Surveying Teens in a Pandemic: The 2021 Youth Risk Behavior Survey

The 2021 Youth Risk Behavior Survey was the first chance since COVID-19 began to compare American teenagers' health with the decades of data before it. Delayed from spring to fall 2021 by virtual schooling and closures, it found a student body more diverse than ever — half from racial and ethnic minority groups and about one in four identifying as LGBQ+ — and warning signs about teen mental health.

The pandemic backdrop

Earlier in 2021, CDC's Adolescent Behaviors and Experiences Survey had found that 37% of high school students experienced poor mental health during the pandemic and 44% felt persistently sad or hopeless in the past year. About one in three had experienced racism at school, 55% reported emotional abuse by a parent or other adult at home, and about a quarter experienced hunger. The pandemic worsened existing disparities for racial, ethnic and sexual minority youth.

The survey system

The Youth Risk Behavior Surveillance System, which CDC calls the largest public health surveillance system in the United States, pairs a nationally representative survey with school-based surveys by states, tribes, territories and districts. In 2021 there were 78 surveys in all: the national survey plus surveys in 45 states, two tribal governments, three territories and 28 local school districts.

What was new. The national questionnaire had 99 questions — the 87-question standard set plus 12 of interest to CDC and partners. The sexual identity question gained options for "questioning," "some other way," and "I do not know what this question is asking," so the survey could report on LGBQ+ students, not only lesbian, gay and bisexual students. New questions covered housing instability, exposure to community violence, mental health, and protective factors such as parental monitoring and school connectedness.

How it was sampled. A three-stage design drew classes from public, private and parochial high schools in all 50 states and DC, starting from 1,257 geographic units.

Who responded

After weighting, 51.7% of students were male. 49.3% identified with a racial or ethnic group other than White, up from 48.9% in 2019 and 46.5% in 2017. On sexual identity, 75.5% identified as heterosexual, 3.2% gay or lesbian, 12.1% bisexual, 5.2% questioning and 3.9% other; the share identifying as other than heterosexual rose from 11% in 2015 to 26% in 2021.

Early findings from the new questions

• School connectedness: about 62% of students felt connected to others at school, and they had lower rates of every risk examined, including poor mental health, prescription opioid misuse and missing school because they felt unsafe.
• Housing instability: about 3% of students experienced it, and they were more likely to face violence, persistent sadness and suicidal thoughts.
• Community violence: 20% had witnessed it, and 3.5% carried a gun.
• Longstanding topics: the share of female students who seriously considered suicide rose from 24% in 2019 to 30% in 2021, while HIV testing fell 3.7 percentage points and STI testing among sexually active students 5 points.

A warning about response rates

Response rates fell below 60%, continuing a decline. Some of the drop came from school COVID-19 precautions, but disinformation campaigns misrepresenting the survey's content, procedures and usefulness also played a part — even as use of YRBS data is at an all-time high. Rising parent refusals, the authors warn, could keep a state or locality from getting representative data.

Sources

Based on Jonetta J. Mpofu, J. Michael Underwood, Jemekia E. Thornton, et al., "Overview and Methods for the Youth Risk Behavior Surveillance System — United States, 2021," MMWR Supplements, volume 72, Centers for Disease Control and Prevention; a work of the United States government in the public domain.