Youth Risk Behavior Survey 2017: How American High School Students Are Doing

Health-risk behaviors drive the leading causes of illness and death among young people and adults in the United States, and some groups of young people bear far more of them. CDC's Youth Risk Behavior Surveillance System (YRBSS) — the largest U.S. system tracking the health behaviors of high school students — watches six areas:

1. behaviors behind unintentional injuries and violence;
2. tobacco use;
3. alcohol and other drug use;
4. sexual behaviors related to unintended pregnancy and sexually transmitted infections, including HIV;
5. unhealthy eating;
6. physical inactivity.

It also tracks obesity, asthma and other health measures. A CDC team led by Laura Kann reported the 2017 results: 121 behaviors from the national survey, plus surveys by 39 states and 21 large urban school districts.

Image from CDC's MMWR report on the 2017 Youth Risk Behavior Survey.

The survey

The national survey drew a three-stage cluster sample of public, Catholic and other private schools with grades 9–12 across the 50 states and D.C., oversampling classes in schools with many Black and Hispanic students. In 2017, 14,765 usable questionnaires came from 144 schools. The school response rate was 75%, the student rate 81% and the overall rate 60%.

Since 2015 the survey has asked about sexual identity and the sex of sexual contacts. Nationally, 85.4% of students identified as heterosexual, 2.4% as gay or lesbian, 8.0% as bisexual, and 4.2% were not sure.

Headline findings

Obesity and overweight are based on self-reported height and weight. Source: CDC, MMWR.

Who is at higher risk

By sex. Male students more often skipped seatbelts, drove after drinking or using marijuana, carried weapons, fought, used most tobacco products and many drugs, and had obesity. Female students more often were bullied — in person and electronically — experienced forced sex and sexual violence, drank alcohol, described themselves as overweight and tried to lose weight. Male students were more physically active on every measure.

By race and ethnicity. Most behaviors varied. White students more often texted while driving, were bullied and used tobacco; Black students more often skipped seatbelts, were threatened or injured with weapons at school, fought and had early sex; Hispanic students more often rode with or were drinking drivers, felt sad or hopeless, and had tried vaping and several drugs. Isolating these differences from income and culture is not possible.

By sexual identity — the clearest pattern. Unlike the differences by sex or race, these almost always pointed one way: gay, lesbian and bisexual students had a higher prevalence of health risks than heterosexual students.

• Of 13 violence-related risks, 10 were more common among gay, lesbian and bisexual students.
• Of 19 tobacco-related risks, 11 were; for current, frequent and daily cigarette smoking, rates were at least double.
• Of 19 alcohol and drug risks, 18 were; for eight — including heroin, methamphetamines, ecstasy, hallucinogens, steroids and injecting drugs — rates were at least double.
• Of six sexual risk behaviors, five were more common.

Students not sure of their sexual identity often looked much like gay, lesbian and bisexual students, and often had higher risks than heterosexual students. Students with no sexual contact had far lower rates of most risks.

Most trends are improving

With data back to 1991, most long-term trends moved in the right direction:

• Injury and violence: declines in not wearing seatbelts, drinking and driving, carrying weapons, fighting, forced sex and dating violence. Staying home from school because of safety concerns, however, rose.
• Tobacco: long-term declines in cigarette smoking and cigar use.
• Alcohol and drugs: declines in 13 of 17 behaviors, including drinking, early marijuana use and use of cocaine, inhalants, heroin, methamphetamines, ecstasy and hallucinogens.
• Sex: declines in all six sexual risk behaviors, and increases in condom and birth control use.
• Diet: less soda, but also fewer vegetables, less fruit and less milk.
• Screens: less television, but more video games and computer use.
• Weight and sleep: obesity, overweight and trying to lose weight rose; getting 8 or more hours of sleep fell.

What the data are for

YRBSS data help compare groups of students, track trends, monitor progress toward 21 national health objectives, give states and cities comparable data, and guide action. Most students grow into healthy, productive adults, but the report points to groups — especially sexual minority students — whose risks may lead to early death, illness and problems such as academic failure, poverty and crime. Schools and youth-friendly health care providers can help connect them with education, health care and effective programs.

Limitations

• Only students in school are covered; about 5% of 16- and 17-year-olds had left without a credential in 2013, and sexual minority youth may be overrepresented among them.
• Answers are self-reported; over- or underreporting can't be measured.
• Some students may not know, disclose or understand their sexual identity, and sexual contact wasn't defined.
• Questions on attraction or gender identity might identify different groups.
• Self-reported height and weight tend to underestimate obesity.
• Not every state or city asked every question, and cross-sectional data show association, not cause.

If you or someone you know is thinking about suicide, call or text 988 to reach the 988 Suicide & Crisis Lifeline in the United States.

Sources

Based on Kann L, McManus T, Harris WA, et al., "Youth Risk Behavior Surveillance — United States, 2017," MMWR Surveillance Summaries, Centers for Disease Control and Prevention; a work of the United States government in the public domain.