youth violence. Using a unique hybrid methodology that combines satellite training with local, face-to-face facilitation by trained experts, PPV trained over 13,000 people, generated youth violence prevention activities across the country, and created a national cadre of youth violence prevention leaders.

Electronic media, violence, and adolescents: an emerging public health problem.

Adolescents' access to and use of new media technology (e.g., cell phone, personal data assistant, computer for Internet access) are on the rise, and this explosion of technology brings with it potential benefits and risks. Attention is growing about the risk of adolescents to become victims of aggression perpetrated by peers with new technology. In September 2006, the Centers for Disease Control and Prevention convened a panel of experts in technology and youth aggression to examine this specific risk. This special issue of the Journal of Adolescent Health presents the data and recommendations for future directions discussed at the meeting. The articles in the Journal support the argument that electronic aggression is an emerging public health problem in need of additional prevalence and etiological research to support the development and evaluation of effective prevention programs.

Homicide survivors: research and practice implications.

Approximately 16.4 million people in the United States have been affected by homicide. Five million adults have experienced the murder of an immediate family member; 6.6 million people have experienced the murder of a relative other than a family member, and 4.8 million have experienced the murder of a close friend. These homicide survivors experience a variety of difficulties, some similar to post-traumatic stress disorder (PTSD). The large incidence of homicide in the U.S. warrants an examination of the research on the impact of a murder on a victim's friends and family and the implications for healthcare providers. Homicide survivors experience negative psychological and physical effects that often result in an increase in the usage of primary care services. Provider training should include protocols to screen for, discuss, and make referrals for the family and friends of homicide victims. This article recommends the development of a training program to equip providers with the tools to recognize and serve this growing population of patients.