Laura Kann, Ph.D.(1) Charles W. Warren, Ph.D.(1) William A. Harris, M.M.(1) Janet L. Collins, Ph.D.(1) Barbara I. Williams, Ph.D.(2)

James G. Ross, M.S.(3) Lloyd J. Kolbe, Ph.D.(1) State and Local YRBSS Coordinators (Appendix)

(1) Division of Adolescent and School Health National Center for Chronic Disease Prevention and Health Promotion, CDC

(2) Westat Incorporated, Rockville, MD (3) Macro International, Calverton, MD

Abstract

Problem/Condition: Priority health-risk behaviors that contribute to the leading causes of mortality, morbidity, and social problems among youth and adults often are established during youth, extend into adulthood, and are interrelated.

Reporting Period: February through May 1995. Description of the System: The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health-risk behaviors among youth and young adults: behaviors that contribute to unintentional and intentional injuries, tobacco use, alcohol and other drug use, sexual behaviors, unhealthy dietary behaviors, and physical inactivity. The YRBSS includes both a national school-based survey conducted by CDC and state and local school-based surveys conducted by state and local education agencies. This report summarizes results from the national survey, 35 state surveys, and 16 local surveys conducted among high school students from February through May 1995.

Results and Interpretation: In the United States, 72% of all deaths among school-age youth and young adults result from four causes: motor vehicle crashes, other unintentional injuries, homicide, and suicide. Results from the 1995 YRBSS suggest that many high school students practice behaviors that may increase their likelihood of death from these four causes: 21.7% had rarely or never used a safety belt, 38.8% had ridden with a driver who had been drinking alcohol during the 30 days preceding the survey, 20.0% had carried a weapon during the 30 days preceding the survey, 51.6% had drunk alcohol during the 30 days preceding the survey, 25.3% had used marijuana during the 30 days preceding the survey, and 8.7% had attempted suicide during the 12 months preceding the survey. Substantial morbidity and social problems among school-age youth and young adults also result from unintended pregnancies and sexually transmitted diseases, including human immunodeficiency virus infection. YRBSS results indicate that in 1995, 53.1% of high school students had had sexual intercourse, 45.6% of sexually active students had not used a condom at last sexual intercourse, and 2.0% had ever injected an illegal drug. Among adults, 65% of all deaths result from three causes: heart disease, cancer, and stroke. Most of the risk behaviors associated with these causes of death are initiated during adolescence. In 1995, 34.8% of high school students had smoked cigarettes during the 30 days preceding the survey, 39.5% had eaten more than two servings of foods typically high in fat content during the day preceding the survey, and only 25.4% had attended physical education class daily.

Actions Taken: YRBSS data are being used nationwide by health and education officials to improve national, state, and local policies and programs designed to reduce risks associated with the leading causes of mortality and morbidity. YRBSS data also are being used to measure progress toward achieving 21 national health objectives and one of eight National Education Goals.

INTRODUCTION

In the United States, 72% of all deaths among youth and young adults 5-24 years of age result from only four causes: motor vehicle crashes (28% of all deaths in this age group), other unintentional injuries (11%), homicide (21%), and suicide (12%) (1). Substantial morbidity and social problems also result from the approximately 1 million pregnancies that occur each year among adolescents (2) and the more than 10 million cases of sexually transmitted diseases (STDs) that occur each year among persons 15-29 years of age (3). In the United States, 65% of all deaths and substantial morbidity among adults greater than or equal to 25 years of age result from three causes: heart disease (34% of all deaths in this age group), cancer (24%), and stroke (7%) (1). Therefore, six categories of behaviors contribute to the leading causes of morbidity and mortality in the United States: behaviors that contribute to unintentional and intentional injuries; tobacco use; alcohol and other drug use; sexual behaviors that contribute to unintended pregnancy and STDs (including human immunodeficiency virus {HIV} infection); unhealthy dietary behaviors; and physical inactivity. These behaviors, which frequently are interrelated, often are established during youth and extend into adulthood.

To monitor the priority health-risk behaviors in each of these categories among youth and young adults, CDC developed the Youth Risk Behavior Surveillance System (YRBSS) (4). The YRBSS includes national, state, * and local school-based surveys of high school students. National surveys were conducted in 1990, 1991, 1993, and 1995. ** Comparable state and local surveys were first conducted in 1990, when 24 states and eight large cities participated. In 1991, 29 states and 10 cities conducted surveys; in 1993, 43 states and 13 cities; and in 1995, 45 states and 16 cities. This report summarizes the results from the 1995 national school-based survey and from the 35 selected state and 16 local school-based surveys. Data from nine state surveys conducted during 1995 were not included in this report because of their low overall response rate. Data from one state survey were not included upon request of the state education agency. --------------- * U.S. territories are included as states.

** The school-based components of the YRBSS were implemented in 1990 and 1991 and then biennially during odd-numbered years thereafter.

METHODS

Sampling

The 1995 national school-based survey employed a three-stage cluster sample design to produce a nationally representative sample of students in grades 9-12. The first-stage sampling frame contained 1,955 primary sampling units (PSUs), consisting of large counties or groups of smaller, adjacent counties. From the 1,955 PSUs, 52 were selected from 16 strata formed on the basis of the degree of urbanization and the relative percentage of black * and Hispanic students in the PSU. The PSUs were selected with probability proportional to school enrollment size. At the second sampling stage, 157 schools were selected with probability proportional to school enrollment size. To enable separate analysis of black and Hispanic students, schools with substantial numbers of black and Hispanic students were sampled at higher rates than all other schools. The third stage of sampling consisted of randomly selecting one or two intact classes of a required subject (e.g., English or social studies) from grades 9-12 at each chosen school. All students in the selected classes were eligible to participate in the survey.

A weighting factor was applied to each student record to adjust for nonresponse and for the varying probabilities of selection, including those resulting from the oversampling of black and Hispanic students. Numbers of students in other racial/ethnic groups were too low for meaningful analysis in this report. The weights were scaled so that a) the weighted count of students was equal to the total sample size and b) the weighted proportions of students in each grade matched national population proportions. SUDAAN was used to compute 95% confidence intervals that were used to determine differences among subgroups at the p less than 0.05 level (5). The national data are representative of students in grades 9-12 in public and private schools in the 50 states and the District of Columbia.

The 1995 state and local school-based surveys employed a two-stage cluster sample design to produce representative samples of students in grades 9-12 in their jurisdictions. In most states and cities, the first-stage sampling frame consisted of all public schools containing any of grades 9-12. Schools were selected with probability proportional to school enrollment size. At the second sampling stage, intact classes of a required subject or a required period (e.g., second period) were randomly selected. All students in the selected classes were eligible to participate in the survey. Some states and cities modified these procedures to meet their individual needs. For example, in some states and cities, either classes were selected as the first stage of sampling or all schools, rather than a sample of schools, were selected to participate.

The surveys from the 25 states and 12 cities, each with an overall response rate of at least 60% and appropriate documentation, were weighted (Table_1). Weighted data from most of these states and cities can be generalized to all public-school students in grades 9-12 in the jurisdiction. Surveys that did not have both an overall response rate of at least 60% and appropriate documentation were not weighted. The unweighted data from 10 state and four local surveys apply only to the students participating in the survey. Surveys from California, Colorado, Michigan, and New Jersey excluded students from Los Angeles, Denver, Detroit, and Newark, respectively.

For the national survey, 10,904 questionnaires were completed in 110 schools. The school response rate was 70%, and the student response rate was 86%, resulting in an overall response rate of 60% (Table_1). For the state and local surveys, sample sizes ranged from 309 to 5,987. School response rates ranged from 48% to 100%, student response rates ranged from 44% to 99%, and overall response rates ranged from 41% to 85%. In the national, state, and local surveys, students were evenly distributed across grades and between sexes (Table_1).

Incidence rates for two variables were calculated to provide data for monitoring relevant year 2000 national health objectives (6). For weapon-carrying, students who replied that they had carried a weapon 2-3 days during the 30 days preceding the survey were assigned a weapon-carrying frequency of 2.5; 4-5 days, 4.5; and greater than or equal to 6 days, 6.0. For physical fighting, students who reported having fought two or three times during the 12 months preceding the survey were assigned a fighting frequency of 2.5; four or five times, 4.5; six or seven times, 6.5; eight or nine times, 8.5; 10-11 times, 10.5; and greater than or equal to 12 times, 12.0. ---------------

• In this report, black refers to black, non-Hispanic students.

Data Collection

Survey procedures were designed to protect the students' privacy by allowing for anonymous and voluntary participation. The self-administered questionnaire was administered in the classroom during a regular class period. Students recorded their responses directly on a booklet or answer sheet that could be scanned by a computer. The core questionnaire contained 84 multiple-choice questions. State and local education agencies added or deleted items to meet individual needs. Local parental consent procedures were followed before survey administration.

RESULTS

Behaviors that Contribute to Unintentional Injuries

Safety-Belt Use

Nationwide, 21.7% of students rarely or never used safety belts when riding in a car or truck driven by someone else (Table_2). Overall, male students (26.0%) were significantly more likely than female students (16.9%) to rarely or never use safety belts. White * male students (25.1%) were significantly more likely than white female students (15.2%) to rarely or never use safety belts, and male students in grades 10-12 (23.9%, 24.2%, and 29.0%, respectively) were significantly more likely than female students in the same grades (15.3%, 13.5%, and 18.8%, respectively) to rarely or never use safety belts. Overall, black students (31.5%) were significantly more likely than white and Hispanic students (20.5% and 18.4%, respectively) to rarely or never use safety belts. Black female students (25.7%) were significantly more likely than white and Hispanic female students (15.2% and 14.2%, respectively) to rarely or never use safety belts, and black male students (37.8%) were significantly more likely than Hispanic male students (22.6%) to rarely or never use safety belts. The prevalence rates across the state surveys varied sixfold from 5.9% to 37.2% (median: 23.5%) (Table_3). Across the local surveys, the prevalence rates varied nearly sixfold from 7.8% to 46.1% (median: 26.1%). ---------------

• In this report, white refers to white, non-Hispanic students.

Motorcycle-Helmet Use

Nationwide, 25.1% of students had ridden a motorcycle during the 12 months preceding the survey. Of these students, 43.8% rarely or never wore a motorcycle helmet (Table_2). Prevalence rates of rarely or never using a motorcycle helmet varied among the state surveys nearly threefold from 26.5% to 73.1% (median: 44.2%) (Table_3). Across the local surveys, prevalence rates ranged from 33.9% to 72.6% (median: 47.0%).

Bicycle-Helmet Use

Nationwide, 76.2% of students had ridden a bicycle during the 12 months preceding the survey. Of these students, 92.8% rarely or never wore a bicycle helmet (Table_2). Overall, black and Hispanic students (97.3% and 96.4%, respectively) were significantly more likely than white students (91.8%) to rarely or never wear a bicycle helmet. Hispanic female students (96.7%) were significantly more likely than white female students (91.3%) to rarely or never wear a bicycle helmet, and black male students (98.3%) were significantly more likely than white male students (92.1%) to rarely or never wear a bicycle helmet. The prevalence rates of rarely or never wearing a bicycle helmet ranged from 75.0% to 98.2% (median: 93.8%) across the state surveys and from 83.8% to 97.4% (median: 94.0%) across the local surveys (Table_3).

Riding with a Driver Who Had Been Drinking Alcohol

During the 30 days preceding the survey, more than one third (38.8%) of students nationwide had ridden with a driver who had been drinking alcohol (Table_2). Black male students (41.6%) were significantly more likely than black female students (33.0%) to have ridden with a driver who had been drinking alcohol. Overall, Hispanic students (49.4%) were significantly more likely than black students (37.1%) to have ridden with a driver who had been drinking alcohol. Hispanic female students (49.7%) were significantly more likely than black female students (33.0%) to report this behavior. Riding with a drinking driver was significantly more likely among 12th-grade male students (44.8%) than among 10th-grade male students (35.1%). Prevalence rates across the state surveys ranged from 21.4% to 49.5% (median: 36.8%) and across the local surveys from 20.6% to 46.3% (median: 32.7%) (Table_3).

Driving After Drinking Alcohol

During the 30 days preceding the survey, 15.4% of students nationwide had driven a vehicle after drinking alcohol (Table_2). Black male students (16.1%) were significantly more likely than black female students (5.3%) to drive after drinking alcohol. White and Hispanic female students (13.6% each) were significantly more likely than black female students (5.3%) to report this behavior. Female students in grade 12 (15.8%) were significantly more likely than 9th-grade female students (7.0%) to report this behavior. Male students in grade 12 (32.0%) were significantly more likely than male students in grades 9-11 (11.4%, 10.9%, and 18.9%, respectively) to drive after drinking alcohol. Prevalence rates across the state surveys varied nearly sixfold from 5.6% to 32.5% (median: 14.3%). Prevalence rates across the local surveys varied fourfold from 3.4% to 14.0% (median: 9.1%) (Table_3).

Behaviors that Contribute to Intentional Injuries

Carrying a Weapon

One fifth (20.0%) of students nationwide had carried a weapon (e.g., a gun, knife, or club) during the 30 days preceding the survey (Table_4). Overall, male students (31.1%) were significantly more likely than female students (8.3%) to have carried a weapon. This significant difference was identified for all the racial/ethnic and grade subgroups. Overall, Hispanic students (24.7%) were significantly more likely than white students (18.9%) to have carried a weapon. Weapon-carrying was significantly more likely among black and Hispanic female students (15.7% and 13.2%, respectively) than among white female students (5.5%). Male students in grade 9 (33.8%) were significantly more likely than male students in grade 12 (26.0%) to have carried a weapon. State prevalence rates ranged from 11.3% to 27.4% (median: 20.6%), and local prevalence rates ranged from 16.6% to 29.2% (median: 20.5%) (Table_5).

Nationwide, 7.6% of students had carried a gun during the 30 days preceding the survey (Table_4). Overall, male students (12.3%) were significantly more likely than female students (2.5%) to have carried a gun. This significant difference was identified for all the racial/ethnic and grade subgroups. Overall, black and Hispanic students (10.6% and 10.5%, respectively) were significantly more likely to have carried a gun than white students (6.2%). Black male students (18.7%) were significantly more likely than white male students (10.2%) to have done so. State prevalence rates varied fourfold from 3.1% to 13.2% (median: 7.7%), and local prevalence rates varied threefold from 3.7% to 12.7% (median: 7.9%) (Table_5).

An estimated 81.3 separate incidents of weapon carrying occurred per 100 students during the 30 days preceding the survey (Table_4). Overall, the weapon-carrying incidence rate for male students (128.1 per 100 students) was significantly higher than for female students (31.3 per 100 students). This significant difference was identified for white and Hispanic students and all the grade subgroups. The weapon-carrying incidence rate for black female students (57.6 per 100 students) was significantly higher than for white female students (20.2 per 100 students). State rates ranged from 37.9 to 121.7 per 100 students (median: 84.8), and local rates ranged from 57.6 to 121.1 per 100 students (median: 79.7) (Table_5).

Engaging in a Physical Fight

Among students nationwide, 38.7% had been in a physical fight during the 12 months preceding the survey (Table_6). Overall, male students (46.1%) were significantly more likely than female students (30.6%) to have been in a physical fight. This significant difference was identified for all the racial/ethnic and grade subgroups. Overall, Hispanic students (47.9%) were significantly more likely than white students (36.0%) to have been in a physical fight. Both Hispanic male and female students (55.9% and 40.4%, respectively) were significantly more likely than white male and female students (44.0% and 26.8%, respectively) to report this behavior. Female students in grade 9 (37.4%) were significantly more likely than female students in grades 11 and 12 (27.5% and 24.1%, respectively) to report this behavior, and female students in grade 10 (34.4%) were significantly more likely than female students in grade 12 (24.1%) to have done so. Male students in grade 9 (55.0%) were significantly more likely than male students in grade 12 (38.0%) to have been in a physical fight. Among the state surveys, the prevalence rates of physical fighting ranged from 28.4% to 40.8% (median: 34.9%). Among the local surveys, the prevalence rates of physical fighting ranged from 27.7% to 48.0% (median: 40.0%).

Nationwide, 4.2% of students had been treated by a doctor or nurse for injuries sustained in a physical fight during the 12 months preceding the survey (Table_6). Overall, male students (5.7%) were significantly more likely than female students (2.5%) to report having been injured in a physical fight. This significant difference was identified for white students and students in grades 11 and 12. Overall, Hispanic students (6.4%) were significantly more likely than white students (3.4%) to have been injured in a physical fight. Among the state surveys, the prevalence rates of injurious physical fighting ranged from 2.5% to 6.0% (median: 4.0%) (Table_7). Among the local surveys, the prevalence rates of injurious physical fighting ranged from 3.5% to 8.4% (median: 5.5%).

Nationwide, an estimated 127.7 incidents of physical fighting occurred per 100 students during the 12 months preceding the survey (Table_6). Overall, male students (161.1 per 100 students) were significantly more likely than female students (91.9 per 100 students) to have been involved in a physical fight. Incidence rates were significantly higher among black male students (180.5 per 100 students) than among black female students (83.3 per 100 students). Across the state surveys, the incidence rates ranged from 92.6 per 100 students to 137.6 per 100 students (median: 115.2) (Table_7). Across the local surveys, the incidence rates ranged from 73.4 per 100 students to 154.7 per 100 students (median: 125.2).

School-Related Violence

Nationwide, 4.5% of students had missed at least 1 day of school during the 30 days preceding the survey because they had felt unsafe at school or when traveling to or from school (Table_8). Overall, black and Hispanic students (7.7% and 8.4%, respectively) were significantly more likely than white students (2.8%) to have felt unsafe. Hispanic and black female students (8.3% and 8.2%, respectively) were significantly more likely than white female students (2.2%) to miss school because they had felt unsafe, and black male students (7.1%) were significantly more likely than white male students (3.4%) to miss school for this reason. A sixfold difference was observed in prevalence rates across the state surveys, which ranged from 2.6% to 15.6% (median: 4.8%) (Table_9). The prevalence rates across the local surveys ranged from 6.9% to 17.0% (median: 10.2%).

The prevalence of weapon-carrying on school property during the 30 days preceding the survey was 9.8% nationwide (Table_8). Overall, male students (14.3%) were significantly more likely than female students (4.9%) to have carried a weapon on school property. This significant difference was identified for white and Hispanic students and all the grade subgroups. Overall, Hispanic students (14.1%) were significantly more likely than white students (9.0%) to have carried a weapon on school property. Hispanic and black female students (8.9% and 8.8%, respectively) were significantly more likely than white female students (3.1%) to have done so. State prevalence rates varied nearly threefold from 5.4% to 14.6% (median: 9.6%), and local prevalence rates varied threefold from 5.2% to 15.3% (median: 9.7%).

Nationwide, the prevalence of students who had been threatened or injured with a weapon on school property during the 12 months preceding the survey was 8.4% (Table_8). Overall, male students (10.9%) were significantly more likely than female students (5.8%) to have been threatened or injured with a weapon on school property. This significant difference was identified for white students and students in grades 9, 11, and 12. Overall, Hispanic students (12.4%) were significantly more likely than white students (7.0%) to have been threatened or injured with a weapon on school property. Hispanic and black male students (15.2% each) were significantly more likely than white male students (9.2%) to report such behavior. State prevalence rates varied threefold from 3.6% to 11.4% (median: 7.9%). Local prevalence rates ranged from 8.1% to 13.3% (median: 10.4%) (Table_9).

Nationwide, 15.5% of students had been in a physical fight on school property during the 12 months preceding the survey (Table_8). Overall, male students (21.0%) were significantly more likely than female students (9.6%) to have been in a physical fight on school property. This significant difference was identified for all the racial/ethnic and grade subgroups. Overall, black and Hispanic students (20.3% and 21.1%, respectively) were significantly more likely than white students (12.9%) to have been in a physical fight on school property. Black male and female students (27.9% and 14.3%, respectively) and Hispanic male and female students (25.7% and 16.6%, respectively) were significantly more likely than white male and female students (18.4% and 6.5%, respectively) to report this behavior. Female students in grade 9 (12.1%) were significantly more likely to have been in a physical fight on school property than female students in grade 12 (5.6%). Male students in grade 9 (29.4%) were significantly more likely to have been in a physical fight on school property than male students in grades 10-12 (20.8%, 18.6%, and 15.5%, respectively). Across the state surveys, prevalence rates ranged from 11.6% to 23.2% (median: 15.0%). Across the local surveys, prevalence rates ranged from 12.5% to 22.2% (median: 17.9%) (Table_9).

Nationwide, approximately one third of students (34.9%) had had property (e.g., a car, clothing, or books) stolen or deliberately damaged on school property during the 12 months preceding the survey (Table_8). Overall, male students (41.4%) were significantly more likely than female students (28.0%) to have had property stolen or damaged on school property. This significant difference was identified for white students and all the grade subgroups. Female students in grades 10 and 11 (31.6% and 28.6%, respectively) were significantly more likely than female students in grade 12 (21.5%) to have experienced this. State prevalence rates ranged from 24.8% to 46.1% (median: 33.4%), and local prevalence rates ranged from 25.6% to 39.8% (median: 32.6%) (Table_9).

Suicide Ideation and Attempts

Nearly one fourth (24.1%) of students nationwide had seriously considered attempting suicide during the 12 months preceding the survey (Table_10). Overall, female students (30.4%) were significantly more likely than male students (18.3%) to have considered attempting suicide. This significant difference was identified for white and Hispanic students and all the grade subgroups. Overall, white students (24.9%) were significantly more likely than black students (20.0%) to have considered attempting suicide. Hispanic and white female students (34.1% and 31.6%, respectively) were significantly more likely than black female students (22.2%) to have considered attempting suicide. Female students in grades 9 and 10 (34.4% and 32.8%, respectively) were significantly more likely than female students in grade 12 (23.9%) to have done so. Prevalence rates ranged from 17.7% to 31.5% (median: 23.9%) across the state surveys and from 17.3% to 26.7% (median: 20.3%) across the local surveys (Table_11).

More serious suicide ideation was observed among the 17.7% of students nationwide who, during the 12 months preceding the survey, had made a specific plan to attempt suicide (Table_10). Overall, female students (21.3%) were significantly more likely than male students (14.4%) to have made a suicide plan. This significant difference was identified for white and Hispanic students and students in grades 9 and 10. White and Hispanic female students (21.9% and 25.5%, respectively) were significantly more likely than black female students (15.5%) to have done so. Female students in grades 9 and 10 (23.3% and 23.8%, respectively) were significantly more likely than female students in grade 12 (16.6%) to have made a suicide plan. Prevalence rates across the state surveys ranged from 13.6% to 26.4% (median: 17.9%) (Table_11). Prevalence rates across the local surveys ranged from 13.5% to 21.1% (median: 15.2%).

Nationwide, 8.7% of students had actually attempted suicide during the 12 months preceding the survey (Table_10). Overall, female students (11.9%) were significantly more likely than male students (5.6%) to have attempted suicide. This significant difference was identified for white and Hispanic students and students in grades 9-11. Overall, Hispanic students (13.4%) were significantly more likely than white students (7.6%) to have attempted suicide. Suicide attempts were significantly more likely among Hispanic female students (21.0%) than among white female students (10.4%) and black female students (10.8%). Female students in grades 9 and 10 (14.9% and 15.1%, respectively) were significantly more likely than female students in grade 12 (6.6%) to have attempted suicide. The percentage of students attempting suicide varied nearly threefold from 7.5% to 20.5% (median: 9.3%) across the state surveys and varied nearly threefold from 5.8% to 15.8% (median: 10.3%) across the local surveys (Table_11).

Nationwide, during the 12 months preceding the survey, 2.8% of students reported having made a suicide attempt that resulted in an injury, poisoning, or overdose that had to be treated by a doctor or nurse (Table_10). Female students in grade 9 (6.3%) were significantly more likely than female students in grade 12 (1.3%) to have made a suicide attempt that required subsequent medical attention. The prevalence of injurious suicide attempts varied fourfold from 1.6% to 7.3% (median: 2.9%) across the state surveys and varied fourfold from 1.1% to 5.0% (median: 3.5%) across the local surveys (Table_11).

Tobacco Use

Cigarette Use

Nationwide, 71.3% of students had ever tried cigarette smoking (Table_12). Overall, Hispanic students (76.3%) were significantly more likely than black students (66.0%) to have ever tried cigarette smoking. Hispanic female students (74.8%) were significantly more likely than black female students (62.8%) to have ever tried cigarette smoking. Female students in grades 11 and 12 (75.1% and 73.6%, respectively) were significantly more likely than female students in grade 9 (60.4%) to have ever tried cigarette smoking, and male students in grade 11 (76.5%) were significantly more likely than male students in grade 9 (66.1%) to have done so. State prevalence rates ranged from 45.2% to 84.9% (median: 71.0%), and local prevalence rates ranged from 59.4% to 75.2% (median: 66.0%) (Table_13).

More than one third of students (34.8%) nationwide had smoked cigarettes on greater than or equal to 1 of the 30 days preceding the survey (i.e., current cigarette use) (Table_12). Black male students (27.8%) were significantly more likely than black female students (12.2%) to report current cigarette use. Overall, white and Hispanic students (38.3% and 34.0%, respectively) were significantly more likely to report current cigarette use than black students (19.2%). White and Hispanic male and female students were significantly more likely than black male and female students to do so. Male students in grade 12 (42.0%) were significantly more likely than male students in grade 9 (32.3%) to currently smoke cigarettes. Across the state surveys, prevalence rates varied nearly fivefold from 8.8% to 43.0% (median: 35.7%); across the local surveys, prevalence rates ranged from 17.8% to 30.3% (median: 23.3%) (Table_13).

Nationwide, 16.1% of students had smoked cigarettes on greater than or equal to 20 of the 30 days preceding the survey (i.e., frequent cigarette use) (Table_12). Black male students (8.5%) were significantly more likely than black female students (1.3%) to report frequent cigarette use. Overall, white students (19.5%) were significantly more likely than black and Hispanic students (4.5% and 10.0%, respectively) to report frequent cigarette use. White female students (20.8%) were significantly more likely than black and Hispanic female students (1.3% and 9.3%, respectively) to report frequent cigarette use, and Hispanic female students (9.3%) were significantly more likely than black female students (1.3%) to do so. White male students (18.4%) were significantly more likely than black male students (8.5%) to report frequent cigarette use. Female and male students in grades 11 and 12 were significantly more likely to report frequent cigarette use than female and male students in grade 9. State prevalence rates varied forty-onefold from 0.6% to 24.6% (median: 17.5%), and local prevalence rates varied threefold from 3.8% to 13.2% (median: 7.3%) (Table_13).

Smokeless-Tobacco Use

Nationwide, more than one in 10 students (11.4%) had used smokeless tobacco during the 30 days preceding the survey (Table_12). Overall, male students (19.7%) were significantly more likely than female students (2.4%) to use smokeless tobacco. This significant difference was identified for white students and all the grade subgroups. Overall, white students (14.5%) were significantly more likely than black and Hispanic students (2.2% and 4.4%, respectively) to use smokeless tobacco. White male students (25.1%) were significantly more likely than Hispanic and black male students (5.8% and 3.5%, respectively) to do so. An eightfold variation in prevalence rates was observed across the state surveys, which ranged from 3.0% to 25.1% (median: 11.6%) (Table_13). Across the local surveys, a fivefold variation was observed, which ranged from 1.3% to 6.7% (median: 3.1%).

Access to Cigarettes

Among students reporting current cigarette use, nationwide 38.7% of those less than 18 years of age had purchased their cigarettes in a store or gas station during the 30 days preceding the survey (Table_14). White students (41.3%) in this subgroup were significantly more likely than black students (27.2%) to have purchased cigarettes in a store or gas station. For both male and female students in this subgroup, the percentage of students who had purchased cigarettes in a store or gas station significantly increased as grade increased; by grade 11, approximately half of students purchased their cigarettes at a store. State prevalence rates varied nearly threefold from 17.5% to 51.0% (median: 36.2%), and local prevalence rates ranged from 29.7% to 63.4% (median: 36.3%) (Table_15).

Nationwide, among students reporting current cigarette use, more than three fourths (77.5%) of students less than 18 years of age who had purchased their cigarettes in a store were not asked to show proof of age (Table_14). State prevalence rates ranged from 55.3% to 82.9% (median: 73.4%), and local prevalence rates ranged from 59.8% to 92.6% (median: 75.7%) (Table_15).

Alcohol and Other Drug Use

Alcohol Use

Nationwide, 80.4% of students had had at least one drink of alcohol during their lifetime (Table_16). Overall, white and Hispanic students (81.7% and 82.9%, respectively) were significantly more likely than black students (73.7%) to have had at least one drink of alcohol during their lifetime. White female students (81.6%) were significantly more likely than black female students (71.7%) to have had at least one drink of alcohol. Female students in grades 10-12 were significantly more likely than female students in grade 9 to have had at least one drink of alcohol, and male students in grades 11 and 12 (84.0% and 86.0%, respectively) were significantly more likely than male students in grade 9 (74.2%) to have done so. The prevalence of lifetime alcohol use across the state surveys ranged from 43.6% to 84.0% (median: 78.2%) (Table_17). The prevalence across the local surveys ranged from 58.0% to 83.9% (median: 71.3%).

Nationwide, more than half (51.6%) of all students had had at least one drink of alcohol during the 30 days preceding the survey (i.e., current alcohol use) (Table_16). Overall, white and Hispanic students (54.1% and 54.7%, respectively) were significantly more likely than black students (42.0%) to report current alcohol use. White and Hispanic female students (53.3% and 52.3%, respectively) were significantly more likely than black female students (38.5%) to report current alcohol use. Male students in grade 12 (59.5%) were significantly more likely than male students in grade 9 (46.9%) to do so. State prevalence rates varied nearly threefold from 22.4% to 60.7% (median: 50.5%), and local prevalence rates ranged from 26.4% to 57.0% (median: 41.0%) (Table_17).

Nationwide, 32.6% of students had had five or more drinks of alcohol on at least one occasion during the 30 days preceding the survey (i.e., episodic heavy drinking) (Table_16). Overall, male students (36.2%) were significantly more likely than female students (28.6%) to report episodic heavy drinking. This significant difference was identified for black students and students in grade 12. Overall, white and Hispanic students (35.6% and 37.7%, respectively) were significantly more likely than black students (18.8%) to report episodic heavy drinking. White and Hispanic male and female students were significantly more likely to report episodic heavy drinking than black male and female students. Male and female students in grades 11 and 12 were significantly more likely than male and female students in grade 9 to report this behavior, and male students in grade 12 (46.5%) were significantly more likely than male students in grades 10 and 11 (32.1% and 37.8%, respectively) to do so. Prevalence rates across the state surveys varied threefold from 12.6% to 43.1% (median: 30.3%) and across the local surveys from 12.6% to 35.5% (median: 18.4%) (Table_17).

Marijuana Use

Nationwide, 42.4% of students had used marijuana during their lifetime (Table_16). Male students in grade 9 (38.9%) were significantly more likely than female students in grade 9 (27.9%) to have used marijuana during their lifetime. Black male students (54.2%) were significantly more likely than white male students (42.7%) to report having used marijuana in their lifetime. Lifetime use was significantly more likely among female students in grades 10, 11, and 12 (39.5%, 43.6%, and 43.8%, respectively) than among female students in grade 9 (27.9%). Lifetime marijuana use varied fourfold from 10.3% to 48.4% (median: 38.9%) across the state surveys and ranged from 27.7% to 61.8% (median: 37.6%) across the local surveys (Table_17).

Nationwide, 25.3% of students had used marijuana at least once during the 30 days preceding the survey (i.e., current marijuana use) (Table_16). Overall, male students (28.4%) were significantly more likely than female students (22.0%) to currently use marijuana. Black male students (36.8%) were significantly more likely than black female students (22.1%) to report this behavior. Black male students (36.8%) also were significantly more likely than white male students (26.8%) to currently use marijuana. Current marijuana use varied sixfold from 5.3% to 31.9% (median: 22.9%) across the state surveys and ranged from 15.6% to 38.7% (median: 21.4%) across the local surveys (Table_17).

Cocaine Use

Nationwide, 7.0% of students had used some form of cocaine during their lifetime (Table_18). Overall, male students (8.8%) were significantly more likely than female students (5.0%) to have ever used cocaine. This significant difference was identified for white and black students. Overall, white and Hispanic students (6.5% and 16.0%, respectively) were significantly more likely than black students (2.0%) to report lifetime cocaine use, and Hispanic students (16.0%) were significantly more likely than white students (6.5%) to do the same. These significant differences by race/ethnicity were identified for both male and female students. A fourfold variation in lifetime and nearly eightfold variation in current cocaine use were observed across the state and local surveys (Table_19). Lifetime cocaine use varied nearly fourfold from 2.9% to 11.5% (median: 5.9%) across the state surveys and nearly threefold from 1.4% to 10.6% (median: 5.3%) across the local surveys.

Nationwide, 3.1% of students had used some form of cocaine at least once during the 30 days preceding the survey (i.e., current cocaine use) (Table_18). Overall, male students (4.3%) were significantly more likely than female students (1.8%) to currently use cocaine. This significant difference was identified for white and black students and students in grade 12. Overall, Hispanic students (7.5%) were significantly more likely than white and black students (2.6% and 1.3%, respectively) to report current cocaine use. This significant difference was identified for both male and female students. Current cocaine use varied nearly fourfold from 1.4% to 4.9% (median: 3.0%) across the state surveys and varied fivefold from 0.9% to 4.6% (median: 2.1%) across the local surveys.

Nationwide, 4.5% of students had used crack or freebase forms of cocaine during their lifetime (Table_18). Black male students (3.2%) were significantly more likely than black female students (0.3%) to have ever used crack cocaine. Overall, white and Hispanic students (4.2% and 10.5%, respectively) were significantly more likely than black students (1.6%) to have ever used crack cocaine, and Hispanic students (10.5%) were significantly more likely than white students (4.2%) to have done so. Hispanic and white female students (11.6% and 2.9%, respectively) were significantly more likely than black female students (0.3%) to have ever used crack cocaine. Hispanic female students (11.6%) also were significantly more likely than white female students (2.9%) to have done so. Hispanic male students (9.4%) were significantly more likely than black male students (3.2%) to have used crack cocaine. A nearly fourfold variation in crack or freebase use was observed across the state surveys, which ranged from 1.8% to 6.9% (median: 4.0%); a greater than tenfold variation was observed across the local surveys, which ranged from 0.7% to 7.4% (median: 2.9%) (Table_19).

Steroid Use

Nationwide, 3.7% of students had used steroids without a physician's prescription during their lifetime (Table_20). Overall, male students (4.9%) were significantly more likely than female students (2.4%) to have used steroids. This significant difference was identified for white students and students in grade 12. Overall, white and Hispanic students (3.8% and 4.7%, respectively) were significantly more likely than black students (1.6%) to have used steroids. Hispanic female students (5.3%) were significantly more likely than black female students (0.9%) to report lifetime steroid use, and white male students (5.3%) were significantly more likely than black male students (2.4%) to do so. Female students in grades 9 and 10 (3.4% and 3.1%, respectively) were significantly more likely to have used steroids than female students in grade 12 (1.0%). Lifetime steroid use varied threefold from 2.0% to 6.5% (median: 3.7%) across the state surveys and varied threefold from 1.7% to 5.1% (median: 3.2%) across the local surveys (Table_21).

Injecting-Drug Use

Nationwide, 2.0% of students had injected illegal drugs during their lifetime * (Table_20). Overall, male students (3.0%) were significantly more likely than female students (1.0%) to report injecting-drug use. This significant difference was identified for white and black students and students in grades 11 and 12. State prevalence rates varied threefold from 1.2% to 3.7% (median: 2.2%), and local prevalence rates varied nearly ninefold from 0.4% to 3.5% (median: 1.7%) (Table_21). ---------------

• Students were classified as injecting-drug users only if they a) reported injecting-drug use not prescribed by a physician and b) answered "one or more" to any of these questions: "During your life, how many times have you used any form of cocaine, including powder, crack, or freebase?"; "During your life, how many times have you used any other type of illegal drug, such as LSD, PCP, ecstacy, mushrooms, speed, ice, or heroin?"; or "During your life, how many times have you taken steroid pills or shots without a doctor's prescription?"

Other Illegal-Drug Use

Nationwide, 16.0% of students reported use of other illegal drugs during their lifetime (e.g., LSD, PCP, ecstasy, mushrooms, speed, ice, or heroin) (Table_20). Overall, white and Hispanic students (18.4% and 18.1%, respectively) were significantly more likely than black students (3.9%) to report use of other illegal drugs. This significant difference was identified for both male and female students. State prevalence rates varied ninefold from 2.4% to 22.3% (median: 15.7%), and local prevalence rates varied ninefold from 2.3% to 20.1% (median: 7.9%) (Table_21).

Inhalant Use

Nationwide, one fifth (20.3%) of students reported they had ever sniffed glue, breathed the contents of aerosol spray cans, or inhaled any paint sprays to get high (Table_20). Overall, white and Hispanic students (22.7% and 22.8%, respectively) were significantly more likely than black students (9.5%) to report inhalant use. This significant difference was identified for both male and female students. Female students in grades 9 and 10 (25.0% and 21.3%, respectively) were significantly more likely than female students in grade 12 (12.6%) to report ever having used inhalants. State prevalence rates varied more than threefold from 7.9% to 28.3% (median: 19.8%), and local prevalence rates ranged from 7.7% to 19.7% (median: 13.1%) (Table_21).

Initiation of Risk Behaviors

Cigarette Smoking

Nationwide, one fourth (24.9%) of students had ever smoked a whole cigarette before 13 years of age (Table_22). Hispanic male students (33.0%) were significantly more likely than Hispanic female students (20.2%) to have smoked a whole cigarette before 13 years of age. Overall, white and Hispanic students (25.9% and 26.6%, respectively) were significantly more likely than black students (17.2%) to have smoked a whole cigarette before 13 years of age. White female students (23.6%) were significantly more likely than black female students (14.8%) to have smoked a whole cigarette before 13 years of age, and white and Hispanic male students (27.9% and 33.0%, respectively) were significantly more likely than black male students (20.1%) to have done so. State prevalence rates varied threefold from 10.6% to 33.2% (median: 26.0%), and local prevalence rates ranged from 15.7% to 26.1% (median: 19.3%) (Table_23).

Alcohol Use

Nationwide, nearly one third (32.4%) of students first drank alcohol (other than a few sips) before 13 years of age (Table_22). Overall, male students (38.6%) were significantly more likely than female students (25.5%) to have tried alcohol before 13 years of age. This significant difference was identified for all the racial/ethnic and grade subgroups. Overall, Hispanic students (39.5%) were significantly more likely than white students (30.3%) to have tried alcohol before 13 years of age. Hispanic male students (46.7%) were significantly more likely than white male students (36.1%) to have initiated alcohol use before 13 years of age. Female and male students in grade 9 were significantly more likely to report alcohol use before 13 years of age than female and male students in grades 11 and 12. State prevalence rates varied nearly fourfold from 10.8% to 42.0% (median: 34.2%). Local prevalence rates ranged from 25.8% to 39.0% (median: 33.1%) (Table_23).

Marijuana Use

Nationwide, 7.6% of students had tried marijuana before 13 years of age (Table_22). Overall, male students (10.2%) were significantly more likely than female students (4.8%) to have tried marijuana before 13 years of age. This significant difference was identified for white and black students and students in grades 9 and 10. Overall, black and Hispanic students (11.1% and 12.6%, respectively) were significantly more likely than white students (5.6%) to have tried marijuana before 13 years of age. Hispanic male and female students (16.5% and 8.8%, respectively) were significantly more likely than white male and female students (7.8% and 3.2%, respectively) to have tried marijuana before 13 years of age, and black male students (16.5%) were significantly more likely than white male students (7.8%) to have done so. State prevalence rates varied more than threefold from 4.1% to 14.1% (median: 7.4%). Local prevalence rates varied threefold from 5.6% to 18.4% (median: 9.2%) (Table_23).

Cocaine Use

Nationwide, 1.2% of students had tried cocaine (including powder, crack, or freebase forms of cocaine) before 13 years of age (Table_22). Overall, male students (1.8%) were significantly more likely than female students (0.5%) to have tried cocaine before 13 years of age. This significant difference was identified for white and black students and students in grade 11. State prevalence rates varied more than elevenfold from 0.3% to 3.5% (median: 1.5%), and local prevalence rates varied fivefold from 0.5% to 2.6% (median: 1.3%) (Table_23).

Tobacco, Alcohol, and Other Drug Use on School Property

Nationwide, 16.0% of students had smoked cigarettes on school property during the 30 days preceding the survey (Table_24). Black male students (11.6%) were significantly more likely than black female students (4.5%) to have smoked cigarettes on school property. Overall, white and Hispanic students (17.6% and 14.9%, respectively) were significantly more likely than black students (7.6%) to have smoked cigarettes on school property. White and Hispanic female students (17.7% and 13.6%, respectively) were significantly more likely than black female students (4.5%) to have engaged in this behavior, and white male students (17.5%) were significantly more likely than black male students (11.6%) to have done so. Across the state surveys, prevalence rates varied fourfold from 5.8% to 22.9% (median: 15.9%) (Table_25). Across the local surveys, the prevalence rates varied threefold from 6.4% to 18.8% (median: 10.3%).

Smokeless-tobacco use on school property during the 30 days preceding the survey was reported by 6.3% of students nationwide (Table_24). Overall, male students (11.2%) were significantly more likely than female students (0.9%) to have used smokeless tobacco on school property. This significant difference was identified for white and black students and all the grade subgroups. Overall, white students (8.0%) were significantly more likely than black and Hispanic students (1.3% and 3.0%, respectively) to have used smokeless tobacco on school property. White male students (14.2%) were significantly more likely to have engaged in this behavior than black and Hispanic male students (2.7% and 3.9%, respectively). A thirteenfold variation was observed across the state surveys, which ranged from 1.4% to 18.3% (median: 6.9%) (Table_25). A sixfold variation was observed across the local surveys, which ranged from 0.5% to 3.3% (median: 1.6%).

Nationwide, 6.3% of students had had at least one drink of alcohol on school property during the 30 days preceding the survey (Table_24). Male students in grade 12 (8.4%) were significantly more likely than female students in the same grade (4.0%) to have engaged in this behavior. Prevalence rates across the state surveys ranged from 3.9% to 9.8% (median: 5.9%) and across the local surveys from 4.4% to 11.5% (median: 6.1%) (Table_25).

Nationwide, 8.8% of students had used marijuana on school property during the 30 days preceding the survey (Table_24). Overall, male students (11.9%) were significantly more likely than female students (5.5%) to have used marijuana on school property. This significant difference was identified for white students and students in grades 10, 11, and 12. Overall, black and Hispanic students (12.3% and 12.9%, respectively) were significantly more likely than white students (7.0%) to have used marijuana on school property. Prevalence rates varied nearly fourfold from 3.0% to 11.3% (median: 6.7%) across the state surveys and ranged from 6.9% to 17.2% (median: 8.7%) across the local surveys (Table_25).

Nearly one third (32.1%) of students had been offered, sold, or given an illegal drug on school property during the 12 months preceding the survey (Table_24). Overall, male students (38.8%) were significantly more likely than female students (24.8%) to have been offered, sold, or given an illegal drug on school property. This significant difference was identified for white and black students and all the grade subgroups. Overall, Hispanic students (40.7%) were significantly more likely than black students (28.5%) to have been offered, sold, or given an illegal drug on school property. Hispanic female students (34.9%) were significantly more likely than white and black female students (23.5% and 22.5%, respectively) to have been offered, sold, or given an illegal drug. Prevalence rates across the state surveys varied nearly threefold from 16.3% to 46.4% (median: 29.6%) and ranged across the local surveys from 21.0% to 46.2% (median: 29.9%) (Table_25).

Sexual Behaviors that Contribute to Unintended Pregnancy and STDs, Including HIV Infection

Sexual Intercourse

Nationwide, more than half (53.1%) of all high school students had had sexual intercourse during their lifetime (i.e., sexual experience) (Table_26). Black male students (81.0%) were significantly more likely than black female students (67.0%) to have had sexual intercourse. Overall, black students (73.4%) were significantly more likely than white and Hispanic students (48.9% and 57.6%, respectively) to have ever had sexual intercourse. Black female students (67.0%) were significantly more likely than white female students (49.0%) to have had sexual intercourse, and black male students (81.0%) were significantly more likely than white and Hispanic male students (48.9% and 62.0%, respectively) to have done so. Among female students, the prevalence rates increased significantly from grade 9 (32.1%) to grades 10, 11, and 12 (46.0%, 60.2%, and 66.0%, respectively); among male students, the prevalence rates increased significantly from grade 9 (40.6%) to grades 11 and 12 (57.1% and 67.1%, respectively). Prevalence rates ranged from 36.3% to 67.6% (median: 48.7%) across the state surveys and from 43.8% to 72.2% (median: 55.8%) across the local surveys (Table_27).

The percentage of students nationwide who had initiated sexual intercourse before 13 years of age was 9.0% (Table_26). Overall, male students (12.7%) were significantly more likely than female students (4.9%) to have initiated sexual intercourse before 13 years of age. This significant difference was identified for all the racial/ethnic subgroups and students in grades 10-12. Overall, black students (24.2%) were significantly more likely than white and Hispanic students (5.7% and 8.8%, respectively) to have initiated sexual intercourse before 13 years of age. Black female students (10.4%) were significantly more likely than white female students (3.6%) to have done so, and black male students (41.4%) were significantly more likely than white and Hispanic male students (7.6% and 12.9%, respectively) to have done so. Female students in grade 9 (7.7%) were significantly more likely than female students in grade 12 (3.2%) to have initiated sexual intercourse before 13 years of age. Across the state surveys, prevalence rates varied fivefold from 4.3% to 22.1% (median: 8.7%) (Table_27). Across the local surveys, the prevalence rates varied more than threefold from 6.4% to 22.9% (median: 16.3%).

The percentage of students nationwide who had had sexual intercourse during their lifetime with four or more sex partners was 17.8% (Table_26). Overall, male students (20.9%) were significantly more likely than female students (14.4%) to have had four or more sex partners during their lifetime. This significant difference was identified for black and Hispanic students and students in grades 9 and 10. Overall, black students (35.6%) were significantly more likely than white and Hispanic students (14.2% and 17.6%, respectively) to have had four or more sex partners. Black male and female students (52.2% and 21.7%, respectively) were significantly more likely than white male and female students (15.2% and 13.1%, respectively) and Hispanic male and female students (23.6% and 11.9%, respectively) to report this behavior. Hispanic male students (23.6%) also were significantly more likely than white male students (15.2%) to have had four or more sex partners. Among female students, those in grade 11 (17.2%) were significantly more likely than those in grade 9 (6.8%) to have had four or more sex partners, and those in grade 12 (20.8%) were significantly more likely than those in grades 9 and 10 (6.8% and 11.3%, respectively) to have done so. Among male students, those in grade 12 (25.2%) were significantly more likely than those in grade 9 (17.5%) to have had four or more sex partners. Prevalence rates across the state surveys varied more than threefold from 8.4% to 29.9% (median: 16.4%) (Table_27). Prevalence rates across the local surveys varied nearly fourfold from 10.6% to 39.3% (median: 21.7%).

More than one third (37.9%) of students nationwide had had sexual intercourse during the 3 months preceding the survey (i.e., current sexual activity) (Table_26). Female students in grade 11 (48.1%) were significantly more likely than male students in the same grade (36.8%) to have had current sexual activity. Overall, black students (54.2%) were significantly more likely than white and Hispanic students (34.8% and 39.3%, respectively) to have had current sexual activity. Black female students (50.6%) were significantly more likely than white female students (38.5%) to have done so, and black male students (58.3%) were significantly more likely than white or Hispanic male students (31.6% and 39.2%, respectively) to have done so. Among female students, current sexual activity was significantly more likely among those in grades 11 and 12 (48.1% and 51.9%, respectively) than among those in grades 9 and 10 (22.3% and 35.4%, respectively); current sexual activity was more likely among those in grade 10 (35.4%) than among those in grade 9 (22.3%). Among male students, current sexual activity was significantly more likely among those in grade 12 (47.9%) than among those in grades 9-11 (24.2%, 32.1%, and 36.8%, respectively); such activity was significantly more likely among those in grade 11 (36.8%) than among those in grade 9 (24.2%). Prevalence rates across the state surveys ranged from 21.7% to 50.2% (median: 33.3%) (Table_27). Prevalence rates across the local surveys ranged from 23.1% to 53.6% (median: 39.1%).

Among students who had had sexual intercourse during their lifetime, more than one fourth nationwide (28.5%) had been abstinent during the 3 months preceding the survey. Overall, male students (34.0%) were significantly more likely than female students (22.5%) to have been abstinent. This significant difference was identified for white students and students in grades 10 and 11. Male students in grade 9 (40.2%) were significantly more likely than male students in grade 12 (28.3%) to have been abstinent. Prevalence rates across the state surveys ranged from 25.4% to 40.7% (median: 28.8%) and across the local surveys from 25.7% to 36.9% (median: 29.6%) (Table_27).

Condom Use

Among currently sexually active students nationwide, 54.4% reported that either they or their partner had used a condom during last sexual intercourse (Table_28). Overall, male students (60.5%) were significantly more likely than female students (48.6%) to report that a condom was used. This significant difference was identified for Hispanic students and students in grades 10 and 12. Overall, black students (66.1%) were significantly more likely than white and Hispanic students (52.5% and 44.4%, respectively) to report that a condom was used. Black female students (60.5%) were significantly more likely than white (48.0%) and Hispanic (33.4%) female students to report that a condom was used during last sexual intercourse. Black male students (71.6%) were significantly more likely than white male students (57.5%) to report this behavior. Female students in grade 9 (58.5%) were significantly more likely than female students in grade 12 (43.1%) to report that a condom was used. Prevalence rates across the state surveys ranged from 29.7% to 64.6% (median: 53.7%) and across the local surveys from 45.5% to 69.1% (median: 62.4%) (Table_29).

Birth Control Pill Use

Nationwide, among students who are currently sexually active, 17.4% reported that either they or their partner had been using birth control pills prior to last sexual intercourse (Table_28). White female students (25.4%) were significantly more likely than white male students (17.0%) to report that birth control pills were used. Overall, white students (21.4%) were significantly more likely than black and Hispanic students (10.2% and 11.4%, respectively) to have used birth control pills. White female students (25.4%) were significantly more likely than black (12.2%) or Hispanic (9.4%) female students to report this behavior. White male students (17.0%) were significantly more likely than black male students (8.3%) to do so. Among female students, those in grade 12 (28.6%) were significantly more likely than those in grades 9-11 (12.6%, 15.7%, and 17.2%, respectively) to report use of birth control pills. Prevalence rates varied nearly thirteenfold from 2.9% to 36.9% (median: 17.2%) across the state surveys and nearly threefold from 5.6% to 15.8% (median: 9.7%) across the local surveys (Table_29).

Alcohol and Drug Use at Last Sexual Intercourse

Nationwide, among students who are currently sexually active, one fourth (24.8%) reported that they had used alcohol or drugs at last sexual intercourse (Table_28). Overall, male students (32.8%) were significantly more likely than female students (16.8%) to report this behavior. This significant difference was identified for white and black students and students in grades 9, 10, and 12. Prevalence rates varied nearly fivefold from 8.7% to 35.4% (median: 24.1%) across the state surveys and ranged from 12.2% to 27.5% (median: 20.1%) across the local surveys (Table_29).

Pregnancy

Nationwide, 6.9% of students reported that they had been pregnant or gotten someone pregnant. Overall, black and Hispanic students (14.8% and 12.5%, respectively) were significantly more likely than white students (4.0%) to have been pregnant or gotten someone pregnant. This significant difference was identified for both male and female students. Male students in grade 12 (9.3%) also were significantly more likely than male students in grade 9 (3.6%) to have done so. Prevalence rates varied threefold from 3.6% to 11.5% (median: 6.1%) across the state surveys and varied threefold from 5.8% to 18.9% (median: 10.2%) across the local surveys (Table_29).

HIV Education

Nationwide, 86.3% of all students had been taught about acquired immunodeficiency syndrome (AIDS) or HIV infection in school (Table_30). Prevalence rates ranged from 79.0% to 96.3% (median: 89.8%) across the state surveys and from 79.7% to 93.8% (median: 88.8%) across the local surveys (Table_31).

Nearly two thirds (63.2%) of students nationwide had talked about AIDS or HIV infection with a parent or other adult family member (Table_30). Overall, female students (69.9%) were significantly more likely than male students (57.1%) to report having done so. This significant difference was identified for all the racial/ethnic and grade subgroups. Overall, black students (73.4%) were significantly more likely than white and Hispanic students (62.1% and 61.5%, respectively) to have talked with an adult or other family member about AIDS or HIV infection. Black female students (77.4%) were significantly more likely than white female students (68.5%) to have talked with a parent or other adult family member about AIDS or HIV infection, and black male students (68.4%) were significantly more likely than white (56.4%) or Hispanic male (53.9%) students to have done so. Across the state surveys, prevalence rates ranged from 51.8% to 78.3% (median: 64.1%) (Table_31). Across the local surveys, prevalence rates ranged from 55.4% to 77.0% (median: 68.2%).

Dietary Behaviors

Consumption of Fruits and Vegetables

More than one fourth (27.7%) of students nationwide had eaten five or more servings of fruits and vegetables * during the day preceding the survey (Table_32). Overall, male students (32.6%) were significantly more likely than female students (22.7%) to report this behavior. This significant difference was identified for white students and students in grades 9 and 12. Female students in grade 10 (26.6%) were significantly more likely than female students in grade 12 (16.8%) to have done so. Across the state surveys, prevalence rates varied nearly threefold from 16.4% to 45.0% (median: 27.2%) (Table_33). Across the local surveys, prevalence rates ranged from 19.7% to 31.0% (median: 27.1%). ---------------

• Fruit, fruit juice, green salad, and cooked vegetables.

Consumption of Foods Typically High in Fat Content

Nationwide, 60.5% of students had eaten two or fewer servings of foods typically high in fat content ** during the day preceding the survey (Table_32). Overall, female students (71.6%) were significantly more likely than male students (50.3%) to have eaten two or fewer servings of such foods. This significant difference was identified across all the racial/ethnic and grade subgroups. Overall, white and Hispanic students (62.4% and 61.9%, respectively) were significantly more likely than black students (50.0%) to have eaten two or fewer servings of foods typically high in fat content. White and Hispanic female students (75.9% and 68.8%, respectively) were significantly more likely to have done so than black female students (56.3%), and Hispanic male students (54.7%) were significantly more likely than black male students (42.6%) to have done so. Across the state surveys, prevalence rates ranged from 41.9% to 76.5% (median: 60.7%) (Table_33). Across the local surveys, prevalence rates ranged from 50.7% to 73.3% (median: 61.1%). --------------- ** Hamburgers, hot dogs, or sausage; french fries or potato chips; and cookies, doughnuts, pie, or cake.

Perceived Overweight

More than one fourth (27.6%) of all students nationwide thought they were overweight (Table_32). Overall, female students (33.6%) were significantly more likely to identify themselves as being overweight than male students (22.1%). This significant difference was observed for all the racial/ethnic subgroups and students in grades 9, 11, and 12. Overall, white and Hispanic students (28.9% and 31.6%, respectively) were significantly more likely than black students (21.2%) to identify themselves as being overweight. This significant difference was identified for both male and female students. Female students in grades 9 and 12 (36.3% and 37.1%, respectively) were significantly more likely than female students in grade 10 (29.1%) to identify themselves as being overweight. Across the state surveys, prevalence rates ranged from 19.9% to 36.0% (median: 28.9%) (Table_33). Across the local surveys, prevalence rates ranged from 21.3% to 29.8% (median: 25.1%).

Attempted Weight Loss

Nationwide, 41.4% of all students were attempting weight loss at the time of the survey (Table_34). Overall, female students (59.8%) were significantly more likely than male students (24.3%) to be attempting weight loss. This significant difference was identified for all the racial/ethnic and grade subgroups. Overall, white and Hispanic students (43.1% and 45.4%, respectively) were significantly more likely than black students (33.2%) to be attempting weight loss. This significant difference was identified for both male and female students. Prevalence rates ranged from 31.6% to 46.8% (median: 42.3%) across the state surveys and from 30.6% to 42.8% across the local surveys (median: 37.9%) (Table_35).

The percentage of students nationwide who had taken laxatives or vomited either to lose weight or to keep from gaining weight during the 30 days preceding the survey was 4.8% (Table_34). Overall, female students (7.6%) were significantly more likely than male students (2.2%) to have taken laxatives or vomited to lose weight. This significant difference was identified for white and Hispanic students and students in grades 9, 10, and 11. White and Hispanic female students (8.2% and 10.9%, respectively) were significantly more likely than black female students (4.1%) to have taken laxatives or vomited to lose weight, and black male students (4.3%) were significantly more likely than white male students (1.2%) to have done so. Female students in grades 9 and 10 (9.3% and 9.4%, respectively) were significantly more likely to have taken laxatives or vomited to lose weight than female students in grade 12 (3.9%). Prevalence rates ranged from 3.8% to 9.0% (median: 5.3%) across the state surveys and from 3.7% to 6.5% across the local surveys (median: 4.5%) (Table_35).

Nationwide, 5.2% of all students had taken diet pills either to lose weight or to keep from gaining weight during the 30 days preceding the survey (Table_34). Overall, female students (8.7%) were significantly more likely than male students (1.9%) to have taken diet pills to lose weight. This significant difference was identified for white and Hispanic students and all of the grade subgroups. Among female students, white students (10.2%) were significantly more likely than black students (4.0%) to have taken diet pills; among male students, black students (3.6%) were significantly more likely than white students (1.1%) to have done so. Prevalence rates ranged from 4.1% to 9.3% (median: 5.8%) across the state surveys and varied threefold from 2.3% to 7.5% across the local surveys (median: 4.8%) (Table_35).

Nearly one third (31.2%) of all students had dieted either to lose weight or to keep from gaining weight during the 30 days preceding the survey (Table_34). Overall, female students (47.8%) were significantly more likely than male students (16.0%) to have dieted to lose weight. This significant difference was identified for all the racial/ethnic and grade subgroups. Overall, white and Hispanic students (32.8% and 36.0%, respectively) were significantly more likely than black students (22.7%) to have dieted to lose weight. Among female students, white and Hispanic students (52.5% and 48.2%, respectively) were significantly more likely to have dieted than black students (31.8%); among male students, Hispanic students (23.4%) were significantly more likely than white or black students (15.6% and 11.7%, respectively) to have done so. Across the state surveys, prevalence rates ranged from 24.2% to 35.2% (median: 30.3%) (Table_35). Across the local surveys, prevalence rates ranged from 21.5% to 33.5% (median: 27.3%).

Approximately half (51.0%) of all students had exercised either to lose weight or to keep from gaining weight during the 30 days preceding the survey (Table_34). Overall, female students (63.8%) were significantly more likely than male students (39.3%) to have exercised to lose weight. This significant difference was identified for all the racial/ethnic and grade subgroups. Overall, white and Hispanic students (53.7% and 52.0%, respectively) were significantly more likely than black students (42.4%) to have exercised to lose weight. Among female students, white and Hispanic students (69.6% and 61.3%, respectively) were significantly more likely to have exercised than black students (49.1%). Female students in grade 9 (72.2%) were significantly more likely than female students in grades 11 and 12 (59.1% and 59.8%, respectively) to have done so. Across the state surveys, prevalence rates ranged from 37.9% to 56.7% (median: 52.7%) (Table_35). Across the local surveys, prevalence rates ranged from 38.3% to 54.7% (median: 46.2%).

Physical Activity

Vigorous and Moderate Physical Activity

Nearly two thirds (63.7%) of all students nationwide had participated in activities that made them sweat and breathe hard for at least 20 minutes on greater than or equal to 3 of the 7 days preceding the survey (i.e., vigorous physical activity) (Table_36). Overall, male students (74.4%) were significantly more likely than female students (52.1%) to report vigorous physical activity. This significant difference was identified for all the racial/ethnic and grade subgroups. Overall, white students (67.0%) were significantly more likely than black students (53.2%) to report having participated in vigorous physical activity. White female students (56.7%) were significantly more likely than black female students (41.3%) to report vigorous physical activity. Prevalence rates among female students in grades 9 and 10 (61.6% and 59.3%, respectively) were significantly higher than among female students in grades 11 and 12 (47.2% and 42.4%, respectively). Prevalence rates among male students in grades 9 and 10 (79.9% and 78.6%, respectively) were significantly higher than among male students in grade 12 (67.2%). Across the state surveys, prevalence rates ranged from 32.5% to 71.9% (median: 63.1%) (Table_37). Across the local surveys, prevalence rates ranged from 44.9% to 63.2% (median: 51.6%).

More than one fifth (21.1%) of all students nationwide had walked or bicycled for at least 30 minutes on greater than or equal to 5 of the 7 days preceding the survey (i.e., moderate physical activity) (Table_36). Overall, black and Hispanic students (27.0% and 26.8%, respectively) were significantly more likely to report this behavior than white students (18.3%). Black and Hispanic female students (26.4% and 27.6%, respectively) were significantly more likely than white female students (16.8%) to report moderate physical activity. Prevalence rates among female students in grades 9 and 10 (27.0% and 22.9%, respectively) were significantly higher than among female students in grade 12 (13.7%). Across the state surveys, prevalence rates ranged from 15.0% to 30.3% (median: 21.4%) (Table_37). Across the local surveys, prevalence rates ranged from 37.4% to 58.9% (median: 29.0%).

Stretching Exercises

Nationwide, 53.0% of all students had done stretching exercises (e.g., toe touching, knee bending, and leg stretching) on greater than or equal to 3 of the 7 days preceding the survey (Table_36). Hispanic male students (54.8%) were significantly more likely than Hispanic female students (43.5%) to report this behavior, and male students in grade 12 (50.7%) were significantly more likely than female students in grade 12 (38.9%) to do so. White female students (53.9%) were significantly more likely than black female students (41.5%) to report moderate physical activity. Among female students, the prevalence rate was significantly higher among students in grade 9 (62.1%) than among students in grades 11 and 12 (45.5% and 38.9%, respectively); the prevalence rate was significantly higher among students in grade 10 (57.8%) than among students in grade 12 (38.9%). Among male students, the prevalence rate was significantly higher among students in grade 9 (62.2%) than among students in grade 11 (50.9%). Across the state surveys, prevalence rates ranged from 24.2% to 58.7% (median: 49.7%) (Table_37). Across the local surveys, prevalence rates ranged from 33.3% to 56.1% (median: 42.8%).

Strengthening Exercises

Half (50.3%) of students nationwide had done strengthening exercises (e.g., push-ups, sit-ups, and weight lifting) on greater than or equal to 3 of the 7 days preceding the survey (Table_36). Overall, male students (59.1%) were significantly more likely than female students (41.0%) to have done strengthening exercises. This significant difference was identified for all the racial/ethnic subgroups and students in grades 9, 11, and 12. Overall, white students (52.8%) were significantly more likely than black students (41.4%) to have done strengthening exercises. White female students (44.4%) were significantly more likely than black female students (31.3%) to report this behavior. Female students in grade 9 (49.6%) were significantly more likely than female students in grades 11 and 12 (37.1% and 29.4%, respectively) to have done strengthening exercises, and female students in grade 10 (49.8%) were significantly more likely than female students in grade 12 (29.4%) to have done so. Male students in grade 9 (64.0%) were significantly more likely than those in grade 12 (53.7%) to have done strengthening exercises. Prevalence rates ranged from 25.8% to 57.4% (median: 46.4%) across the state surveys and from 32.1% to 51.6% (median: 42.3%) across the local surveys (Table_37).

Participation in Physical Education (PE) Class

Nationwide, 59.6% of students were enrolled in a PE class (Table_38). Among both male and female students, students in grade 9 were significantly more likely to be enrolled in a PE class than students in grades 11 and 12; students in grade 10 were significantly more likely to be enrolled than students in grade 12. The percentage of students enrolled in PE varied threefold from 26.6% to 93.4% (median: 48.2%) across the state surveys and ranged from 33.6% to 89.8% (median: 55.9%) across the local surveys (Table_39).

One fourth (25.4%) of students had attended PE class daily (Table_38). Among female students, those in grades 9 and 10 (39.7% and 33.8%, respectively) were significantly more likely than students in grades 11 and 12 (12.3% and 11.1%, respectively) to have attended PE class daily. Among male students, students in grade 9 (42.1%) were significantly more likely than students in grade 12 (14.8%) to have done so. The percentage of students who attended PE class daily varied sevenfold from 9.2 to 64.4% (median: 33.1%) across the state surveys and varied nearly ninefold from 9.0% to 78.2% (median: 33.9%) across the local surveys (Table_39).

Nationwide, 69.7% of students enrolled in PE class reported exercising greater than or equal to 20 minutes during an average PE class. Overall, male students enrolled in PE class (74.8%) were significantly more likely than female students enrolled in PE class (63.7%) to report exercising greater than or equal to 20 minutes during an average PE class. This significant difference was identified for black and Hispanic students and students in grade 11. Overall, white students enrolled in PE class (71.3%) were significantly more likely than black students enrolled in PE class (59.0%) to report exercising greater than or equal to 20 minutes during an average PE class. White female students (67.1%) were significantly more likely than black female students (46.6%) to have done so. The percentage of students enrolled in PE class who reported exercising greater than or equal to 20 minutes during an average PE class varied from 41.8% to 85.1% (median: 75.7%) across the state surveys and from 46.5% to 80.7% (median: 62.0%) across the local surveys (Table_39).

Participation on Sports Teams

Half (50.3%) of all students nationwide had played on a sports team run by their school during the 12 months preceding the survey (Table_38). Overall, male students (57.8%) were significantly more likely than female students (42.4%) to have played on a sports team run by their school. This significant difference was identified for all the racial/ethnic subgroups and students in grades 9, 11, and 12. Overall, white students (53.9%) were significantly more likely than Hispanic students (37.8%) to have played on a sports team run by their school. White female students (47.1%) were significantly more likely than black and Hispanic female students (34.9% and 27.3%, respectively) to have played on a sports team run by their school, and white male students (59.9%) were significantly more likely than Hispanic male students (48.6%) to have done so. Across the state surveys, the percentage of students who played on a sports team run by their school ranged from 25.3% to 59.2% (median: 47.5%) (Table_39). Across the local surveys, the percentage ranged from 29.0% to 47.4% (median: 36.4%).

Nationwide, 36.9% of all students had played on a sports team run by an organization other than their school during the 12 months preceding the survey (Table_38). Overall, male students (46.4%) were significantly more likely than female students (26.8%) to have played on a sports team run by an organization other than their school. Among female students, white students (29.9%) were significantly more likely than black and Hispanic students (21.1% and 21.2%, respectively) to have played on a sports team run by an organization other than their school, students in grade 9 (32.0%) were significantly more likely to have done so than students in grades 11 and 12 (23.8% and 19.8%, respectively), and students in grade 10 (32.4%) were significantly more likely than students in grade 12 (19.8%) to have done so. Among male students, those in grade 9 (52.8%) were significantly more likely to report this behavior than students in grades 11 and 12 (43.1% and 42.8%, respectively). The percentage of students who played on a sports team run by an organization other than their school ranged from 28.5% to 58.1% (median: 39.0%) across the state surveys and from 27.5% to 37.5% (median: 33.2%) across the local surveys (Table_39).

DISCUSSION

These results indicate that many high school students throughout the United States practice behaviors that place them at risk for serious health problems. Some risk behaviors are more likely to be found among particular subgroups of students. For example, male students were more likely than female students to report rarely or never wearing safety belts, weapon carrying, physical fighting, smokeless-tobacco use, episodic heavy drinking, current marijuana use, lifetime and current cocaine use, injecting-drug use, four or more lifetime sex partners, and using alcohol and drugs at last sexual intercourse. In contrast, female students were more likely than male students to report suicide-related behaviors, perceiving themselves as overweight, and using each type of weight-loss method. White students were more likely than black or Hispanic students to report seriously considering attempting suicide, frequent cigarette use, and smokeless-tobacco use. Black students were more likely than white or Hispanic students to report rarely or never wearing safety belts, sexual experience, sexual activity, and having had four or more lifetime sex partners. Hispanic students were more likely than white or black students to report riding with a driver who had been drinking alcohol, carrying a weapon, physical fighting, attempting suicide, lifetime cigarette use, lifetime and current cocaine use, and lifetime crack use. Students in grades 9 and 10 were more likely than students in grades 11 and 12 to report carrying a weapon, physical fighting, attempting suicide, lifetime use of inhalants, and use of laxatives or vomiting to lose weight. In contrast, students in grades 11 and 12 were more likely than students in grades 9 and 10 to report driving after drinking alcohol; lifetime, current, and frequent cigarette use; lifetime and current alcohol use; episodic heavy drinking; lifetime and current marijuana use; sexual experience; sexual activity; four or more lifetime sex partners; and ever having been pregnant or getting someone pregnt. These subgroup findings can assist in identifying the need for education and services based on higher prevalences of risk behaviors. However, the underlying causes (e.g., education levels, economic factors, or cultural influences) for subgroup differences (7) could not be addressed in this analysis.

Considerable variation occurs from state to state and from city to city for some priority health-risk behaviors. For example, among the state surveys, a fivefold variation or greater was identified for not using safety belts, drinking and driving, not attending school because of concerns about safety, frequent cigarette use, smokeless-tobacco use (including smokeless-tobacco use on school property), marijuana use, use of other illegal drugs, and initiation of sexual activity and cocaine use before 13 years of age. Among the local surveys, a similar level of variation was found for not using safety belts, smokeless-tobacco use (including smokeless-tobacco use on school property), cocaine use (including cocaine use on school property and crack cocaine use), injecting-drug use, use of other illegal drugs, and initiation of cocaine use before 13 years of age. Though not addressed in this analysis, these state and local survey variations may be attributable to differences in state and local laws and policies, enforcement practices, access to illegal drugs, available intervention programs, and prevailing norms and adult practices. Further exploration of the variations may indicate important intervention needs.

The median prevalence rates for the state and local surveys were similar for all behaviors except for the following behaviors where the state median was higher: drinking and driving, current cigarette use, frequent cigarette use, smokeless-tobacco use, cigarette and smokeless-tobacco use on school property, episodic heavy drinking, use of other illegal drugs, and use of birth control pills. The median for the local surveys was higher for the following behaviors: being injured in a physical fight, feeling unsafe going to school, initiating sexual intercourse before 13 years of age, and ever having been pregnant.

YRBSS is the only school-based surveillance system to monitor priority health-risk behaviors among representative samples of students at the national, state, and local levels. Since the system was implemented in 1990, the number of participating states and cities has almost doubled -- from 34 to 61. Consequently, the system is an increasingly useful tool for monitoring 21 national health objectives (6) and National Education Goal 7, which focuses on safe, disciplined, and drug-free schools (8). At the state and local levels, the surveillance system continues to be used to improve health-related policies and programs for youth. For example, in Alabama, YRBS data were used to help establish a state-wide Task Force on Violence. In West Virginia, YRBS data were used to increase support for comprehensive school health programs. West Virginia schools are now required by law to develop a local School Improvement Council that must include business and community representatives. In Maine, YRBS data encouraged the adoption of skill-based health education curricula in grade 8. In Dallas, YRBS data were used to help establish six community health clinics. In Boston, YRBS data are being used to support a proposed state mandate requiring comprehensive school health education in grades kindergarten through 12. Continued support for the YRBSS will enhance its ability to provide useful data for state and local health and education officials to use in improving policies and programs for youth.

References

1. National Center for Health Statistics. Advance report of final mortality statistics, 1993. Hyattsville, MD: US Department of Health and Human Services, Public Health Service, CDC 1996. (Monthly vital statistics report; vol. 44, no. 7, suppl.).

2. National Center for Health Statistics. Trends in pregnancies and pregnancy rates: estimates for the United States, 1980-1992. Hyattsville, MD: US Department of Health and Human Services, Public Health Service, CDC 1995. (Monthly vital statistics report; vol. 43, no. 11, suppl.).

3. CDC. Sexually transmitted disease surveillance, 1990. Atlanta: US Department of Health and Human Services, Public Health Service, 1991.

4. Kann L, Kolbe LJ, Collins JL, eds. Measuring the health behavior of adolescents: the Youth Risk Behavior Surveillance System. Public Health Rep 1993;108(suppl 1).

5. Shah BV, Barnwell BG, Bieler GS. SUDAAN user's manual, release 6.40. Research Triangle Park, NC: Research Triangle Institute, 1995.

6. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives -- mid-course review and 1995 revisions. Washington, DC: US Department of Health and Human Services, Public Health Service, 1995.

7. Lowry R, Kann L, Collins JL, Kolbe LJ. The effect of socioeconomic status on risk behaviors for chronic disease among U.S. adolescents. JAMA 1996;276(10):792-7.

8. National Education Goals Panel. The national education goals report. Washington, DC: National Education Goals Panel, 1995.

TABLE 1. Size  response rates and demographic characteristics of samples -- United States and selected U.S. sites, Youth Risk Behavior Surveys, 1995
=====================================================================================================================================================

                                   Response rate (%)           Sex (%)                Grade (%)                       Race/Ethnicity (%)
                   Sample     ---------------------------   -------------    ---------------------------     ------------------------------------
Site                size      School    Student   Overall   Female   Male     9th    10th   11th    12th     White *   Black *   Hispanic   Other
-----------------------------------------------------------------------------------------------------------------------------------------------------
NATIONAL SURVEY    10,904       70         86        60      47.9    52.1    22.9    25.2   25.4    26.4      67.2      14.2       10.7       7.9
STATE SURVEYS

Weighted data
Alabama             3,911       89         85        76      50.1    49.9    31.3    24.9   22.1    20.5      61.3      34.4        1.2       3.1
Alaska              1,634       82         78        64      47.6    52.4    29.8    25.8   23.0    21.0      68.3       5.2        3.3      23.2
Arkansas            2,267       82         92        75      49.1    50.9    28.6    26.8   23.1    21.3      66.9      27.4        1.6       4.1
Colorado +          2,246       70         85        60      48.6    51.4    29.1    26.2   23.4    21.0      70.6       4.9       14.7       9.8
Guam &                309       NA @       62        62      47.4    52.6    34.9    28.3   20.8    15.8       6.2       2.7        1.7      89.4
Hawaii              1,244      100         62        62      50.6    49.4    31.0    23.9   22.9    22.1      13.1       1.9        4.6      82.2
Illinois            3,102       91         77        70      50.2    49.8    29.0    26.5   23.2    21.3      62.3      19.5       10.9       7.3
Maine               1,388       68         98        67      48.7    51.3    27.6    26.1   24.0    22.3      93.7       0.6        0.9       4.8
Massachusetts       4,159       94         77        72      49.3    50.7    28.3    25.7   23.8    22.0      75.4       6.4        8.2      10.1
Mississippi         1,273       75         87        65      50.0    50.0    32.8    25.7   21.5    19.9      44.0      47.9        0.3       7.8
Missouri            4,900       79         80        63      49.1    50.9    29.2    26.2   23.1    21.2      87.4       6.1        1.8       4.6
Montana             2,535       70         89        62      48.6    51.4    27.9    25.6   23.6    22.6      87.5       0.8        1.7      10.0
Nevada              1,538       98         61        60      48.7    51.3    29.1    26.7   23.6    20.4      68.4       7.6       11.4      12.5
New Hampshire       2,092       76         86        65      49.6    50.4    28.9    25.7   23.7    21.6      93.2       0.8        1.4       4.7
New Jersey+         3,518       80         81        65      50.3    49.7    28.7    25.6   23.3    22.3      66.2      13.4        9.2      11.2
North Carolina      1,779       71         84        60      49.9    50.1    31.6    26.4   21.8    20.1      61.8      31.8        1.3       5.2
North Dakota        1,517       86         99        85      50.7    49.3    26.7    25.4   24.5    23.4      93.8       1.2        1.2       3.8
Puerto Rico&        3,103       96         78        75      52.0    48.0    28.1    27.8   23.7    20.2      11.4       5.2       70.9      12.5
South Carolina      5,527       74         85        63      48.9    51.1    33.4    25.7   21.4    19.3      52.8      42.1        1.2       3.8
South Dakota        1,192       78         83        65      49.4    50.6    28.8    26.3   23.1    21.7      88.1       0.9        1.2       9.8
Utah                3,291       80         84        67      49.5    50.5    26.0    25.9   22.8    23.3      87.4       1.0        3.6       8.1
Vermont             5,987       74         85        63      48.6    51.4    28.0    25.6   23.4    23.0       NA         NA         NA       NA
Virgin Islands&       687      100         76        76      55.6    44.4    32.3    26.6   20.7    20.2       1.2      82.0        8.1       8.6
West Virginia       2,079       98         80        78      48.7    51.3    27.8    25.3   23.9    22.9      92.5       3.4        0.7       3.3
Wyoming             1,687       86         85        73      49.0    51.0    27.4    26.9   23.6    22.0      83.9       0.6        6.6       9.0

Unweighted data
California+         1,672       71         60        43      55.5    44.5    27.0    26.5   23.9    22.5      42.9       8.4       26.0      22.8
Delaware            2,580       79         91        72      51.1    48.9    31.1    28.7   23.1    16.8      69.2      21.0        3.4       6.5
Georgia             1,512       60         82        49      54.7    45.3    27.4    22.2   26.5    22.8      36.6      58.4        0.8       4.2
Idaho               2,726       48         87        42      47.2    52.8    26.7    30.1   25.8    16.5      86.7       0.8        4.9       7.6
Marshall Islands&   1,117       80         56        45      55.0    45.0    33.1    27.7   21.0    17.7       2.1       9.4        5.9      82.6
Michigan+           1,351       58         83        48      47.4    52.6    35.6    21.4   25.5    17.4      90.0       2.5        2.5       5.1
Nebraska            2,043       63         78        49      47.1    52.9    24.3    29.8   24.4    21.4      91.6       1.9        2.5       4.1
Ohio                2,034       67         81        54      49.4    50.6    30.9    25.8   21.2    22.0      77.2      15.6        2.1       5.0
Rhode Island        1,215       60         68        41      52.2    47.8    36.3    25.8   18.2    19.3      74.7       7.4        7.1      11.0
Tennessee           3,197       56         83        46      52.8    47.2    28.9    23.6   23.3    24.0      70.6      24.5        1.1       3.8
LOCAL SURVEYS

Weighted data
Boston              1,601       96         66        63      50.0    50.0    30.0    25.6   23.5    20.3      16.1      38.0       24.1      21.8
Chicago             1,697      100         70        70      51.8    48.2    33.3    29.3   21.3    15.9      11.7      42.4       34.0      11.8
Dallas              3,146       96         63        60      51.2    48.8    39.7    24.0   18.6    17.7      14.6      47.9       32.9       4.5
Denver              1,625      100         64        64      50.5    49.5    31.5    26.0   23.0    19.0      33.8      18.7       35.4      12.1
Ft. Lauderdale      1,656      100         82        82      51.1    48.9    35.0    27.8   21.1    16.1      41.2      33.5       17.2       8.0
Houston             1,477      100         78        78      51.1    48.9    39.2    23.8   18.5    18.4      11.5      37.4       45.7       5.4
Jersey City           714      100         74        74      51.6    48.4    37.7    25.2   18.2    18.6       6.4      45.8       30.5      17.3
Miami               1,746       83         82        68      49.1    50.9    29.7    26.1   22.8    20.0      12.1      29.3       52.0       6.6
New Orleans         1,744       96         62        60      52.6    47.4    35.4    24.0   20.2    18.2       3.8      88.1        1.5       6.6
Philadelphia        1,816      100         76        76      50.6    49.4    38.1    26.2   20.2    15.3      20.5      58.4        9.3      11.8
San Diego           1,997      100         75        75      52.8    47.2    29.3    27.0   24.6    19.0      31.3      15.8       24.4      28.4
Seattle             2,405      100         81        81      51.3    48.7    26.9    25.3   23.5    23.8      34.4      17.4        4.3      43.9

Unweighted data
Detroit             2,291       85         59        50      54.3    45.7    24.1    28.1   27.3    19.7       2.5      87.7        3.4       6.4
Dist. of Columbia   1,643       89         66        58      55.0    45.0    19.9    29.3   28.8    21.9       1.8      86.6        5.2       6.4
Los Angeles           867      100         44        44      52.8    47.2    23.1    25.0   27.6    24.2      12.0       5.0       70.2      12.9
San Francisco       1,236      100         47        47      49.9    50.1    27.1    26.7   26.7    19.4       8.3      13.6       14.9      63.2
-----------------------------------------------------------------------------------------------------------------------------------------------------
* Non-Hispanic.
+ Survey did not include students from the state's largest city.
& U.S. territories are included as states.
@ Not available.
=====================================================================================================================================================

TABLE 2. Percentage of high school students who rarely or never used safety belts, * motorcycle helmets, + or bicycle helmets; &
percentage who rode with a driver who had been drinking alcohol; @ and percentage who drove after drinking alcohol, @ by
sex, race/ethnicity, and grade -- United States, Youth Risk Behavior Survey, 1995
=======================================================================================================================================================================================
                  Rarely or never used                Rarely or never used             Rarely or never used             Rode with a driver who              Drove after drinking
                      safety belts                     motorcycle helmets                 bicycle helmets              had been drinking alcohol                   alcohol
               ----------------------------      -----------------------------      ----------------------------      ----------------------------     -----------------------------
Category       Female       Male      Total      Female        Male      Total      Female       Male      Total      Female       Male      Total     Female       Male       Total
Race/Ethnicity
White **        15.2        25.1       20.5        42.4        41.4       41.8        91.3       92.1       91.8        37.3       37.9       37.7       13.6       19.4        16.8
             (+/-3.6) ++ (+/-5.3)   (+/-4.1)   (+/-23.1)   (+/-12.6)  (+/-16.1)    (+/-2.7)   (+/-2.1)   (+/-2.1)    (+/-5.8)   (+/-6.5)   (+/-5.4)   (+/-4.6)   (+/-4.9)    (+/-4.5)

Black **        25.7        37.8       31.5        32.3        54.6       47.3        96.3       98.3       97.3        33.0       41.6       37.1        5.3       16.1        10.5
             (+/-5.5)   (+/-7.8)    (+/-5.4)   (+/-17.2)   (+/-11.1)   (+/-9.0)    (+/-2.6)   (+/-0.7)   (+/-1.2)    (+/-4.5)   (+/-4.0)   (+/-3.2)   (+/-1.6)   (+/-5.0)    (+/-2.1)

Hispanic        14.2        22.6       18.4        47.8        62.6       57.8        96.7       96.2       96.4        49.7       49.2       49.4       13.6       17.1        15.3
             (+/-5.4)    (+/-6.2)   (+/-4.9)   (+/-23.6)    (+/-8.7)  (+/-11.7)    (+/-1.2)   (+/-2.3)   (+/-1.1)    (+/-6.9)   (+/-8.9)   (+/-7.0)   (+/-4.4)   (+/-5.0)    (+/-3.4)
Grade
 9th            20.7        26.9       24.3        40.2        43.5       42.5        93.0       91.2       92.0        35.4       39.1       37.6        7.0       11.4         9.6
             (+/-5.1)    (+/-3.9)   (+/-3.6)   (+/-19.7)   (+/-13.9)  (+/-14.6)    (+/-3.5)   (+/-3.4)   (+/-2.9)    (+/-5.6)   (+/-5.9)   (+/-4.3)   (+/-3.5)   (+/-3.7)    (+/-2.5)

10th            15.3        23.9       19.7        34.5        37.7       36.6        92.1       92.8       92.5        39.6       35.1       37.3        9.8       10.9        10.4
             (+/-3.2)    (+/-5.0)   (+/-3.3)   (+/-17.2)   (+/-11.0)  (+/-11.9)    (+/-3.7)   (+/-2.7)   (+/-2.7)    (+/-6.1)   (+/-5.3)   (+/-4.3)   (+/-5.0)   (+/-2.2)    (+/-3.1)

11th            13.5        24.2       19.1        38.7        45.5       43.0        91.6       94.8       93.4        36.0       38.7       37.4       13.2       18.9        16.1
             (+/-4.3)    (+/-5.9)   (+/-4.0)   (+/-19.9)    (+/-8.5)  (+/-10.5)    (+/-3.4)   (+/-1.8)   (+/-1.5)    (+/-4.6)   (+/-6.0)   (+/-4.5)   (+/-3.3)   (+/-5.5)    (+/-3.7)

12th            18.8        29.0       23.8        50.1        51.7       51.1        92.3       94.8       93.7        39.2       44.8       42.2       15.8       32.0        24.0
             (+/-4.2)    (+/-5.2)   (+/-4.0)   (+/-25.2)   (+/-12.6)  (+/-16.1)    (+/-4.2)   (+/-1.9)   (+/-2.5)    (+/-4.0)   (+/-3.9)   (+/-3.5)   (+/-4.5)   (+/-3.8)    (+/-3.6)

Total           16.9        26.0       21.7        42.0        44.7       43.8        92.3       93.3       92.8        37.8       39.5       38.8       11.9       18.5        15.4
             (+/-3.3)    (+/-4.0)   (+/-3.2)   (+/-20.8)   (+/-10.1)  (+/-13.4)    (+/-2.0)   (+/-1.6)   (+/-1.6)    (+/-4.3)   (+/-4.4)   (+/-3.9)   (+/-3.7)   (+/-3.2)    (+/-3.2)
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
 * When riding in a car or truck driven by someone else.
 + Among students who rode motorcycles during the 12 months preceding the survey.
 & Among students who rode bicycles during the 12 months preceding the survey.
 @ One or more times during the 30 days preceding the survey.
** Non-Hispanic.
++ Ninety-five percent confidence interval.
=======================================================================================================================================================================================

TABLE 3. Percentage of high school students who rarely or never used safety belts, * motorcycle helmets, + or bicycle helmets; & percentage who rode with a driver who had
been drinking alcohol; @ and percentage who drove after drinking alcohol, @ by sex -- selected U.S. sites, Youth Risk Behavior Surveys, 1995
==================================================================================================================================================================================
                        Rarely or never used          Rarely or never used           Rarely or never used             Rode with a driver who         Drove after drinking
                            safety belts              motorcycle   helmets              bicycle helmets             had been drinking alcohol              alcohol
                      --------------------------   ---------------------------     -------------------------      ----------------------------   ---------------------------
Site                  Female       Male    Total   Female       Male     Total     Female       Male   Total      Female       Male      Total   Female      Male      Total
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
STATE SURVEYS

Weighted data
Alabama                 14.9       29.8     22.4     36.6       39.1      38.4       94.8       91.8    93.1        34.9       41.6       38.4     10.1      21.2       15.6
Alaska                  15.4       23.2     19.5     35.6       42.7      40.8       88.6       88.3    88.4        32.1       31.5       31.9      9.4      14.7       12.3
Arkansas                19.3       33.0     26.2     32.8       43.2      40.0       97.1       96.7    96.9        39.3       44.5       41.9     11.0      24.9       18.0
Colorado **             16.5       27.0     21.9     59.5       53.8      55.9       88.1       86.1    87.0        38.6       37.4       38.0     13.1      18.4       15.8
Guam ++                  8.9       10.7      9.8     NA &&        NA        NA       91.9       86.7    88.9        38.1       39.3       38.8      4.4      13.2        9.1
Hawaii                   7.7       10.8      9.3     67.7       68.2      67.8       96.6       96.8    96.7        38.7       36.7       37.6      8.8      14.6       11.7
Illinois                22.6       35.8     29.1     77.3       70.5      73.1       96.2       95.6    95.9        38.1       37.9       38.0      9.6      18.0       13.8
Maine                   16.6       25.8     21.3     36.2       43.1      40.3       85.5       83.3    84.4        33.0       35.5       34.2     12.4      15.4       13.9
Massachusetts           22.8       36.6     29.8     20.3       29.2      26.5       90.5       90.0    90.2        33.4       39.6       36.6     12.0      19.8       15.9
Mississippi             21.7       36.3     29.0     36.2       47.5      44.2       97.9       97.2    97.6        41.4       47.7       44.6     11.4      28.1       19.6
Missouri                22.4       39.3     31.0     35.9       47.3      43.6       96.8       95.2    96.0        43.3       47.0       45.2     15.8      27.0       21.4
Montana                 24.5       38.7     31.9     61.7       50.2      54.5       93.4       90.7    92.0        46.8       49.2       48.1     21.9      32.4       27.4
Nevada                  14.5       23.5     19.0     26.9       27.9      28.2       95.4       94.2    94.7        38.6       35.2       36.8     10.7      16.7       13.9
New Hampshire           17.5       29.8     23.8     18.7       33.7      27.4       84.5       82.7    83.6        27.9       35.1       31.5     11.5      18.3       14.9
New Jersey **           16.7       30.5     23.5     20.1       32.4      29.0       90.5       93.1    91.9        28.2       32.7       30.4      6.6      16.0       11.2
North Carolina           5.5       11.0      8.2     19.3       38.7      31.8       93.4       91.6    92.4        26.4       31.2       28.7      9.6      13.4       11.5
North Dakota              NA         NA       NA     65.0       49.7      56.1       98.9       97.7    98.2        48.5       48.8       48.7     28.9      36.5       32.5
Puerto Rico ++          17.2       19.7     18.5     60.9       52.1      55.5       96.9       96.0    96.3        34.7       46.1       40.1      2.6      14.0        8.1
South Carolina          16.6       33.1     25.0     52.7       64.1      59.9       97.2       95.8    96.4        36.7       42.0       39.5     11.2      23.1       17.3
South Dakota            23.8       50.3     37.2     54.9       55.6      55.3       96.8       93.8    95.4        48.1       50.9       49.5     26.7      33.2       30.0
Utah                    14.4       24.1     19.3     60.3       57.3      58.4       94.0       88.5    91.1        22.2       20.6       21.4      5.8       9.4        7.6
Vermont                  8.4       18.6     13.8       NA         NA        NA       74.5       75.6    75.0        33.4       39.5       36.6     10.4      19.4       15.0
Virgin Islands ++        7.6       10.8      9.3       NA         NA      48.8         NA         NA      NA        17.7       28.2       22.7      3.6       7.7        5.6
West Virginia           13.1       27.2     20.3     41.7       52.9      49.5       96.1       95.0    95.5        31.9       40.4       36.3     10.8      22.0       16.6
Wyoming                 24.0       42.6     33.4     44.9       43.8      44.2       95.2       92.5    93.8        40.6       44.0       42.3     18.0      26.7       22.4

Unweighted data
California **            4.8        7.4      5.9     24.4       39.7      33.8       87.2       87.8    87.4        31.3       34.5       32.8      7.7      14.8       10.9
Delaware                13.4       23.3     18.3     27.1       46.1      38.8       94.1       91.8    92.9        32.8       34.4       33.7     10.4      16.0       13.1
Georgia                 19.1       33.6     25.7     51.1       44.8      47.0       94.3       93.3    93.8        34.2       39.4       36.5      8.2      20.3       13.6
Idaho                   16.6       33.7     25.6     48.6       45.5      46.6       92.6       89.9    91.1        30.1       31.5       30.8     10.3      17.6       14.3
Marshall Islands ++       NA         NA       NA       NA         NA      57.4       89.2       79.0    83.4        33.8       43.8       38.4      3.1      11.1        6.6
Michigan**               8.6       22.2     15.8     24.0       28.8      27.4       95.4       94.4    94.9        38.8       39.6       39.2     16.7      22.8       19.9
Nebraska                22.6       42.3     33.1     34.5       59.1      51.7       97.6       96.4    97.0        48.6       49.1       48.8     21.6      32.4       27.2
Ohio                    19.6       30.2     25.0     48.3       52.7      51.0       96.3       95.0    95.5        34.0       35.4       34.8     10.3      18.7       14.6
Rhode Island            31.1       42.6     36.6     25.6       47.9      40.7       95.0       94.4    94.7        33.4       34.4       33.9      9.2      15.6       12.3
Tennessee               21.4       35.5     28.1     29.1       39.5      35.7       95.9       92.9    94.4        34.0       37.4       35.6      9.9      19.3       14.3
LOCAL SURVEYS

Weighted data
Boston                  39.7       43.0     41.3     49.5       46.5      47.0       92.0       91.6    91.7        27.1       31.5       29.3      4.7      10.5        7.8
Chicago                 40.1       42.4     41.2     79.7       67.3      72.6       94.7       92.5    93.6        32.9       37.8       35.2      4.5      10.3        7.3
Dallas                  10.0       16.3     13.1     52.3       58.4      56.9       97.7       97.3    97.4        43.2       49.5       46.3      8.1      19.8       13.8
Denver                  26.3       35.3     30.9     65.0       58.3      60.9       87.1       87.9    87.5        41.2       43.8       42.6     10.2      17.7       14.0
Ft. Lauderdale          15.1       22.8     18.9     39.8       48.6      45.0       96.7       96.8    96.8        30.2       29.5       29.9      7.8       9.8        8.8
Houston                 11.4       16.7     14.2     44.4       49.3      47.7       92.5       88.2    90.1        41.3       45.7       43.8      7.3      21.4       14.0
Jersey City             42.4       49.7     46.1       NA         NA        NA       95.0       96.2    95.7        29.0       34.4       31.5      4.0       7.4        5.7
Miami                   16.9       26.3     21.7     41.6       51.5      48.9       97.7       97.0    97.2        26.6       33.5       30.1      4.0      14.6        9.5
New Orleans             44.4       46.5     45.5     46.1       42.0      43.1       96.9       96.2    96.3        36.9       42.0       39.3      5.7      12.9        9.1
Philadelphia            42.5       46.1     44.5     44.2       53.3      50.1       94.2       92.9    93.5        27.2       32.1       29.6      2.9       8.5        5.7
San Diego                6.0        9.8      7.8     24.6       38.5      33.9       84.6       83.1    83.8        32.6       32.6       32.7      7.7      14.0       10.6
Seattle                  9.1       17.7     13.3       NA         NA        NA         NA         NA      NA          NA         NA         NA       NA        NA         NA

Unweighted data
Detroit                 28.3       39.9     33.6     33.3       37.4      36.2       97.7       96.0    96.9        38.7       43.1       40.7      6.3      15.1       10.3
Dist. of Columbia       26.9       34.8     30.5     39.6       45.6      43.8       94.5       94.1    94.3        29.6       36.2       32.7      5.5      11.5        8.2
Los Angeles              7.2       14.2     10.5       NA         NA      36.4       89.4       94.4    92.2        36.1       37.7       36.9      6.8      13.5       10.0
San Francisco            9.2        7.3      8.3       NA         NA        NA         NA         NA      NA        22.6       18.6       20.6      2.8       3.9        3.4
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
 * When riding in a car or truck driven by someone else.
 + Among  students who rode motorcycles during the 12 months preceding the survey.
 & Among students who rode bicycles during the 12 months preceding the survey.
 @ One or more times during the 30 days preceding the survey.
** Survey did not include students from the state's largest city.
++ U.S. territories are included as states.
&& Not available.
==================================================================================================================================================================================

TABLE 4.  Percentage  of high school students who carried a weapon * or a gun + and the 30-day incidence of w