Risky Youth Behaviors, Such As E-Cigarette Use by High School Students, Concerning

Cigarette smoking among high school students dropped to the lowest levels since the National Youth Risk Behavior Survey (YRBS) began in 1991, but the use of electronic vapor products, including e-cigarettes, among students poses new challenges according to the 2015 survey results released on June 10, 2016, by the CDC.


Although current cigarette use decreased significantly from 28 percent in 1991 to 11 percent in 2015, new data from the 2015 survey found that 24 percent of high school students reported using e-cigarettes during the past 30 days.


“Current cigarette smoking is at an all-time low, which is great news. However, it’s troubling to see that students are engaging in new risk behaviors, such as using e-cigarettes,” said CDC Director Tom Frieden, M.D., M.P.H. “We must continue to invest in programs that help reduce all forms of tobacco use, including e-cigarettes, among youth.”


In May 2016, the FDA finalized an important rule extending its authority to all tobacco products, including e-cigarettes. The rule includes, for the first time, a restriction on the sale of these products to minors nationwide.


The Youth Risk Behavior Survey (YRBS) of students in grades nine to twelve provides important data related to student behaviors, such as behaviors that contribute to unintentional injuries and violence. The leading causes of mortality, morbidity, and social problems among youth and adults in the United States are related to six categories of priority health behaviors: (1) behaviors that contribute to unintentional injuries and violence; (2) tobacco use; (3) alcohol and other drug use; (4) sexual behaviors that related to unintended pregnancy and sexually transmitted infections (STIs), including HIV infection; (5) unhealthy dietary behaviors; and (6) physical inactivity. These behaviors frequently are interrelated and are established during childhood and adolescence and extend into adulthood. The survey also monitors obesity and asthma.


The 2015 survey findings indicate that youth continue to be at risk by using wireless devices while driving. Among high school students who had driven a car or other vehicle during the past 30 days, the percentage of high school students who texted or e-mailed while driving ranged from 26 percent to 63 percent across 35 states and from 14 percent to 39 percent across 18 large urban school districts. Nationwide, 42 percent of students who had driven a car or other vehicle during the past 30 days reported texting or e-mailing while driving. This percentage did not change from 2013.


The 2015 survey findings showed encouraging reductions in physical fighting among adolescents. The percentage of high school students nationwide who had been in a physical fight at least once during the past 12 months decreased from 42 percent in 1991 to 23 percent in 2015.


However, nationwide, the percentage of students who had not gone to school because of safety concerns is still high. Six percent of students missed at least one day of school during the past 30 days because they felt they would be unsafe at school or on their way to or from school. The percentage of students not going to school because of safety concerns decreased from 2013 (seven percent) to 2015 (six percent).


The survey also included questions on prescription drug use. Prescription drug use among youth decreased from 20 percent in 2009 to 17 percent in 2015. Nationwide, 17 percent of students had taken prescription drugs (e.g., Oxycontin, Percocet, Vicodin, codeine, Adderall, Ritalin, or Xanax) without a doctor’s prescription one or more times during their life.


The 2015 YRBS report also included data on youth sexual risk behaviors. The percentage of high school students who are currently sexually active (had sexual intercourse during the past three months) has been decreasing since 1991, dropping from 38 percent in 1991 to 30 percent in 2015. Current sexual activity also decreased from 34 percent in 2013 to 30 percent in 2015.


Among high school students who are currently sexually active, condom use decreased from 63 percent in 2003 to 57 percent in 2015, following more than a decade of increases that peaked in the early 2000s. Condom use did not change from 2013 (59 percent) to 2015 (57 percent). Nationwide, 10 percent of all students had ever been tested for HIV. This is a decrease from 13 percent in 2011 and 2013.


Trends in dietary and sedentary-related behaviors, such as drinking sugar-sweetened beverages and screen time, have varied in recent years. There was a significant decrease in drinking soda one or more times a day from 27 percent in 2013 to 20 percent in 2015. From 2003-2015, the percentage of high school students playing video or computer games or using a computer three or more hours per day (for non-school related work) nearly doubled from 22 percent to 42 percent.


“Health risk behaviors among youth vary over time and across the nation, making the YRBS an important tool to better understand youth. The YRBS helps us identify newly emerging behaviors and monitor long-standing youth risk behaviors over time,” said Laura Kann, Ph.D., chief of the CDC’s School-Based Surveillance Branch. “While overall trends for the 2015 report are positive, the results highlight the continued need for improvements in reducing risks among teens.”


The CDC’s YRBSS is the only surveillance system designed to monitor a wide range of priority health risk behaviors among representative samples of high school students at the national, state, and large urban school district levels. Surveys are conducted every two years among high school students throughout the United States.


More than 15,000 U.S. high school students participated in the 2015 National YRBS. Parental permission was obtained for students to participate in the survey, student participation was voluntary, and responses were anonymous. States and large urban school districts could modify the questionnaire to meet their needs. The 2015 YRBSS report includes National YRBS results and results from surveys conducted in 37 states and 19 large urban school districts.


The prevalence of most health behaviors varies by sex. For example, the prevalence of two injury-related behaviors (rarely or never wearing a seatbelt and driving when drinking alcohol) was higher among male than female students. The prevalence of seven violence-related behaviors (carrying a weapon, carrying a gun, carrying a weapon on school property, being threatened or injured with a weapon on school property, being in a physical fight, being injured in a physical fight, and being in a physical fight on school property) was also higher among male than female students. However, the prevalence of having not gone to school because of safety concerns, being electronically bullied, being bullied on school property, being forced to have sexual intercourse, physical dating violence, and sexual dating violence was higher among female than male students.


The prevalence of all five suicide-related behaviors (feeling sad or hopeless, seriously considering attempting suicide, having made a suicide plan, attempting suicide, and making a suicide attempt resulting in an injury, poisoning, or overdose that had to be treated by a doctor or nurse) also was higher among female than male students. Rarely or never wearing a bicycle helmet, riding with a driver who had been drinking alcohol, and texting or e-mailing while driving did not vary by sex.


The prevalence of nine tobacco use risk behaviors (smoking a whole cigarette before age 13 years; current cigarette use; usually obtaining their own cigarettes by buying them in a store or gas station; current smokeless tobacco use; current cigar use; current electronic vapor product use; current cigarette or cigar use; current cigarette, cigar, or smokeless tobacco use; and current cigarette, cigar, smokeless tobacco, or electronic vapor product use) was higher among male than female students. Having tried to quit smoking cigarettes had a higher prevalence among female than male students. However, the prevalence of six tobacco use behaviors (ever trying cigarette smoking, current frequent cigarette use, smoking more than 10 cigarettes per day, currently smoking cigarettes daily, usually obtaining their own cigarettes by buying them on the Internet, and ever use of electronic vapor products) did not vary by sex.


At the state and local level, health and education agencies and nongovernmental organizations use YRBS data in a variety of ways to improve health-related policies, programs, and practices. For example, Connecticut’s YRBS data on sexual behaviors were used by the Connecticut State Board of Education to support inclusion of comprehensive sexuality education in their position statement on coordinated school health and by the Connecticut Department of Education to help develop Guidelines for the Sexual Health Education Component of Comprehensive Health Education for local school districts on best practice policies, programs, and instruction in sexual health education.


Boston Public Schools used their YRBS data on sexual behaviors in an annual presentation to the Boston City Council to demonstrate the need for sexual health education and services and to garner support for the District Wellness Policy requiring schools to teach comprehensive sexual health education and provide sexual health services, including distribution of condoms at the high school level.


The Hawaii Department of Health used the dietary behavior data from their YRBS to support their public education campaign (on television, in malls, and in movie theaters) to reduce youth consumption of sugar-sweetened beverages and to track the impact of school wellness policies which restrict access to sugar-sweetened beverages on campus and at school-sponsored events.


The Los Angeles Unified School District used their YRBS data to support a new Los Angeles County ordinance on electronic vapor products and to support passage of a city-wide ordinance banning electronic vapor products from public spaces, bars, and restaurants.


Montana YRBS data on bullying were used to support passage of a new Student Protections Procedures rule requiring schools to address bullying and threatening behavior in schools, on school buses, at school-sponsored activities, and online and to create a Bully Free Montana website and toolkit.


The Bureau of Children, Youth, and Families used New York City YRBS data on attempted suicide to support a mental health awareness campaign for teens that included videos and other online resources on New York City’s dedicated website for teens and that is available as part of the Teen Talk Toolkit distributed to health educators in New York City public middle and high schools.


See the CDC Announcement


Also see the CDC’s 2015 Youth Risk Behavior Surveillance Data


See also the Medical Law Perspectives April 2015 Report: COPD Liability Risks: When Taking a Breath Is Not Easy