How CDC Surveys America's High Schoolers: The 2023 Youth Risk Behavior Survey

Since 1991, CDC has asked American high school students about the behaviors and experiences that shape their health — from vaping and sexual activity to bullying, diet and suicidal thoughts. The 2023 Youth Risk Behavior Survey (YRBS) brought the biggest changes in years: tablets instead of paper, a special sample of American Indian and Alaska Native students, and new questions on topics like social media and racism at school.

The system

The Youth Risk Behavior Surveillance System includes a nationally representative survey run by CDC and separate school-based surveys run by states, tribes, territories and local districts. In 2023 there were 68 of those site-level surveys, in 39 states, three tribal governments, five territories and 21 school districts. The national survey is usually given in the spring of odd-numbered years; after the pandemic pushed the previous one to fall 2021, the 2023 survey returned to the January–June semester.

What changed in 2023

Tablets brought other benefits too. Students finished in about 25 minutes instead of a full 45-minute class period; they tend to prefer electronic surveys; no paper was needed; and data were available as soon as each day's tablets were synced — tablets weren't online, but data collectors synchronized them to a central repository nightly. The tablet showed pictures for questions about tobacco products, prescription opioids and contraceptives, skipped follow-up questions that didn't apply, and flagged impossible answers like implausible heights. Students absent on survey day could take a web version later; 323 did.

The questionnaire

The 2023 survey had 107 questions: 87 in the standard questionnaire every site builds on, plus 20 of particular interest to CDC and partners. Experts from CDC, academia, other federal agencies and nongovernmental organizations proposed changes, site coordinators voted on the standard questionnaire, and CDC refined wording through cognitive testing with students. It was offered in English and Spanish. Except for height, weight and race, questions were multiple choice with up to eight options, and a test-retest study found most were substantially reliable.

Who was sampled

• Main sample: a three-stage cluster design covering public (including charter), parochial and other private schools with grades 9–12 in all 50 states and DC. From 1,257 geographic units, 60 were chosen; within them, 180 schools plus 20 extra small schools (204 physical schools in all); then one or two classes per grade. Alternative, special education, Department of Defense and Bureau of Indian Education schools, and schools with 40 or fewer high school students, were excluded.
• AI/AN sample: 55 school units (114 physical schools) chosen by American Indian and Alaska Native enrollment, among public schools with at least 28 students per grade, with two classes per grade.

Participation was voluntary and anonymous, with local parental permission procedures.

Response and weighting

Responses were weighted by sex, race and ethnicity, and grade to adjust for nonresponse, so estimates represent all U.S. students in grades 9–12 in public and private schools. Students answering "yes" to being Hispanic or Latino were classed as Hispanic; those choosing more than one race as multiracial. For analysis by sexual identity, students identifying as gay or lesbian, bisexual, another way or questioning were usually grouped as LGBQ+.

The results appear in ten companion reports and in CDC's online tools, YRBS Explorer, Youth Online and the YRBS Analysis Tool.

Why response fell

Overall, school and student response rates, 2013–2023. CDC, MMWR.

The 35.4% overall response rate was the lowest in the survey's history. Students responded almost as before (71.0%), but far fewer schools took part (49.8%). Overall rates have fallen steadily since 2011 — in the low 60s from 2015, under 60% after COVID in 2021. Getting approval from districts and schools has become harder, and disinformation campaigns that misrepresent the survey's content, methods and uses have added to the decline.

A high response rate does not by itself guarantee an unbiased sample. Participating and non-participating schools differed in type, locale, share of Asian students, per-pupil spending and whether they offered career and technical education; together, only spending still predicted participation — schools that spend less per pupil were less likely to take part. Weighting adjusts for this.

How the data are analyzed

Estimates come with confidence intervals and are suppressed when fewer than 30 students answer. Group differences use chi-square and t-tests, significant at p<0.05. Trends since 2013 are tested for straight-line and curved change, controlling for sex, grade and race and ethnicity (at least 3 survey years for a linear trend, 6 for a curved one), and 2021 is compared with 2023 only for identically worded questions.

State, tribal, territorial and local surveys

Sites that ran a YRBS in 2023. CDC, MMWR.

Every two years, sites run their own surveys of public high school students, comparable across years and with the national survey. In 2023, 68 sites took part — 39 states, three tribal governments, five territories and 21 local school districts; 32 collected data on computers, phones or tablets and 36 on paper. Sites start from the 87-question standard questionnaire and must keep at least 58 questions, including every demographic one. Most sample schools by enrollment and then classes; some survey every school, and seven sites — Vermont, the District of Columbia, the Navajo Nation, the Winnebago Tribe of Nebraska, American Samoa, the Northern Mariana Islands and Palau — survey every student. 36 states, three tribal governments, five territories and 21 districts had representative (weighted) data.

Sites with representative data, 1991–2023. CDC, MMWR.

National and site data for 1991–2023 are free at cdc.gov/yrbs/data and through Youth Online, the YRBS Analysis Tool and YRBS Explorer.

Who answered in 2023

After weighting, 51.9% of students were male. By race and ethnicity, 48.1% were White, 27.4% Hispanic, 13.3% Black, 6.1% multiracial, 4.3% Asian, 0.4% Native Hawaiian or other Pacific Islander and 0.3% American Indian or Alaska Native. 73.3% identified as heterosexual, 4.0% gay or lesbian, 11.4% bisexual and 4.4% questioning. 53.7% had never had sexual contact.

What the 2023 reports found

• New data: electronic surveys, which don't change estimates; the first precise national estimates for American Indian and Alaska Native students; and the first nationally representative teen data on adverse childhood experiences (ACEs) — 76.1% reported at least one and 18.5% four or more.
• Social media: about three fourths used it several times a day or more, which went with more bullying, sadness and hopelessness, and suicidal thoughts and plans.
• Racism: about one in three had experienced it at school, more often Asian, multiracial and Black students.
• Transgender identity: 3.3% identified as transgender and 2.2% were questioning; they faced more violence, poor mental health and unstable housing.
• Consent and discipline: 79.8% asked for consent verbally at last sexual contact; 19.1% reported unfair discipline in the past year (23.1% of Black and 18.1% of White students).
• Mental health: 39.7% felt persistently sad or hopeless, 20.4% seriously considered suicide and 9.5% attempted it. Physical activity, an adult at home who met their needs, and school connectedness went with better mental health. 17.9% skipped breakfast every day.

If you or someone you know is struggling, call or text 988, the Suicide & Crisis Lifeline.

Limitations

• It covers only students in school — not homeschooled teens or the roughly 5% of youths aged 14–17 not enrolled in 2022.
• Lower-spending schools were less likely to take part.
• Over- or underreporting can't be measured, though most questions test reliably.
• Some students answered a site's questionnaire instead of the national one, so answer counts vary.
• The surveys are cross-sectional and descriptive: they show associations, not causes.

Since 1991, the system has surveyed about 5 million high school students in about 2,300 surveys, and it remains the best source for tracking the behaviors behind young people's leading causes of death and illness.

Sources

Based on Nancy D. Brener, Jonetta J. Mpofu, Kathleen H. Krause, et al., "Overview and Methods for the Youth Risk Behavior Surveillance System — United States, 2023," MMWR Supplements, volume 73, Centers for Disease Control and Prevention; a work of the United States government in the public domain. The report has been corrected since publication. Data and documentation: cdc.gov/yrbs.