Youth Risk Behavior Surveillance --- United States, 2007

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Danice K. Eaton, PhD,¹ Laura Kann, PhD,¹ Steve Kinchen,¹ Shari Shanklin, MS,¹ James Ross, MS,² Joseph Hawkins, MA,³ William A. Harris, MM,¹Richard Lowry, MD,¹ Tim McManus, MS,¹ David Chyen, MS,¹ Connie Lim, MPA,¹ Nancy D. Brener, PhD,¹ Howell Wechsler, EdD^1

1Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
²Macro International Inc., Calverton, Maryland
³Westat, Rockville, Maryland

Corresponding author: Danice K. Eaton, PhD, Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, MS K-33, 4770 Buford Hwy, NE, Atlanta, GA 30341. Telephone: 770-488-6143; Fax: 770-488-6156; E-mail: dhe0@cdc.gov.

Abstract

Problem: Priority health-risk behaviors, which are behaviors that contribute to the leading causes of morbidity and mortality among youth and adults, often are established during childhood and adolescence, extend into adulthood, are interrelated, and are preventable.

Description of the System: The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health-risk behaviors among youth and young adults, including behaviors that contribute to unintentional injuries and violence; tobacco use; alcohol and other drug use; sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infection; unhealthy dietary behaviors; and physical inactivity. In addition, YRBSS monitors the prevalence of obesity and asthma. YRBSS includes a national school-based survey conducted by CDC and state and local school-based surveys conducted by state and local education and health agencies. This report summarizes results from the national survey, 39 state surveys, and 22 local surveys conducted among students in grades 9--12 during 2007.

Results: In the United States, 72% of all deaths among persons aged 10--24 years result from four causes: motor-vehicle crashes, other unintentional injuries, homicide, and suicide. Results from the 2007 national Youth Risk Behavior Survey (YRBS) indicated that many high school students engaged in behaviors that increased their likelihood of death from these four causes. Among high school students nationwide during 2007, 11.1% had never or rarely worn a seat belt when riding in a car driven by someone else. During the 30 days before the survey, 29.1% of high school students had ridden in a car or other vehicle driven by someone who had been drinking alcohol, 18.0% had carried a weapon, and 5.5% had not gone to school because they felt they would be unsafe at school or on their way to or from school. During the 12 months before the survey, 6.9% of high school students had attempted suicide. In addition, 75.0% of high school students had ever drunk alcohol, and 4.4% had ever used methamphetamines. Substantial morbidity and social problems among youth also result from unintended pregnancies and STDs, including HIV infection. Results from the 2007 survey indicated that 47.8% of students had ever had sexual intercourse, 35.0% of high school students were currently sexually active, and 38.5% of currently sexually active high school students had not used a condom during last sexual intercourse. Among U.S. adults aged >25 years, 59% of all deaths result from two causes: cardiovascular disease and cancer. Results from the 2007 national YRBS indicated that risk behaviors associated with these two causes of death were present during adolescence. Among high school students nationwide during 2007, 20.0% had smoked cigarettes during the 30 days before the survey, 35.4% had watched television 3 or more hours per day on an average school day, and 13.0% were obese. During the 7 days before the survey, 78.6% of high school students had not eaten fruits and vegetables five or more times per day, 33.8% had drunk soda or pop at least one time per day, and 65.3% had not met recommended levels of physical activity.

Interpretation: Since 1991, the prevalence of many health-risk behaviors among high school students nationwide has decreased. However, many high school students continue to engage in behaviors that place them at risk for the leading causes of mortality and morbidity. The prevalence of most risk behaviors does not vary substantially among cities and states.

Public Health Action: YRBS data are used to measure progress toward achieving 15 national health objectives for Healthy People 2010 and three of the 10 leading health indicators, to assess trends in priority health-risk behaviors among high school students, and to evaluate the impact of broad school and community interventions at the national, state, and local levels. More effective school health programs and other policy and programmatic interventions are needed to reduce risk and improve health outcomes among youth.

Introduction

In the United States, 72% of all deaths among youth and young adults aged 10--24 years result from four causes: motor-vehicle crashes (30%), other unintentional injuries (15%), homicide (15%), and suicide (12%) (1). Substantial morbidity and social problems also result from the approximately 757,000 pregnancies among women aged 15--19 years (2), the estimated 9.1 million cases of sexually transmitted diseases (STDs) among persons aged 15--24 years (3), and the estimated 5,089 cases of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) among persons aged 15--24 years (4) that occur annually. Among adults aged >25 years, 59% of all deaths in the United States result from cardiovascular disease (36%) and cancer (23%) (1). These leading causes of morbidity and mortality among youth and adults in the United States are related to six categories of priority health-risk behaviors: behaviors that contribute to unintentional injuries and violence; tobacco use; alcohol and other drug use; sexual behaviors that contribute to unintended pregnancy and STDs, including HIV infection; unhealthy dietary behaviors; and physical inactivity. These behaviors frequently are interrelated and are established during childhood and adolescence and extend into adulthood.

To monitor priority health-risk behaviors in each of these six categories and obesity and asthma among youth and young adults, CDC developed the Youth Risk Behavior Surveillance System (YRBSS) (5). YRBSS includes national, state, and local school-based surveys of students in grades 9--12. National, state, and local surveys have been conducted biennially since 1991 (Box).

This report summarizes results from the 2007 national Youth Risk Behavior Survey (YRBS) and trends during 1991--2007 in selected risk behaviors. Data from the 39 state and 22 local surveys with weighted data for the 2007 YRBSS cycle also are included (Figure 1) in this report. Data from the remaining five state surveys with unweighted data are not included. The national survey, 37 weighted state surveys, and 22 weighted local surveys were conducted during spring 2007, and two of the weighted state surveys were conducted during fall 2007.

Methods

Detailed information about the local, state, and national YRBSs has been described elsewhere (5). Information also is available at http://www.cdc.gov/yrbs.

Sampling

The sampling frame for the 2007 national YRBS consisted of all public and private schools with students in at least one of grades 9--12 in the 50 states and the District of Columbia. The sampling frame was obtained from the Quality Education Data (QED), Inc., database (6). The QED database includes information on both public and private schools and the most recent data from the Common Core of Data from the National Center for Education Statistics (7). A three-stage cluster sample design produced a nationally representative sample of students in grades 9--12 who attend public and private schools. The first-stage sampling frame consisted of 1,268 primary sampling units (PSUs), consisting of counties, subareas of large counties, or groups of smaller, adjacent counties. The 1,268 PSUs were categorized into 16 strata according to their metropolitan statistical area (MSA) status (i.e., urbanicity) and the percentages of black* and Hispanic^† students in the PSUs. From the 1,268 PSUs, 57 were selected with probability proportional to overall school enrollment size for the PSU.

In the second stage of sampling, 195 schools with any of grades 9--12 were selected with probability proportional to school enrollment size. The third stage of sampling consisted of randomly selecting, in each chosen school and in each of grades 9--12, one or two classrooms from either a required subject (e.g., English or social studies) or a required period (e.g., homeroom or second period). All students in selected classes were eligible to participate. Schools, classes, and students that refused to participate were not replaced.

To enable a separate analysis of data for black and Hispanic students, three strategies were used to oversample these students: 1) larger sampling rates were used to select PSUs that are in high-black and high-Hispanic strata; 2) a modified measure of size was used that increased the probability of selecting schools with a disproportionately high minority enrollment; and 3) two classes per grade, rather than one, were selected in schools with a high minority enrollment.

In 2007, each state and local school-based survey used a two-stage cluster sample design to produce a representative sample of public school students in grades 9--12 in their jurisdiction. In the first sampling stage, schools with any of grades 9--12 were selected with probability proportional to school enrollment size in 37 states and five cities; all schools with any of grades 9--12 were selected in two states and 17 cities. In the second sampling stage, intact classes from either a required subject (e.g., English or social studies) or a required period (e.g., homeroom or second period) were selected randomly, and all students in selected classes were eligible to participate in 38 states and 22 cities; all students in selected schools were eligible to participate in one state.

Data Collection Procedures and Questionnaires

Survey procedures for the national, state, and local surveys were designed to protect students' privacy by allowing for anonymous and voluntary participation. Before survey administration, local parental permission procedures were followed. Students completed the self-administered questionnaire during one class period and recorded their responses directly on a computer-scannable booklet or answer sheet. CDC's Institutional Review Board approved the protocol for the national YRBS.

The core questionnaire contained 87 questions. States and cities could add or delete questions from the core questionnaire. For the national questionnaire, 11 questions were added to the core questionnaire. Skip patterns were not included in any YRBS questionnaire to protect students' privacy by ensuring all students took about the same amount of time to complete the survey. For state and local surveys, only data from core questions are presented in this report. Information about the reliability of the core questionnaire has been published elsewhere (8).

Data Processing Procedures and Response Rates

For the 2007 national YRBS, 14,103 questionnaires were completed in 157 schools. The national data set was cleaned and edited for inconsistencies. Missing data were not statistically imputed. Of the 14,103 completed questionnaires from the national YRBS, 62 failed quality control^§ and were excluded from analysis, leaving 14,041 usable questionnaires (Table 1). The school response rate was 81%; the student response rate was 84%; the overall response rate was 68%^¶ (Table 1).

In 2007, a total of 39 state and 22 local surveys had weighted data. Data from each state and local data set were cleaned and edited for inconsistencies with the same procedures used for the national data set. The number of completed questionnaires that failed quality control checks and were excluded from analysis from the state and local surveys ranged from 0 to 117 (median: six). The student sample sizes ranged from 1,118 to 13,439 (Table 1). School response rates ranged from 69% to 100%; student response rates ranged from 60% to 92%; and overall response rates ranged from 60% to 90%.

Race/ethnicity was computed from two questions: 1) "Are you Hispanic or Latino?" (response options were "yes" or "no"), and 2) "What is your race?" (response options were "American Indian or Alaska Native," "Asian," "black or African American," "Native Hawaiian or other Pacific Islander," or "white"). For the second question, students could select more than one response option. For this report, students were classified as "Hispanic/Latino" if they answered "yes" to the first question, regardless of how they answered the second question. Students were classified as "black" if they answered "no" to the first question and selected only "black or African American" to the second question. Students were classified as "white" if they answered "no" to the first question and selected only "white" to the second question. Students were classified as "other" if they answered "no" to the first question and selected "American Indian or Alaska Native," "Asian," and/or "Native Hawaiian or other Pacific Islander" or selected more than one response to the second question. Race/ethnicity was classified as missing for students who did not answer the first question and for students who answered "no" to the first question but did not answer the second question. Throughout this report, students who self-identified as "Hispanic/Latino" are referred to as "Hispanic" and students who self-identified as "black or African American" are referred to as "black."

Students were classified as obese or overweight based on their body mass index (kg/m²) (BMI), which was calculated from self-reported height and weight. The BMI values were compared with sex- and age-specific reference data from the 2000 CDC growth charts (9). Obese was defined as a BMI of >95th percentile for age and sex. Overweight was defined as a BMI of >85th percentile and <95th percentile for age and sex. Previous YRBS reports used the terms "overweight" to describe youth with a BMI >95th percentile for age and sex and "at risk for overweight" for those with a BMI >85th percentile and <95th percentile. However, this report uses the terms "obese" and "overweight" in accordance with the 2007 recommendations from the Expert Committee on the Assessment, Prevention, and Treatment of Child and Adolescent Overweight and Obesity convened by the American Medical Association (AMA) and cofunded by AMA in collaboration with the Health Resources and Services Administration and CDC (10). These classifications are not intended to diagnose obesity or overweight in individual students, rather to provide estimates of obesity and overweight for the population of students surveyed.

Weighting

For the national YRBS, a weight based on student sex, race/ethnicity, and grade was applied to each record to adjust for school and student nonresponse and oversampling of black and Hispanic students. The overall weights were scaled so that the weighted count of students equals the total sample size, and the weighted proportions of students in each grade match the national population proportions. Therefore, weighted estimates are representative of all students in grades 9--12 attending public and private school in the United States.

State and local surveys that had a representative sample of students, appropriate documentation, and an overall response rate of 60% or higher were weighted. A weight was applied to each record to adjust for student nonresponse and the distribution of students by grade, sex, and race/ethnicity in each jurisdiction. Therefore, weighted state and local estimates are representative of all students in grades 9--12 attending public schools in each jurisdiction.

Analytic Methods

Statistical analyses were conducted on weighted data using SAS^® (11) and SUDAAN (12) software to account for the complex sampling designs. Prevalence estimates and confidence intervals were computed for all variables and all data sets. In addition, for the national YRBS data, t tests were used to determine pairwise differences between subpopulations and temporal changes during 2005--2007 (13). Differences between prevalence estimates were considered statistically significant if the t test p value was <0.05 for main effects (sex, race/ethnicity, and grade), for interactions (sex by race/ethnicity, sex by grade, race/ethnicity by sex, and grade by sex), and for changes over time. Only statistically significant differences in prevalence estimates are reported in the results section in the following order: sex, sex by race/ethnicity, sex by grade, race/ethnicity, race/ethnicity by sex, grade, and grade by sex.

For the national YRBS data, temporal changes from the earliest year of data collection to 2007 were analyzed using logistic regression analyses that controlled for sex, grade, and race/ethnicity and that simultaneously assessed linear and quadratic time effects (13). Quadratic trends indicate a significant but nonlinear trend in the data over time. Trends that include significant linear and quadratic components demonstrate nonlinear variation (e.g., leveling off or change in direction) in addition to an overall increase or decrease over time. Trends are described only for variables with significant temporal changes from the earliest year of data collection to 2007 or during 2005--2007.

Results

Behaviors that Contribute to Unintentional Injuries

Nationwide, 11.1% of students had rarely or never worn a seat belt when riding in a car driven by someone else (Table 2). Overall, the prevalence of having rarely or never worn a seat belt was higher among male (13.6%) than female (8.5%) students; higher among white male (13.0%), black male (14.7%), and Hispanic male (14.3%) than white female (7.3%), black female (10.0%), and Hispanic female (11.4%) students, respectively; and higher among 9th-grade male (15.1%), 10th-grade male (13.2%), 11th-grade male (12.2%), and 12th-grade male (13.8%) than 9th-grade female (9.2%), 10th-grade female (8.3%), 11th-grade female (8.9%), and 12th-grade female (7.3%) students, respectively. Prevalence of having rarely or never worn a seat belt ranged from 6.0% to 19.4% across state surveys (median: 11.2%) and from 5.6% to 25.1% across local surveys (median: 9.6%) (Table 3).

Among the 66.8% of students nationwide who had ridden a bicycle during the 12 months before the survey, 85.1% had rarely or never worn a bicycle helmet (Table 2). Overall, the prevalence of having rarely or never worn a bicycle helmet was higher among male (87.4%) than female (82.2%) students; higher among white male (85.6%) than white female (79.5%) students; and higher among 9th-grade male (86.4%), 10th-grade male (88.1%), and 11th-grade male (88.1%) than 9th-grade female (80.1%), 10th-grade female (83.0%), and 11th-grade female (83.0%) students, respectively. Overall, the prevalence of having rarely or never worn a bicycle helmet was higher among black (94.2%) and Hispanic (88.7%) than white (82.9%) students; higher among black (94.2%) than Hispanic (88.7%) students; higher among black female (93.0%) and Hispanic female (86.6%) than white female (79.5%) students; higher among black female (93.0%) than Hispanic female (86.6%) students; higher among black male (95.0%) and Hispanic male (90.3%) than white male (85.6%) students; and higher among black male (95.0%) than Hispanic male (90.3%) students. Prevalence of having rarely or never worn a bicycle helmet among students who had ridden a bicycle during the 12 months before the survey ranged from 57.6% to 94.8% across state surveys (median: 87.8%) and from 69.7% to 96.4% across local surveys (median: 88.8%) (Table 3).

Among the 24.3% of students nationwide who had ridden a motorcycle during the 12 months before the survey, 33.9% had rarely or never worn a motorcycle helmet (Table 4). Overall, the prevalence of having rarely or never worn a motorcycle helmet was higher among male (38.1%) than female (27.1%) students; higher among white male (30.8%) and black male (52.4%) than white female (19.2%) and black female (36.0%) students, respectively; and higher among 9th-grade male (41.4%), 11th-grade male (38.1%), and 12th-grade male (36.5%) than 9th-grade female (29.8%), 11th-grade female (24.9%), and 12th-grade female (24.8%) students, respectively. Overall, the prevalence of having rarely or never worn a motorcycle helmet was higher among black (46.0%) and Hispanic (51.3%) than white (26.3%) students; higher among black female (36.0%) and Hispanic female (49.6%) than white female (19.2%) students; and higher among black male (52.4%) and Hispanic male (52.4%) than white male (30.8%) students.

During the 30 days before the survey, 29.1% of students nationwide had ridden one or more times in a car or other vehicle driven by someone who had been drinking alcohol (Table 5). The prevalence of having ridden with a driver who had been drinking alcohol was higher among 11th-grade male (31.4%) than 11th-grade female (26.8%) students. Overall, the prevalence of having ridden with a driver who had been drinking alcohol was higher among Hispanic (35.5%) than white (27.9%) and black (27.4%) students; higher among Hispanic female (35.1%) than white female (28.0%) and black female (26.9%) students; and higher among Hispanic male (36.0%) than white male (27.8%) and black male (28.1%) students. Overall, the prevalence of having ridden with a driver who had been drinking alcohol was higher among 12th-grade (31.5%) than 9th-grade (27.6%) students and higher among 11th-grade male (31.4%) and 12th-grade male (32.5%) than 10th-grade male (27.1%) students. The prevalence of having ridden with a driver who had been drinking alcohol ranged from 14.8% to 35.6% across state surveys (median: 27.4%) and from 18.0% to 38.4% across local surveys (median: 27.0%) (Table 6).

During the 30 days before the survey, 10.5% of students nationwide had driven a car or other vehicle one or more times when they had been drinking alcohol (Table 5). Overall, the prevalence of having driven when they had been drinking alcohol was higher among male (12.8%) than female (8.1%) students; higher among white male (13.9%), black male (7.5%), and Hispanic male (13.0%) than white female (9.3%), black female (3.9%), and Hispanic female (7.7%) students, respectively; and higher among 9th-grade male (6.8%), 11th-grade male (13.7%), and 12th-grade male (23.6%) than 9th-grade female (4.1%), 11th-grade female (9.1%), and 12th-grade female (13.1%) students, respectively. Overall, the prevalence of having driven when they had been drinking alcohol was higher among white (11.6%) and Hispanic (10.3%) than black (5.7%) students; higher among white female (9.3%) and Hispanic female (7.7%) than black female (3.9%) students; and higher among white male (13.9%) and Hispanic male (13.0%) than black male (7.5%) students. Overall, the prevalence of having driven when they had been drinking alcohol was higher among 10th-grade (8.7%), 11th-grade (11.5%), and 12th-grade (18.3%) than 9th-grade (5.5%) students; higher among 11th-grade (11.5%) and 12th-grade (18.3%) than 10th-grade (8.7%) students; higher among 12th-grade (18.3%) than 11th-grade (11.5%) students; higher among 10th-grade female (7.3%), 11th-grade female (9.1%), and 12th-grade female (13.1%) than 9th-grade female (4.1%) students; higher among 12th-grade female (13.1%) than 10th-grade female (7.3%) and 11th-grade female (9.1%) students; higher among 10th-grade male (10.0%), 11th-grade male (13.7%), and 12th-grade male (23.6%) than 9th-grade male (6.8%) students; higher among 11th-grade male (13.7%) and 12th-grade male (23.6%) than 10th-grade male (10.0%) students; and higher among 12th-grade male (23.6%) than 11th-grade male (13.7%) students. The prevalence of having driven a car when they had been drinking alcohol ranged from 4.7% to 18.7% across state surveys (median: 10.4%) and from 2.8% to 12.9% across local surveys (median: 6.6%) (Table 6).

Behaviors that Contribute to Violence

Nationwide, 18.0% of students had carried a weapon (e.g., a gun, knife, or club) on at least 1 day during the 30 days before the survey (Table 7). Overall, the prevalence of having carried a weapon was higher among male (28.5%) than female (7.5%) students; higher among white male (30.3%), black male (24.6%), and Hispanic male (28.2%) than white female (6.1%), black female (10.0%), and Hispanic female (9.0%) students, respectively; and higher among 9th-grade male (31.0%), 10th-grade male (29.3%), 11th-grade male (27.7%), and 12th-grade male (25.0%) than 9th-grade female (8.9%), 10th-grade female (8.1%), 11th-grade female (6.0%), and 12th-grade female (6.2%) students, respectively. The prevalence of having carried a weapon was higher among black female (10.0%) and Hispanic female (9.0%) than white female (6.1%) students; and higher among white male (30.3%) than black male (24.6%) students. Overall, the prevalence of having carried a weapon was higher among 9th-grade (20.1%) than 11th-grade (16.7%) and 12th-grade (15.5%) students; higher among 10th-grade (18.8%) than 12th-grade (15.5%) students; higher among 9th-grade female (8.9%) than 11th-grade female (6.0%) and 12th-grade female (6.2%) students; and higher among 9th-grade male (31.0%) and 10th-grade male (29.3%) than 12th-grade male (25.0%) students. The prevalence of having carried a weapon ranged from 12.0% to 27.5% across state surveys (median: 18.5%) and from 8.6% to 21.7% across local surveys (median: 16.3%) (Table 8).

Nationwide, 5.2% of students had carried a gun on at least 1 day during the 30 days before the survey (Table 7). Overall, the prevalence of having carried a gun was higher among male (9.0%) than female (1.2%) students; higher among white male (7.8%), black male (11.2%), and Hispanic male (10.4%) than white female (0.8%), black female (1.3%), and Hispanic female (2.1%) students, respectively; and higher among 9th-grade male (8.9%), 10th-grade male (9.8%), 11th-grade male (8.1%), and 12th-grade male (9.2%) than 9th-grade female (1.4%), 10th-grade female (1.1%), 11th-grade female (1.2%), and 12th-grade female (0.9%) students, respectively. Overall, the prevalence of having carried a gun was higher among black (6.2%) and Hispanic (6.2%) than white (4.3%) students; higher among Hispanic female (2.1%) than white female (0.8%) students; and higher among black male (11.2%) and Hispanic male (10.4%) than white male (7.8%) students. Prevalence of having carried a gun ranged from 3.5% to 11.7% across state surveys (median: 6.5%) and from 2.1% to 8.9% across local surveys (median: 5.5%) (Table 8).

Nationwide, 35.5% of students had been in a physical fight one or more times during the 12 months before the survey (Table 9). Overall, the prevalence of having been in a physical fight was higher among male (44.4%) than female (26.5%) students; higher among white male (41.9%), black male (50.3%), and Hispanic male (47.3%) than white female (21.5%), black female (39.4%), and Hispanic female (33.5%) students, respectively; and higher among 9th-grade male (49.6%), 10th-grade male (45.1%), 11th-grade male (46.3%), and 12th-grade male (34.3%) than 9th-grade female (31.8%), 10th-grade female (27.2%), 11th-grade female (23.5%), and 12th-grade female (21.8%) students, respectively. Overall, the prevalence of having been in a physical fight was higher among black (44.7%) and Hispanic (40.4%) than white (31.7%) students; higher among black (44.7%) than Hispanic (40.4%) students; higher among black female (39.4%) and Hispanic female (33.5%) than white female (21.5%) students; higher among black female (39.4%) than Hispanic female (33.5%) students; and higher among black male (50.3%) and Hispanic male (47.3%) than white male (41.9%) students. Overall, the prevalence of having been in a physical fight was higher among 9th-grade (40.9%) than 10th-grade (36.2%), 11th-grade (34.8%), and 12th-grade (28.0%) students; higher among 10th-grade (36.2%) and 11th-grade (34.8%) than 12th-grade (28.0%) students; higher among 9th-grade female (31.8%) than 10th-grade female (27.2%), 11th-grade female (23.5%), and 12th-grade female (21.8%) students; higher among 10th-grade female (27.2%) than 11th-grade female (23.5%) and 12th-grade female (21.8%) students; and higher among 9th-grade male (49.6%), 10th-grade male (45.1%), and 11th-grade male (46.3%) than 12th-grade male (34.3%) students. Prevalence of having been in a physical fight ranged from 24.0% to 37.1% across state surveys (median: 30.3%) and from 22.8% to 45.0% across local surveys (median: 33.6%) (Table 10).

Nationwide, 4.2% of students had been in a physical fight one or more times during the 12 months before the survey in which they were injured and had to be treated by a doctor or nurse (Table 9). Overall, the prevalence of having been injured in a physical fight was higher among male (5.5%) than female (2.9%) students; higher among white male (4.1%) and Hispanic male (7.6%) than white female (2.0%) and Hispanic female (5.1%) students, respectively; and higher among 9th-grade male (6.7%), 10th-grade male (5.4%), 11th-grade male (4.6%), and 12th-grade male (4.4%) than 9th-grade female (4.3%), 10th-grade female (2.1%), 11th-grade female (2.5%), and 12th-grade female (2.3%) students, respectively. Overall, the prevalence of having been injured in a physical fight was higher among black (5.3%) and Hispanic (6.3%) than white (3.0%) students; higher among black female (4.2%) and Hispanic female (5.1%) than white female (2.0%) students; and higher among black male (6.5%) and Hispanic male (7.6%) than white male (4.1%) students. Overall, the prevalence of having been injured in a physical fight was higher among 9th-grade (5.6%) than 10th-grade (3.7%), 11th-grade (3.5%), and 12th-grade (3.3%) students; higher among 9th-grade female (4.3%) than 10th-grade female (2.1%), 11th-grade female (2.5%), and 12th-grade female (2.3%) students; and higher among 9th-grade male (6.7%) than 11th-grade male (4.6%) and 12th-grade male (4.4%) students. The prevalence of having been injured in a physical fight ranged from 2.2% to 6.0% across state surveys (median: 3.8%) and from 3.3% to 9.6% across local surveys (median: 4.6%) (Table 10).

During the 12 months before the survey, 9.9% of students nationwide had been hit, slapped, or physically hurt on purpose by their boyfriend or girlfriend (i.e., dating violence) (Table 11). Overall, the prevalence of dating violence was higher among male (11.0%) than female (8.8%) students and higher among 9th-grade male (10.5%) and 12th-grade male (14.1%) than 9th-grade female (6.3%) and 12th-grade female (10.1%) students, respectively. Overall, the prevalence of dating violence was higher among black (14.2%) and Hispanic (11.1%) than white (8.4%) students; higher among black (14.2%) than Hispanic (11.1%) students; higher among black female (13.2%) and Hispanic female (10.1%) than white female (7.4%) students; higher among black female (13.2%) than Hispanic female (10.1%) students; and higher among black male (15.2%) than white male (9.3%) students. Overall, the prevalence of dating violence was higher among 11th-grade (10.6%) and 12th-grade (12.1%) than 9th-grade (8.5%) and 10th-grade (8.9%) students; higher among 11th-grade female (10.2%) and 12th-grade female (10.1%) than 9th-grade female (6.3%) students; and higher among 12th-grade male (14.1%) than 9th-grade male (10.5%) and 10th-grade male (9.1%) students. Prevalence of dating violence ranged from 7.2% to 15.7% across state surveys (median: 11.8%) and from 6.6% to 17.4% across local surveys (median: 12.0%) (Table 12).

Nationwide, 7.8% of students had ever been physically forced to have sexual intercourse when they did not want to (Table 11). Overall, the prevalence of having been forced to have sexual intercourse was higher among female (11.3%) than male (4.5%) students; higher among white female (11.0%), black female (13.3%), and Hispanic female (11.4%) than white male (3.2%), black male (7.8%), and Hispanic male (6.2%) students, respectively; and higher among 9th-grade female (9.2%), 10th-grade female (13.1%), 11th-grade female (12.0%), and 12th-grade female (10.9%) than 9th-grade male (4.1%), 10th-grade male (3.4%), 11th-grade male (5.0%), and 12th-grade male (5.7%) students, respectively. Overall, the prevalence of having been forced to have sexual intercourse was higher among black (10.5%) and Hispanic (8.8%) than white (7.0%) students and higher among black male (7.8%) and Hispanic male (6.2%) than white male (3.2%) students. Overall, the prevalence of having been forced to have sexual intercourse was higher among 11th-grade (8.5%) and 12th-grade (8.3%) than 9th-grade (6.6%) students; higher among 10th-grade female (13.1%) than 9th-grade female (9.2%) students; and higher among 11th-grade male (5.0%) and 12th-grade male (5.7%) than 10th-grade male (3.4%) students. Prevalence of having been forced to have sexual intercourse ranged from 6.3% to 14.0% across state surveys (median: 9.1%) and from 5.6% to 12.2% across local surveys (median: 8.5%) (Table 12).

Nationwide, 5.9% of students had carried a weapon (e.g., a gun, knife, or club) on school property on at least 1 day during the 30 days before the survey (Table 13). Overall, the prevalence of having carried a weapon on school property was higher among male (9.0%) than female (2.7%) students; higher among white male (8.5%), black male (8.4%), and Hispanic male (10.4%) than white female (2.1%), black female (3.5%), and Hispanic female (4.1%) students, respectively; and higher among 9th-grade male (8.7%), 10th-grade male (8.8%), 11th-grade male (8.6%), and 12th-grade male (9.8%) than 9th-grade female (3.1%), 10th-grade female (2.6%), 11th-grade female (2.4%), and 12th-grade female (2.3%) students, respectively. The prevalence of having carried a weapon on school property was higher among black female (3.5%) and Hispanic female (4.1%) than white female (2.1%) students. Prevalence of having carried a weapon on school property ranged from 3.6% to 11.4% across state surveys (median: 5.6%) and from 2.6% to 9.9% across local surveys (median: 5.2%) (Table 14).

During the 12 months before the survey, 7.8% of students nationwide had been threatened or injured with a weapon (e.g., a gun, knife, or club) on school property one or more times (Table 13). Overall, the prevalence of having been threatened or injured with a weapon on school property was higher among male (10.2%) than female (5.4%) students; higher among white male (9.2%), black male (11.2%), and Hispanic male (12.0%) than white female (4.6%), black female (8.1%), and Hispanic female (5.4%) students, respectively; and higher among 9th-grade male (11.4%), 10th-grade male (10.4%), 11th-grade male (10.5%), and 12th-grade male (8.1%) than 9th-grade female (6.8%), 10th-grade female (6.3%), 11th-grade female (3.2%), and 12th-grade female (4.5%) students, respectively. Overall, the prevalence of having been threatened or injured with a weapon on school property was higher among black (9.7%) and Hispanic (8.7%) than white (6.9%) students; higher among black female (8.1%) than white female (4.6%) and Hispanic female (5.4%) students; and higher among Hispanic male (12.0%) than white male (9.2%) students. Overall, the prevalence of having been threatened or injured with a weapon on school property was higher among 9th-grade (9.2%) and 10th-grade (8.4%) than 11th-grade (6.8%) and 12th-grade (6.3%) students; higher among 9th-grade female (6.8%) and 10th-grade female (6.3%) than 11th-grade female (3.2%) students; and higher among 9th-grade male (11.4%) and 11th-grade male (10.5%) than 12th-grade male (8.1%) students. Prevalence of having been threatened or injured with a weapon on school property ranged from 5.2% to 11.4% across state surveys (median: 8.1%) and from 5.8% to 12.8% across local surveys (median: 9.1%) (Table 14).

Nationwide, 12.4% of students had been in a physical fight on school property one or more times during the 12 months before the survey (Table 15). Overall, the prevalence of having been in a physical fight on school property was higher among male (16.3%) than female (8.5%) students; higher among white male (14.5%), black male (20.0%), and Hispanic male (18.5%) than white female (5.9%), black female (15.2%), and Hispanic female (12.4%) students, respectively; and higher among 9th-grade male (22.3%), 10th-grade male (15.0%), 11th-grade male (14.8%), and 12th-grade male (11.1%) than 9th-grade female (11.4%), 10th-grade female (8.3%), 11th-grade female (7.3%), and 12th-grade female (6.2%) students, respectively. Overall, the prevalence of having been in a physical fight on school property was higher among black (17.6%) and Hispanic (15.5%) than white (10.2%) students; higher among black female (15.2%) and Hispanic female (12.4%) than white female (5.9%) students; and higher among black male (20.0%) and Hispanic male (18.5%) than white male (14.5%) students. Overall, the prevalence of having been in a physical fight on school property was higher among 9th-grade (17.0%) than 10th-grade (11.7%), 11th-grade (11.0%), and 12th-grade (8.6%) students; higher among 10th-grade (11.7%) and 11th-grade (11.0%) than 12th-grade (8.6%) students; higher among 9th-grade female (11.4%) than 10th-grade female (8.3%), 11th-grade female (7.3%), and 12th-grade female (6.2%) students; higher among 9th-grade male (22.3%) than 10th-grade male (15.0%), 11th-grade male (14.8%), and 12th-grade male (11.1%) students; and higher among 10th-grade male (15.0%) and 11th-grade male (14.8%) than 12th-grade male (11.1%) students. Prevalence of having been in a physical fight on school property ranged from 7.0% to 16.9% across state surveys (median: 11.3%) and from 8.1% to 21.2% across local surveys (median: 14.5%) (Table 16).

Nationwide, 27.1% of students had had their property (e.g., car, clothing, or books) stolen or deliberately damaged on school property one or more times during the 12 months before the survey (Table 15). Overall, the prevalence of having property stolen or damaged on school property was higher among male (30.4%) than female (23.7%) students; higher among white male (29.3%), black male (32.8%), and Hispanic male (32.0%) than white female (22.6%), black female (25.6%), and Hispanic female (26.0%) students, respectively; and higher among 11th-grade male (32.1%) and 12th-grade male (27.2%) than 11th-grade female (19.7%) and 12th-grade female (18.8%) students, respectively. Overall, the prevalence of having property stolen or damaged on school property was higher among black (29.3%) and Hispanic (29.0%) than white (25.9%) students. Overall, the prevalence of having property stolen or damaged on school property was higher among 9th-grade (30.6%) than 11th-grade (25.9%) and 12th-grade (22.9%) students; higher among 10th-grade (27.6%) than 12th-grade (22.9%) students; higher among 9th-grade female (28.8%) and 10th-grade female (25.8%) than 11th-grade female (19.7%) and 12th-grade female (18.8%) students; and higher among 9th-grade male (32.2%) than 12th-grade male (27.2%) students. Prevalence of having property stolen or deliberately damaged on school property ranged from 19.8% to 34.0% across state surveys (median: 27.2%) and from 22.8% to 36.6% across local surveys (median: 27.4%) (Table 16).

Nationwide, 5.5% of students had not gone to school on at least 1 day during the 30 days before the survey because they felt they would be unsafe at school or on their way to or from school (Table 17). Overall, the prevalence of having not gone to school because of safety concerns was higher among black (6.6%) and Hispanic (9.6%) than white (4.0%) students; higher among Hispanic (9.6%) than black (6.6%) students; higher among black female (6.3%) and Hispanic female (9.7%) than white female (4.2%) students; higher among Hispanic female (9.7%) than black female (6.3%) students; higher among black male (6.8%) and Hispanic male (9.6%) than white male (3.7%) students; and higher among Hispanic male (9.6%) than black male (6.8%) students. Overall, the prevalence of having not gone to school because of safety concerns was higher among 9th-grade (6.6%) than 11th-grade (4.7%) and 12th-grade (4.8%) students; and higher among 9th-grade female (7.4%) and 10th-grade female (6.0%) than 11th-grade female (3.9%) and 12th-grade female (4.3%) students. Prevalence of having not gone to school because of safety concerns ranged from 3.8% to 9.0% across state surveys (median: 5.8%) and from 5.4% to 14.4% across local surveys (median: 9.1%) (Table 18).

During the 12 months before the survey, 28.5% of students nationwide had felt so sad or hopeless almost every day for 2 or more weeks in a row that they stopped doing some usual activities (Table 19). Overall, the prevalence of having felt sad or hopeless almost every day for 2 or more weeks in a row was higher among female (35.8%) than male (21.2%) students; higher among white female (34.6%), black female (34.5%), and Hispanic female (42.3%) than white male (17.8%), black male (24.0%), and Hispanic male (30.4%) students, respectively; and higher among 9th-grade female (34.8%), 10th-grade female (37.7%), 11th-grade female (34.5%), and 12th-grade female (35.9%) than 9th-grade male (22.1%), 10th-grade male (20.3%), 11th-grade male (19.5%), and 12th-grade male (22.6%) students, respectively. Overall, the prevalence of having felt sad or hopeless almost every day for 2 or more weeks in a row was higher among black (29.2%) and Hispanic (36.3%) than white (26.2%) students; higher among Hispanic (36.3%) than black (29.2%) students; higher among Hispanic female (42.3%) than white female (34.6%) and black female (34.5%) students; higher among black male (24.0%) and Hispanic male (30.4%) than white male (17.8%) students; and higher among Hispanic male (30.4%) than black male (24.0%) students. Prevalence of having felt sad or hopeless almost every day for 2 or more weeks ranged from 17.1% to 32.5% across state surveys (median: 26.1%) and from 24.8% to 32.2% across local surveys (median: 27.8%) (Table 20).

Nationwide, 14.5% of students had seriously considered attempting suicide during the 12 months before the survey (Table 21). Overall, the prevalence of having seriously considered attempting suicide was higher among female (18.7%) than male (10.3%) students; higher among white female (17.8%), black female (18.0%), and Hispanic female (21.1%) than white male (10.2%), black male (8.5%), and Hispanic male (10.7%) students, respectively; and higher among 9th-grade female (19.0%), 10th-grade female (22.0%), 11th-grade female (16.3%), and 12th-grade female (16.7%) than 9th-grade male (10.8%), 10th-grade male (9.3%), 11th-grade male (10.7%), and 12th-grade male (10.2%) students, respectively. The prevalence of having seriously considered attempting suicide was higher among Hispanic female (21.1%) than white female (17.8%) students. The prevalence of having seriously considered attempting suicide was higher among 10th-grade female (22.0%) than 11th-grade female (16.3%) and 12th-grade female (16.7%) students. Prevalence of having seriously considered attempting suicide ranged from 10.4% to 19.3% across state surveys (median: 14.5%) and from 9.7% to 15.0% across local surveys (median: 12.7%) (Table 22).

During the 12 months before the survey, 11.3% of students nationwide had made a plan about how they would attempt suicide (Table 21). Overall, the prevalence of having made a suicide plan was higher among female (13.4%) than male (9.2%) students; higher among white female (12.8%), black female (12.0%), and Hispanic female (15.2%) than white male (8.8%), black male (7.1%), and Hispanic male (10.4%) students, respectively; and higher among 9th-grade female (13.4%) and 10th-grade female (16.1%) than 9th-grade male (9.2%) and 10th-grade male (8.9%) students, respectively. Overall, the prevalence of having made a suicide plan was higher among Hispanic (12.8%) than white (10.8%) and black (9.5%) students; higher among Hispanic female (15.2%) than white female (12.8%) students; and higher among Hispanic male (10.4%) than black male (7.1%) students, respectively. The prevalence of having made a suicide plan was higher among 10th-grade female (16.1%) than 11th-grade female (11.6%) and 12th- grade female (11.7%) students. Prevalence of having made a suicide plan ranged from 8.1% to 17.8% across state surveys (median: 11.5%) and from 8.0% to 14.7% across local surveys (median: 10.9%) (Table 22).

Nationwide, 6.9% of students had attempted suicide one or more times during the 12 months before the survey (Table 23). Overall, the prevalence of having attempted suicide was higher among female (9.3%) than male (4.6%) students; higher among white female (7.7%), black female (9.9%), and Hispanic female (14.0%) than white male (3.4%), black male (5.5%), and Hispanic male (6.3%) students, respectively; and higher among 9th-grade female (10.5%), 10th-grade female (11.2%), 11th-grade female (7.8%), and 12th-grade female (6.5%) than 9th-grade male (5.3%), 10th-grade male (4.9%), 11th-grade male (3.7%), and 12th-grade male (4.2%) students, respectively. Overall, the prevalence of having attempted suicide was higher among black (7.7%) and Hispanic (10.2%) than white (5.6%) students; higher among Hispanic (10.2%) than black (7.7%) students; higher among Hispanic female (14.0%) than white female (7.7%) and black female (9.9%) students; and higher among black male (5.5%) and Hispanic male (6.3%) than white male (3.4%) students. Overall, the prevalence of having attempted suicide was higher among 9th-grade (7.9%) and 10th-grade (8.0%) than 11th-grade (5.8%) and 12th-grade (5.4%) students; higher among 9th-grade female (10.5%) than 12th-grade female (6.5%) students; and higher among 10th-grade female (11.2%) than 11th-grade female (7.8%) and 12th-grade female (6.5%) students. Prevalence of having attempted suicide ranged from 4.8% to 14.3% across state surveys (median: 7.9%) and from 5.1% to 13.3% across local surveys (median: 9.0%) (Table 24).

During the 12 months before the survey, 2.0% of students nationwide had made a suicide attempt that resulted in an injury, poisoning, or an overdose that had to be treated by a doctor or nurse (Table 23). Overall, the prevalence of having made a suicide attempt that resulted in an injury, poisoning, or an overdose that had to be treated by a doctor or nurse was higher among female (2.4%) than male (1.5%) students; higher among white female (2.1%) and Hispanic female (3.9%) than white male (0.9%) and Hispanic male (1.8%) students, respectively; and higher among 10th-grade female (3.1%) than 10th-grade male (1.0%) students. Overall, the prevalence of having made a suicide attempt that resulted in an injury, poisoning, or an overdose that had to be treated by a doctor or nurse was higher among Hispanic (2.9%) than white (1.5%) students; higher among Hispanic female (3.9%) than white female (2.1%) and black female (2.1%) students; and higher among black male (2.5%) and Hispanic male (1.8%) than white male (0.9%) students. Overall, the prevalence of having made a suicide attempt that resulted in an injury, poisoning, or an overdose that had to be treated by a doctor or nurse was higher among 9th-grade (2.3%) than 12th-grade (1.7%) students and higher among 10th-grade female (3.1%) than 11th-grade female (1.7%) students. Prevalence of having made a suicide attempt that resulted in an injury, poisoning, or an overdose that had to be treated by a doctor or nurse ranged from 1.5% to 4.8% across state surveys (median: 2.6%) and from 1.4% to 4.7% across local surveys (median: 2.9%) (Table 24).

Tobacco Use

Nationwide, 50.3% of students had ever tried cigarette smoking (even one or two puffs) (i.e., lifetime cigarette use) (Table 25). Overall, the prevalence of lifetime cigarette use was higher among male (51.8%) than female (48.8%) students; higher among white male (51.7%) than white female (48.3%) students; and higher among 9th-grade male (46.0%) than 9th-grade female (39.2%) students. Overall, the prevalence of lifetime cigarette use was higher among 10th-grade (48.8%), 11th-grade (53.4%), and 12th-grade (59.3%) than 9th-grade (42.7%) students; higher among 11th-grade (53.4%) and 12th-grade (59.3%) than 10th-grade (48.8%) students; and higher among 12th-grade (59.3%) than 11th-grade (53.4%) students. Overall, the prevalence of lifetime cigarette use was higher among 10th-grade female (48.7%), 11th-grade female (51.4%), and 12th-grade female (58.5%) students than 9th-grade female (39.2%) students; higher among 12th-grade female (58.5%) than 10th-grade female (48.7%) and 11th-grade female (51.4%) students; and higher among 11th-grade male (55.4%) and 12th-grade male (60.1%) than 9th-grade male (46.0%) and 10th-grade male (48.8%) students. Prevalence of lifetime cigarette use ranged from 24.9% to 62.2% across state surveys (median: 51.9%) and from 36.5% to 57.6% across local surveys (median: 43.6%) (Table 26).

Nationwide, 12.4% of students had ever smoked at least one cigarette every day for 30 days (i.e., lifetime daily cigarette use) (Table 25). The prevalence of lifetime daily cigarette use was higher among black male (7.3%) than black female (5.0%) students and higher among 9th-grade male (10.3%) than 9th-grade female (6.3%) students. Overall, the prevalence of lifetime daily cigarette use was higher among white (15.4%) than black (6.2%) and Hispanic (8.0%) students; higher among white female (14.9%) than black female (5.0%) and Hispanic female (7.1%) students; and higher among white male (15.8%) than black male (7.3%) and Hispanic male (8.9%) students. Overall, the prevalence of lifetime daily cigarette use was higher among 10th-grade (12.0%), 11th-grade (13.8%), and 12th-grade (16.8%) than 9th-grade (8.3%) students; higher among 12th-grade (16.8%) than 10th-grade (12.0%) students; higher among 10th-grade female (12.4%), 11th-grade female (14.0%), and 12th-grade female (15.8%) than 9th-grade female (6.3%) students; higher among 12th-grade female (15.8%) than 10th-grade female (12.4%) students; and higher among 12th-grade male (18.0%) than 9th-grade male (10.3%), 10th-grade male (11.7%), and 11th-grade male (13.4%) students. Prevalence of lifetime daily cigarette use ranged from 4.6% to 21.1% across state surveys (median: 13.3%) and from 4.0% to 9.1% across local surveys (median: 6.0%) (Table 26).

Nationwide, 20.0% of students had smoked cigarettes on at least 1 day during the 30 days before the survey (i.e., current cigarette use) (Table 27). Overall, the prevalence of current cigarette use was higher among male (21.3%) than female (18.7%) students and higher among black male (14.9%) and Hispanic male (18.7%) than black female (8.4%) and Hispanic female (14.6%) students, respectively. Overall, the prevalence of current cigarette use was higher among white (23.2%) than black (11.6%) and Hispanic (16.7%) students; higher among Hispanic (16.7%) than black (11.6%) students; higher among white female (22.5%) than black female (8.4%) and Hispanic female (14.6%) students; higher among Hispanic female (14.6%) than black female (8.4%) students; and higher among white male (23.8%) than black male (14.9%) and Hispanic male (18.7%) students. Overall, the prevalence of current cigarette use was higher among 10th-grade (19.6%), 11th-grade (21.6%), and 12th-grade (26.5%) than 9th-grade (14.3%) students; higher among 12th-grade (26.5%) than 10th-grade (19.6%) and 11th-grade (21.6%) students; higher among 10th-grade female (19.1%), 11th-grade female (19.6%), and 12th-grade female (25.5%) than 9th-grade female (12.3%) students; higher among 12th-grade female (25.5%) than 10th-grade female (19.1%) and 11th-grade female (19.6%) students; higher among 11th-grade male (23.4%) and 12th-grade male (27.4%) than 9th-grade male (16.2%) students; and higher among 12th-grade male (27.4%) than 10th-grade male (20.0%) students. Prevalence of current cigarette use ranged from 7.9% to 27.6% across state surveys (median: 20.0%) and from 6.2% to 15.3% across local surveys (median: 11.4%) (Table 28).

Nationwide, 8.1% of students had smoked cigarettes on 20 or more days during the 30 days before the survey (i.e., current frequent cigarette use) (Table 27). Overall, the prevalence of current frequent cigarette use was higher among male (8.7%) than female (7.4%) students and higher among black male (5.8%) than black female (2.1%) students. Overall, the prevalence of current frequent cigarette use was higher among white (10.4%) than black (3.9%) and Hispanic (4.2%) students; higher among white female (10.2%) than black female (2.1%) and Hispanic female (3.3%) students; and higher among white male (10.6%) than black male (5.8%) and Hispanic male (5.1%) students. Overall, the prevalence of current frequent cigarette use was higher among 10th-grade (7.0%), 11th-grade (10.1%), and 12th-grade (12.2%) than 9th-grade (4.3%) students; higher among 11th-grade (10.1%) and 12th-grade (12.2%) than 10th-grade (7.0%) students; higher among 10th-grade female (6.8%), 11th-grade female (9.7%), and 12th-grade female (11.3%) than 9th-grade female (3.3%) students; higher among 12th-grade female (11.3%) than 10th-grade female (6.8%) students; and higher among 11th-grade male (10.5%) and 12th-grade male (13.1%) than 9th-grade male (5.4%) and 10th-grade male (7.2%) students. Prevalence of current frequent cigarette use ranged from 2.5% to 14.4% across state surveys (median: 8.1%) and from 1.8% to 5.8% across local surveys (median: 3.0%) (Table 28).

Among the 20.0% of students nationwide who currently smoked cigarettes, 10.7% of students had smoked more than 10 cigarettes per day on the days they smoked during the 30 days before the survey (Table 29). Overall, the prevalence of having smoked more than 10 cigarettes per day was higher among male (13.8%) than female (7.1%) students; higher among white male (15.7%) and black male (8.6%) than white female (8.0%) and black female (1.7%) students, respectively; higher among 10th-grade male (12.6%) and 12th-grade male (19.2%) than 10th-grade female (5.3%) and 12th-grade female (7.8%) students, respectively. Overall, the prevalence of having smoked more than 10 cigarettes per day was higher among white (11.9%) than black (6.1%) and Hispanic (6.8%) students; higher among white female (8.0%) than black female (1.7%) students; and higher among white male (15.7%) than black male (8.6%) and Hispanic male (8.4%) students. The prevalence of having smoked more than 10 cigarettes per day was higher among 12th-grade male (19.2%) than 11th-grade male (9.9%) students. The prevalence of having smoked more than 10 cigarettes per day ranged from 4.1% to 20.3% across state surveys (median: 9.7%) and from 1.9% to 12.8% across local surveys (median: 7.4%) (Table 30).

Among the 20.0% of students nationwide who currently smoked cigarettes, 49.7% had tried to quit smoking cigarettes during the 12 months before the survey (Table 29). Overall, the prevalence of having tried to quit smoking cigarettes was higher among female (55.1%) than male (45.1%) students; higher among white female (55.6%) and black female (67.5%) than white male (43.8%) and black male (53.6%) students, respectively; and higher among 11th-grade female (56.1%) and 12th-grade female (56.4%) than 11th-grade male (44.9%) and 12th-grade male (41.1%) students, respectively. Overall, the prevalence of having tried to quit smoking cigarettes was higher among black (58.4%) than white (49.4%) and Hispanic (48.3%) students; and higher among black female (67.5%) than white female (55.6%) and Hispanic female (47.2%) students. The prevalence of having tried to quit smoking cigarettes ranged from 43.4% to 62.5% across state surveys (median: 55.7%) and from 41.4% to 64.2% across local surveys (median: 55.5%) (Table 30).

Nationwide, 16.0% of the 16.1% of students who currently smoked cigarettes and were aged <18 years usually obtained their own cigarettes by buying them in a store (i.e., convenience store, supermarket, or discount store) or gas station during the 30 days before the survey (Table 31). Overall, the prevalence of having bought their own cigarettes in a store or gas station was higher among male (20.0%) than female (11.3%) students; higher among white male (20.4%) than white female (10.9%) students; and higher among 10th-grade male (20.2%), 11th-grade male (20.9%), and 12th-grade male (34.8%) than 10th-grade female (9.4%), 11th-grade female (13.6%), and 12th-grade female (17.0%) students, respectively. Overall, the prevalence of having bought their own cigarettes in a store or gas station was higher among 11th-grade (17.8%) and 12th-grade (25.6%) than 9th-grade (9.7%) students; higher among 12th-grade (25.6%) than 10th-grade (15.0%) and 11th-grade (17.8%) students; higher among 11th-grade female (13.6%) and 12th-grade female (17.0%) than 9th-grade female (7.0%) students; higher among 10th-grade male (20.2%), 11th-grade male (20.9%), and 12th-grade male (34.8%) than 9th-grade male (11.8%) students; and higher among 12th-grade male (34.8%) than 10th-grade male (20.2%) and 11th-grade male (20.9%) students. Prevalence of having bought their own cigarettes in a store or gas station ranged from 3.0% to 27.0% across state surveys (median: 14.1%) and from 10.2% to 39.4% across local surveys (median: 23.2%) (Table 32).

Nationwide, 7.9% of students had used smokeless tobacco (e.g., chewing tobacco, snuff, or dip) on at least 1 day during the 30 days before the survey (i.e., current smokeless tobacco use) (Table 31). Overall, the prevalence of current smokeless tobacco use was higher among male (13.4%) than female (2.3%) students; higher among white male (18.0%), black male (2.0%), and Hispanic male (6.7%) than white female (2.5%), black female (0.5%), and Hispanic female (2.7%) students, respectively; and higher among 9th-grade male (10.4%), 10th-grade male (14.4%), 11th-grade male (13.3%), and 12th-grade male (15.9%) than 9th-grade female (2.0%), 10th-grade female (2.8%), 11th-grade female (2.0%), and 12th-grade female (2.2%) students, respectively. Overall, the prevalence of current smokeless tobacco use was higher among white (10.3%) than black (1.2%) and Hispanic (4.7%) students; higher among Hispanic (4.7%) than black (1.2%) students; higher among white female (2.5%) and Hispanic female (2.7%) than black female (0.5%) students; higher among white male (18.0%) than black male (2.0%) and Hispanic male (6.7%) students; and higher among Hispanic male (6.7%) than black male (2.0%) students. Overall, the prevalence of current smokeless tobacco use was higher among 10th-grade (8.7%) and 12th-grade (8.9%) than 9th-grade (6.3%) students; and higher among 10th-grade male (14.4%) and 12th-grade male (15.9%) than 9th-grade male (10.4%) students. Prevalence of current smokeless tobacco use ranged from 4.2% to 15.8% across state surveys (median: 8.6%) and from 1.0% to 7.2% across local surveys (median: 3.2%) (Table 32).

Nationwide, 13.6% of students had smoked cigars, cigarillos, or little cigars on at least 1 day during the 30 days before the survey (i.e., current cigar use) (Table 33). Overall, the prevalence of current cigar use was higher among male (19.4%) than female (7.6%) students; higher among white male (22.0%), black male (13.2%), and Hispanic male (16.3%) than white female (7.4%), black female (6.7%), and Hispanic female (9.0%) students, respectively; and higher among 9th-grade male (13.5%), 10th-grade male (16.9%), 11th-grade male (23.2%), and 12th-grade male (26.2%) than 9th-grade female (6.1%), 10th-grade female (7.9%), 11th-grade female (7.6%), and 12th-grade female (9.2%) students, respectively. Overall, the prevalence of current cigar use was higher among white (14.8%) than black (10.0%) and Hispanic (12.7%) students; higher among Hispanic (12.7%) than black (10.0%) students; and higher among white male (22.0%) than black male (13.2%) and Hispanic male (16.3%) students. Overall, the prevalence of current cigar use was higher among 11th-grade (15.5%) and 12th-grade (17.6%) than 9th-grade (9.9%) and 10th-grade (12.5%) students; higher among 12th-grade female (9.2%) than 9th-grade female (6.1%) students; and higher among 11th-grade male (23.2%) and 12th-grade male (26.2%) than 9th-grade male (13.5%) and 10th-grade male (16.9% ) students. Prevalence of current cigar use ranged from 7.0% to 18.9% across state surveys (median: 14.5%) and from 4.5% to 16.9% across local surveys (median: 10.1%) (Table 34).

Nationwide, 25.7% of students had reported current cigarette use, current smokeless tobacco use, or current cigar use (i.e., current tobacco use) (Table 33). Overall, the prevalence of current tobacco use was higher among male (30.3%) than female (21.0%) students; higher among white male (35.3%), black male (19.9%), and Hispanic male (23.9%) than white female (24.3%), black female (12.1%), and Hispanic female (16.4%) students, respectively; and higher among 9th-grade male (22.6%), 10th-grade male (28.5%), 11th-grade male (34.5%), and 12th-grade male (38.3%) than 9th-grade female (14.4%), 10th-grade female (21.0%), 11th-grade female (21.8%), and 12th-grade female (28.6%) students, respectively. Overall, the prevalence of current tobacco use was higher among white (29.9%) than black (16.0%) and Hispanic (20.1%) students; higher among white female (24.3%) than black female (12.1%) and Hispanic female (16.4%) students; and higher among white male (35.3%) than black male (19.9%) and Hispanic male (23.9%) students. Overall, the prevalence of current tobacco use was higher among 10th-grade (24.8%), 11th-grade (28.2%), and 12th-grade (33.4%) than 9th-grade (18.6%) students; higher among 12th-grade (33.4%) than 10th-grade (24.8%) and 11th-grade (28.2%) students; higher among 10th-grade female (21.0%), 11th-grade female (21.8%), and 12th-grade female (28.6%) than 9th-grade female (14.4%) students; higher among 12th-grade female (28.6%) than 10th-grade female (21.0%) and 11th-grade female (21.8%) students; higher among 10th-grade male (28.5%), 11th-grade male (34.5%), and 12th-grade male (38.3%) than 9th-grade male (22.6%) students; and higher among 11th-grade male (34.5%) and 12th-grade male (38.3%) than 10th-grade male (28.5%) students. Prevalence of current tobacco use ranged from 8.9% to 34.5% across state surveys (median: 25.8%) and from 10.3% to 20.3% across local surveys (median: 14.6%) (Table 34).

Alcohol and Other Drug Use

Nationwide, 75.0% of students had had at least one drink of alcohol on at least 1 day during their life (i.e., lifetime alcohol use) (Table 35). The prevalence of lifetime alcohol use was higher among 12th-grade female (85.2%) than 12th-grade male (80.2%) students. Overall, the prevalence of lifetime alcohol use was higher among white (76.1%) and Hispanic (77.9%) than black (69.1%) students; higher among white female (76.4%) and Hispanic female (79.3%) than black female (70.0%) students; and higher among white male (75.8%) and Hispanic male (76.5%) than black male (68.4%) students. Overall, the prevalence of lifetime alcohol use was higher among 10th-grade (74.7%), 11th-grade (79.4%), and 12th-grade (82.8%) than 9th-grade (65.5%) students; higher among 11th-grade (79.4%) and 12th-grade (82.8%) than 10th-grade (74.7%) students; higher among 12th-grade (82.8%) than 11th-grade (79.4%) students; higher among 10th-grade female (74.6%), 11th-grade female (79.1%), and 12th-grade female (85.2%) than 9th-grade female (66.1%) students; higher among 12th-grade female (85.2%) than 10th-grade female (74.6%) and 11th-grade female (79.1%) students; higher among 10th-grade male (74.9%), 11th-grade male (79.7%), and 12th-grade male (80.2%) than 9th-grade male (65.0%) students; and higher among 11th-grade male (79.7%) and 12th-grade male (80.2%) than 10th-grade male (74.9%) students. Prevalence of lifetime alcohol use ranged from 36.7% to 78.2% across state surveys (median: 73.5%) and from 53.2% to 74.8% across local surveys (median: 66.7%) (Table 36).

Nationwide, 44.7% of students had had at least one drink of alcohol on at least 1 day during the 30 days before the survey (i.e., current alcohol use) (Table 35). The prevalence of current alcohol use was higher among 11th-grade male (51.5%) than 11th-grade female (46.5%) students. Overall, the prevalence of current alcohol use was higher among white (47.3%) and Hispanic (47.6%) than black (34.5%) students; higher among white female (47.1%) and Hispanic female (47.5%) than black female (34.9%) students; and higher among white male (47.4%) and Hispanic male (47.7%) than black male (34.1%) students. Overall, the prevalence of current alcohol use was higher among 10th-grade (41.8%), 11th-grade (49.0%), and 12th-grade (54.9%) than 9th-grade (35.7%) students; higher among 11th-grade (49.0%) and 12th-grade (54.9%) than 10th-grade (41.8%) students; higher among 12th-grade (54.9%) than 11th-grade (49.0%) students; higher among 11th-grade female (46.5%) and 12th-grade female (54.2%) than 9th-grade female (37.2%) students; higher among 12th-grade female (54.2%) than 10th-grade female (42.3%) and 11th-grade female (46.5%) students; higher among 10th-grade male (41.4%), 11th-grade male (51.5%), and 12th-grade male (55.6%) than 9th-grade male (34.3%) students; and higher among 11th-grade male (51.5%) and 12th-grade male (55.6%) than 10th-grade male (41.4%) students. Prevalence of current alcohol use ranged from 17.0% to 48.9% across state surveys (median: 42.9%) and from 22.3% to 44.3% across local surveys (median: 36.4%) (Table 36).

Nationwide, 26.0% of students had had five or more drinks of alcohol in a row (i.e., within a couple of hours) on at least 1 day during the 30 days before the survey (i.e., episodic heavy drinking) (Table 37). Overall, the prevalence of episodic heavy drinking was higher among male (27.8%) than female (24.1%) students; higher among black male (14.5%) than black female (10.7%) students; and higher among 11th-grade male (33.1%) and 12th-grade male (40.4%) than 11th-grade female (26.7%) and 12th-grade female (32.8%) students, respectively. Overall, the prevalence of episodic heavy drinking was higher among white (29.8%) and Hispanic (26.8%) than black (12.5%) students; higher among white female (27.9%) and Hispanic female (25.3%) than black female (10.7%) students; and higher among white male (31.8%) and Hispanic male (28.3%) than black male (14.5%) students. Overall, the prevalence of episodic heavy drinking was higher among 10th-grade (23.7%), 11th-grade (29.9%), and 12th-grade (36.5%) than 9th-grade (17.0%) students; higher among 11th-grade (29.9%) and 12th-grade (36.5%) than 10th-grade (23.7%) students; higher among 12th-grade (36.5%) than 11th-grade (29.9%) students; higher among 10th-grade female (21.8%), 11th-grade female (26.7%), and 12th-grade female (32.8%) than 9th-grade female (17.2%) students; higher among 12th-grade female (32.8%) than 10th-grade female (21.8%) and 11th-grade female (26.7%) students; higher among 10th-grade male (25.5%), 11th-grade male (33.1%), and 12th-grade male (40.4%) than 9th-grade male (17.0%) students; higher among 11th-grade male (33.1%) and 12th-grade male (40.4%) than 10th-grade male (25.5%) students; and higher among 12th-grade male (40.4%) than 11th-grade male (33.1%) students. Prevalence of episodic heavy drinking ranged from 11.7% to 32.7% across state surveys (median: 26.2%) and from 8.7% to 24.6% across local surveys (median: 18.5%) (Table 38).

Nationwide, 5.2% of the 44.7% students who currently drank alcohol usually obtained the alcohol they drank by buying it in a store (e.g., liquor store, convenience store, supermarket, discount store, or gas station) during the 30 days before the survey (Table 37). Overall, the prevalence of having bought alcohol in a store was higher among male (7.6%) than female (2.7%) students; higher among white male (6.9%) and Hispanic male (9.8%) than white female (2.2%) and Hispanic female (3.6%) students, respectively; and higher among 9th-grade male (5.1%), 11th-grade male (9.1%), and 12th-grade male (11.1%) than 9th-grade female (1.1%), 11th-grade female (2.0%), and 12th-grade female (5.0%) students, respectively. Overall, the prevalence of having bought alcohol in a store was higher among 12th-grade (8.0%) than 9th-grade (3.1%) students; higher among 11th-grade (5.6%) and 12th-grade (8.0%) than 10th-grade (3.6%) students; higher among 12th-grade female (5.0%) than 9th-grade female (1.1%) and 11th-grade female (2.0%) students; higher among 12th-grade male (11.1%) than 9th-grade male (5.1%) students; and higher among 11th-grade male (9.1%) and 12th-grade male (11.1%) than 10th-grade male (4.6%) students. Prevalence of having bought alcohol in a store ranged from 1.8% to 10.0% across state surveys (median: 4.1%) and from 4.5% to 16.2% across local surveys (median: 9.0%) (Table 38).

Nationwide, 38.1% of students had used marijuana one or more times during their life (i.e., lifetime marijuana use) (Table 39). Overall, the prevalence of lifetime marijuana use was higher among male (41.6%) than female (34.5%) students; higher among white male (41.8%), black male (44.5%), and Hispanic male (42.0%) than white female (34.1%), black female (35.0%), and Hispanic female (35.9%) students, respectively; and higher among 9th-grade male (33.0%) and 11th-grade male (48.3%) than 9th-grade female (21.7%) and 11th-grade female (36.6%) students, respectively. Overall, the prevalence of lifetime marijuana use was higher among 10th-grade (36.9%), 11th-grade (42.4%), and 12th-grade (49.1%) than 9th-grade (27.5%) students; higher among 11th-grade (42.4%) and 12th-grade (49.1%) than 10th-grade (36.9%) students; higher among 12th-grade (49.1%) than 11th-grade (42.4%) students; higher among 10th-grade female (34.5%), 11th-grade female (36.6%), and 12th-grade female (48.3%) than 9th-grade female (21.7%) students; higher among 12th-grade female (48.3%) than 10th-grade female (34.5%) and 11th-grade female (36.6%) students; higher among 10th-grade male (39.2%), 11th-grade male (48.3%), and 12th-grade male (49.9%) than 9th-grade male (33.0%) students; and higher among 11th-grade male (48.3%) and 12th-grade male (49.9%) than 10th-grade male (39.2%) students. Prevalence of lifetime marijuana use ranged from 17.4% to 44.7% across state surveys (median: 36.1%) and from 22.8% to 50.8% across local surveys (median: 35.9%) (Table 40).

Nationwide, 19.7% of students had used marijuana one or more times during the 30 days before the survey (i.e., current marijuana use) (Table 39). Overall, the prevalence of current marijuana use was higher among male (22.4%) than female (17.0%) students; higher among white male (22.7%) and black male (26.0%) than white female (17.0%) and black female (17.1%) students, respectively; and higher among 9th-grade male (16.9%), 10th-grade male (22.0%), 11th-grade male (25.2%), and 12th-grade male (27.8%) than 9th-grade female (12.5%), 10th-grade female (16.5%), 11th-grade female (17.5%), and 12th-grade female (22.6%) students, respectively. The prevalence of current marijuana use was higher among black male (26.0%) than Hispanic male (20.5%) students. Overall, the prevalence of current marijuana use was higher among 10th-grade (19.3%), 11th-grade (21.4%), and 12th-grade (25.1%) than 9th-grade (14.7%) students; higher among 12th-grade (25.1%) than 10th-grade (19.3%) students; higher among 10th-grade female (16.5%), 11th-grade female (17.5%), and 12th-grade female (22.6%) than 9th-grade female (12.5%) students; higher among 12th-grade female (22.6%) than 10th-grade female (16.5%) students; higher among 10th-grade male (22.0%), 11th-grade male (25.2%), and 12th-grade male (27.8%) than 9th-grade male (16.9%) students; and higher among 12th-grade male (27.8%) than 10th-grade male (22.0%) students. Prevalence of current marijuana use ranged from 8.7% to 25.1% across state surveys (median: 19.0%) and from 11.4% to 26.8% across local surveys (median: 18.4%) (Table 40).

Nationwide, 7.2% of students had used any form of cocaine (e.g., powder, crack,** or freebase^††) one or more times during their life (i.e., lifetime cocaine use) (Table 41). Overall, the prevalence of lifetime cocaine use was higher among male (7.8%) than female (6.5%) students; higher among black male (2.8%) than black female (0.9%) students; and higher among 12th-grade male (11.4%) than 12th-grade female (7.6%) students. Overall, the prevalence of lifetime cocaine use was higher among white (7.4%) than black (1.8%) students; higher among Hispanic (10.9%) than white (7.4%) and black (1.8%) students; higher among white female (6.9%) than black female (0.9%) students; higher among Hispanic female (10.2%) than white female (6.9%) and black female (0.9%) students; and higher among white male (7.9%) and Hispanic male (11.5%) than black male (2.8%) students. Overall, the prevalence of lifetime cocaine use was higher among 10th-grade (7.2%), 11th-grade (7.7%), and 12th-grade (9.5%) than 9th-grade (4.8%) students; higher among 12th-grade (9.5%) than 10th-grade (7.2%) students; higher among 12th-grade female (7.6%) than 9th-grade female (4.7%) students; higher among 10th-grade male (7.7%), 11th-grade male (8.0%), and 12th-grade male (11.4%) than 9th-grade male (5.0%) students; and higher among 12th-grade male (11.4%) than 10th-grade male (7.7%) and 11th-grade male (8.0%) students. Prevalence of lifetime cocaine use ranged from 5.2% to 14.4% across state surveys (median: 7.4%) and from 0.9% to 12.6% across local surveys (median: 5.9%) (Table 42).

Nationwide, 3.3% of students had used any form of cocaine (e.g., powder, crack, or freebase) one or more times during the 30 days before the survey (i.e., current cocaine use) (Table 41). Overall, the prevalence of current cocaine use was higher among male (4.0%) than female (2.5%) students; higher among Hispanic male (6.7%) than Hispanic female (3.9%) students; and higher among 12th-grade male (6.0%) than 12th-grade female (2.8%) students. Overall, the prevalence of current cocaine use was higher among white (3.0%) than black (1.1%) students; higher among Hispanic (5.3%) than white (3.0%) and black (1.1%) students; higher among white female (2.6%) and Hispanic female (3.9%) than black female (0.5%) students; higher among white male (3.4%) than black male (1.7%) students; and higher among Hispanic male (6.7%) than white male (3.4%) and black male (1.7%) students. Overall, the prevalence of current cocaine use was higher among 12th-grade (4.4%) than 9th-grade (2.7%) and 11th-grade (2.9%) students and higher among 12th-grade male (6.0%) than 9th-grade male (3.0%), 10th-grade male (3.7%), and 11th-grade male (3.5%) students. Prevalence of current cocaine use ranged from 1.7% to 6.6% across state surveys (median: 3.3%) and from 0.5% to 6.2% across local surveys (median: 2.9%) (Table 42).

Nationwide, 2.0% of students had used a needle to inject any illegal drug into their body one or more times during their life (i.e., lifetime illegal injection-drug use) (Table 43). Overall, the prevalence of lifetime illegal injection-drug use was higher among male (2.6%) than female (1.3%) students; higher among white male (2.0%) and black male (2.8%) than white female (1.1%) and black female (0.8%) students, respectively; and higher among 9th-grade male (2.7%) and 12th-grade male (4.1%) than 9th-grade female (1.3%) and 12th-grade female (0.7%) students, respectively. Overall, the prevalence of lifetime illegal injection-drug use was higher among Hispanic (3.1%) than white (1.5%) and black (1.8%) students; higher among Hispanic female (2.5%) than white female (1.1%) and black female (0.8%) students; and higher among Hispanic male (3.6%) than white male (2.0%) students. The prevalence of lifetime illegal injection-drug use was higher among 10th-grade female (1.6%) and 11th-grade female (1.4%) than 12th-grade female (0.7%) students; higher among 9th-grade male (2.7%), 11th-grade male (2.3%), and 12th-grade male (4.1%) than 10th-grade male (1.3%) students; and higher among 12th-grade male (4.1%) than 11th-grade male (2.3%) students. Prevalence of lifetime illegal injection-drug use ranged from 1.1% to 4.7% across state surveys (median: 2.6%) and from 0.5% to 5.5% across local surveys (median: 2.4%) (Table 44).

Nationwide, 13.3% of students had sniffed glue, breathed the contents of aerosol spray cans, or inhaled any paints or sprays to get high one or more times during their life (i.e., lifetime inhalant use) (Table 43). Overall, the prevalence of lifetime inhalant use was higher among female (14.3%) than male (12.4%) students; higher among white female (15.6%) than white male (13.1%) students; and higher among 9th-grade female (17.2%) and 10th-grade female (16.6%) than 9th-grade male (13.0%) and 10th-grade male (12.5%) students, respectively. Overall, the prevalence of lifetime inhalant use was higher among white (14.4%) and Hispanic (14.1%) than black (8.5%) students; higher among white female (15.6%) and Hispanic female (15.5%) than black female (7.9%) students; and higher among white male (13.1%) than black male (9.2%) students. Overall, the prevalence of lifetime inhalant use was higher among 9th-grade (15.0%), 10th-grade (14.6%), and 11th-grade (12.5%) than 12th-grade (10.2%) students and higher among 9th-grade female (17.2%) and 10th-grade female (16.6%) than 11th-grade female (12.4%) and 12th-grade female (9.7%) students. Prevalence of lifetime inhalant use ranged from 9.8% to 19.2% across state surveys (median: 12.8%) and from 6.9% to 17.4% across local surveys (median: 10.0%) (Table 44).

Nationwide, 3.9% of students had taken steroid pills or shots without a doctor's prescription one or more times during their life (i.e., lifetime illegal steroid use) (Table 45). Overall, the prevalence of lifetime illegal steroid use was higher among male (5.1%) than female (2.7%) students; higher among white male (5.3%) and black male (3.4%) than white female (2.8%) and black female (1.0%) students, respectively; and higher among 11th-grade male (4.4%) and 12th-grade male (5.6%) than 11th-grade female (1.9%) and 12th-grade female (1.9%) students, respectively. Overall, the prevalence of lifetime illegal steroid use was higher among white (4.1%) and Hispanic (4.6%) than black (2.2%) students; higher among white female (2.8%) and Hispanic female (4.5%) than black female (1.0%) students; and higher among white male (5.3%) than black male (3.4%) students. The prevalence of lifetime illegal steroid use was higher among 9th-grade female (3.8%) than 11th-grade female (1.9%) and 12th-grade female (1.9%) students and higher among 10th-grade female (2.9%) than 11th-grade female (1.9%) students. Prevalence of lifetime illegal steroid use ranged from 1.8% to 6.1% across state surveys (median: 3.9%) and from 1.6% to 6.5% across local surveys (median: 3.0%) (Table 46).

Nationwide, 7.8% of students had used hallucinogenic drugs (e.g., LSD, acid, PCP, angel dust, mescaline, or mushrooms) one or more times during their life (i.e., lifetime hallucinogenic drug use) (Table 45). Overall, the prevalence of lifetime hallucinogenic drug use was higher among male (9.5%) than female (6.1%) students; higher among white male (11.1%) and black male (4.0%) than white female (6.8%) and black female (0.9%) students, respectively; and higher among 10th-grade male (9.5%), 11th-grade male (9.5%), and 12th-grade male (14.0%) than 10th-grade female (6.4%), 11th-grade female (6.5%), and 12th-grade female (7.0%) students, respectively. Overall, the prevalence of lifetime hallucinogenic drug use was higher among white (9.0%) and Hispanic (7.9%) than black (2.4%) students; higher among white female (6.8%) and Hispanic female (7.4%) than black female (0.9%) students; and higher among white male (11.1%) and Hispanic male (8.4%) than black male (4.0%) students. Overall, the prevalence of lifetime hallucinogenic drug use was higher among 10th-grade (8.0%), 11th-grade (8.1%), and 12th-grade (10.4%) than 9th-grade (5.1%) students; higher among 12th-grade (10.4%) than 10th-grade (8.0%) and 11th-grade (8.1%) students; higher among 10th-grade male (9.5%), 11th-grade male (9.5%), and 12th-grade male (14.0%) than 9th-grade male (5.8%) students; and higher among 12th-grade male (14.0%) than 10th-grade male (9.5%) and 11th-grade male (9.5%) students.

Nationwide, 2.3% of students had used heroin (also called "smack," "junk," or "China White") one or more times during their life (i.e., lifetime heroin use) (Table 47). Overall, the prevalence of lifetime heroin use was higher among male (2.9%) than female (1.6%) students; higher among black male (2.9%) than black female (0.7%) students; and higher among 11th-grade male (2.4%) and 12th-grade male (4.0%) than 11th-grade female (1.2%) and 12th-grade female (1.3%) students, respectively. Overall, the prevalence of lifetime heroin use was higher among Hispanic (3.7%) than white (1.7%) and black (1.8%) students; higher among Hispanic female (3.3%) than white female (1.3%) and black female (0.7%) students; and higher among Hispanic male (4.0%) than white male (2.1%) students. Overall, the prevalence of lifetime heroin use was higher among 12th-grade (2.6%) than 10th-grade (1.8%) students and higher among 12th-grade male (4.0%) than 10th-grade male (1.9%) students. Prevalence of lifetime heroin use ranged from 1.4% to 5.6% across state surveys (median: 3.0%) and from 0.6% to 5.4% across local surveys (median: 2.8%) (Table 48).

Nationwide, 4.4% of students had used methamphetamines (also called "speed," "crystal," "crank," or "ice") one or more times during their life (i.e., lifetime methamphetamine use) (Table 47). The prevalence of lifetime methamphetamine use was higher among black male (3.0%) than black female (0.8%) students and higher among 12th-grade male (5.6%) than 12th-grade female (3.5%) students. Overall, the prevalence of lifetime methamphetamine use was higher among white (4.5%) and Hispanic (5.7%) than black (1.9%) students; higher among white female (4.5%) and Hispanic female (5.3%) than black female (0.8%) students; and higher among Hispanic male (6.1%) than black male (3.0%) students. The prevalence of lifetime methamphetamine use was higher among 11th-grade female (5.3%) than 12th-grade female (3.5%) students. Prevalence of lifetime methamphetamine use ranged from 3.0% to 8.6% across state surveys (median: 4.8%) and from 0.7% to 9.0% across local surveys (median: 3.8%) (Table 48).

Nationwide, 5.8% of students had used ecstasy (also called "MDMA") one or more times during their life (i.e., lifetime ecstasy use) (Table 49). Overall, the prevalence of lifetime ecstasy use was higher among male (6.7%) than female (4.8%) students; higher among white male (6.5%) and black male (5.1%) than white female (4.6%) and black female (2.4%) students, respectively; and higher among 9th-grade male (5.9%) and 12th-grade male (9.6%) than 9th-grade female (3.3%) and 12th-grade female (5.6%) students, respectively. Overall, the prevalence of lifetime ecstasy use was higher among white (5.6%) than black (3.7%) students; higher among Hispanic (7.4%) than white (5.6%) and black (3.7%) students; higher among white female (4.6%) than black female (2.4%) students; and higher among Hispanic female (6.9%) than white female (4.6%) and black female (2.4%) students. Overall, the prevalence of lifetime ecstasy use was higher among 12th-grade (7.6%) than 9th-grade (4.6%), 10th-grade (5.3%), and 11th-grade (5.6%) students; higher among 12th-grade female (5.6%) than 9th-grade female (3.3%) students; and higher among 12th-grade male (9.6%) than 9th-grade male (5.9%), 10th-grade male (5.7%), and 11th-grade male (6.0%) students. Prevalence of lifetime ecstasy use ranged from 3.0% to 9.9% across state surveys (median: 6.6%) and from 2.5% to 10.3% across local surveys (median: 6.5%) (Table 50).

Age of Initiation of Risk Behaviors

Nationwide, 14.2% of students had smoked a whole cigarette for the first time before age 13 years (Table 51). Overall, the prevalence of having smoked a whole cigarette before age 13 years was higher among male (16.4%) than female (11.9%) students; higher among white male (16.5%), black male (14.6%), and Hispanic male (16.8%) than white female (12.2%), black female (10.5%), and Hispanic female (11.9%) students, respectively; and higher among 9th-grade male (19.2%), 11th-grade male (14.6%), and 12th-grade male (15.2%) than 9th-grade female (13.2%), 11th-grade female (9.2%), and 12th-grade female (11.5%) students, respectively. Overall, the prevalence of having smoked a whole cigarette before age 13 years was higher among 9th-grade (16.3%) than 11th-grade (12.0%) and 12th-grade (13.3%) students; higher among 9th-grade female (13.2%) and 10th-grade female (12.9%) than 11th-grade female (9.2%) students; and higher among 9th-grade male (19.2%) than 10th-grade male (15.7%), 11th-grade male (14.6%), and 12th-grade male (15.2%) students. Prevalence of having smoked a whole cigarette before age 13 years ranged from 8.6% to 23.8% across state surveys (median: 14.1%) and from 8.0% to 17.4% across local surveys (median: 11.0%) (Table 52).

Nationwide, 23.8% of students had drunk alcohol (other than a few sips) for the first time before age 13 years (Table 51). Overall, the prevalence of having drunk alcohol before age 13 years was higher among male (27.4%) than female (20.0%) students; higher among white male (25.0%), black male (30.7%), and Hispanic male (33.6%) than white female (17.8%), black female (22.7%), and Hispanic female (24.2%) students, respectively; and higher among 9th-grade male (34.5%), 10th-grade male (26.6%), 11th-grade male (25.1%), and 12th-grade male (21.2%) than 9th-grade female (27.1%), 10th-grade female (22.2%), 11th-grade female (13.8%), and 12th-grade female (14.8%) students, respectively. Overall, the prevalence of having drunk alcohol before age 13 years was higher among black (26.7%) and Hispanic (29.0%) than white (21.5%) students; higher among black female (22.7%) and Hispanic female (24.2%) than white female (17.8%) students; and higher among black male (30.7%) and Hispanic male (33.6%) than white male (25.0%) students. Overall, the prevalence of having drunk alcohol before age 13 years was higher among 9th-grade (30.9%) than 10th-grade (24.4%), 11th-grade (19.6%), and 12th-grade (18.0%) students; higher among 10th-grade (24.4%) than 11th-grade (19.6%) and 12th-grade (18.0%) students; higher among 9th-grade female (27.1%) than 10th-grade female (22.2%), 11th-grade female (13.8%), and 12th-grade female (14.8%) students; higher among 10th-grade female (22.2%) than 11th-grade female (13.8%) and 12th-grade female (14.8%) students; higher among 9th-grade male (34.5%) than 10th-grade male (26.6%), 11th-grade male (25.1%), and 12th-grade male (21.2%) students; and higher among 10th-grade male (26.6%) than 12th-grade male (21.2%) students. Prevalence of having drunk alcohol before age 13 years ranged from 13.0% to 30.7% across state surveys (median: 23.0%) and from 18.3% to 29.2% across local surveys (median: 24.4%) (Table 52).

Nationwide, 8.3% of students had tried marijuana for the first time before age 13 years (Table 53). Overall, the prevalence of having tried marijuana before age 13 years was higher among male (11.2%) than female (5.2%) students; higher among white male (10.0%), black male (14.2%), and Hispanic male (12.4%) than white female (4.4%), black female (4.9%), and Hispanic female (7.1%) students, respectively; and higher among 9th-grade male (13.3%), 10th-grade male (11.7%), 11th-grade male (10.1%), and 12th-grade male (9.1%) than 9th-grade female (6.1%), 10th-grade female (5.7%), 11th-grade female (4.2%), and 12th-grade female (4.2%) students, respectively. Overall, the prevalence of having tried marijuana before age 13 years was higher among Hispanic (9.8%) than white (7.2%) students and higher among Hispanic female (7.1%) than white female (4.4%) students. Overall, the prevalence of having tried marijuana before age 13 years was higher among 9th-grade (9.8%) than 11th-grade (7.2%) and 12th-grade (6.6%) students; higher among 10th-grade (8.7%) than 12th-grade (6.6%) students; higher among 9th-grade female (6.1%) than 12th-grade female (4.2%) students; and higher among 9th-grade male (13.3%) and 10th-grade male (11.7%) than 12th-grade male (9.1%) students. Prevalence of having tried marijuana before age 13 years ranged from 4.4% to 18.2% across state surveys (median: 8.7%) and from 5.5% to 16.1% across local surveys (median: 9.7%) (Table 54).

Tobacco, Alcohol, and Other Drug Use on School Property

Nationwide, 5.7% of students had smoked cigarettes on school property on at least 1 day during the 30 days before the survey (Table 55). Overall, the prevalence of having smoked cigarettes on school property was higher among male (6.5%) than female (4.8%) students; higher among white male (7.1%) and black male (5.1%) than white female (5.6%) and black female (1.7%) students, respectively; and higher among 11th-grade male (7.2%) and 12th-grade male (8.9%) than 11th-grade female (4.7%) and 12th-grade female (5.9%) students, respectively. Overall, the prevalence of having smoked cigarettes on school property was higher among white (6.4%) and Hispanic (4.9%) than black (3.4%) students; and higher among white female (5.6%) and Hispanic female (4.2%) than black female (1.7%) students. Overall, the prevalence of having smoked cigarettes on school property was higher among 12th-grade (7.4%) than 9th-grade (4.2%) and 10th-grade (5.4%) students and higher among 12th-grade male (8.9%) than 9th-grade male (4.7%) and 10th-grade male (5.8%) students. Prevalence of having smoked cigarettes on school property ranged from 2.4% to 9.5% across state surveys (median: 6.3%) and from 2.2% to 5.8% across local surveys (median: 3.7%) (Table 56).

Nationwide, 4.9% of students had used smokeless tobacco (e.g., chewing tobacco, snuff, or dip) on school property on at least 1 day during the 30 days before the survey (Table 55). Overall, the prevalence of having used smokeless tobacco on school property was higher among male (8.9%) than female (1.0%) students; higher among white male (11.3%), black male (1.5%), and Hispanic male (4.9%) than white female (1.0%), black female (0.2%), and Hispanic female (1.5%) students, respectively; and higher among 9th-grade male (6.9%), 10th-grade male (10.4%), 11th-grade male (7.9%), and 12th-grade male (10.2%) than 9th-grade female (0.9%), 10th-grade female (1.3%), 11th-grade female (0.6%), and 12th-grade female (1.0%) students, respectively. Overall, the prevalence of having used smokeless tobacco on school property was higher among white (6.2%) than black (0.9%) and Hispanic (3.2%) students; higher among Hispanic (3.2%) than black (0.9%) students; higher among white female (1.0%) and Hispanic female (1.5%) than black female (0.2%) students; higher among white male (11.3%) than black male (1.5%) and Hispanic male (4.9%) students; and higher among Hispanic male (4.9%) than black male (1.5%) students. Overall, the prevalence of having used smokeless tobacco on school property was higher among 10th-grade (5.9%) than 9th-grade (4.0%) and 11th-grade (4.2%) students and higher among 10th-grade male (10.4%) than 9th-grade male (6.9%) students. Prevalence of having used smokeless tobacco on school property ranged from 1.9% to 10.6% across state surveys (median: 5.4%) and from 0.5% to 3.8% across local surveys (median: 1.9%) (Table 56).

Nationwide, 4.1% of students had drunk at least one drink of alcohol on school property on at least 1 day during the 30 days before the survey (Table 57). Overall, the prevalence of having drunk alcohol on school property was higher among male (4.6%) than female (3.6%) students; higher among white male (3.8%) than white female (2.6%) students; and higher among 12th-grade male (6.3%) than 12th-grade female (3.4%) students. Overall, the prevalence of having drunk alcohol on school property was higher among Hispanic (7.5%) than white (3.2%) and black (3.4%) students; higher among Hispanic female (7.1%) than white female (2.6%) and black female (3.2%) students; and higher among Hispanic male (7.8%) than white male (3.8%) and black male (3.7%) students. Overall, the prevalence of having drunk alcohol on school property was higher among 12th-grade (4.8%) than 9th-grade (3.4%) students and higher among 12th-grade male (6.3%) than 9th-grade male (3.4%) and 11th-grade male (4.5%) students. Prevalence of having drunk alcohol on school property ranged from 3.2% to 8.7% across state surveys (median: 4.8%) and from 3.1% to 10.9% across local surveys (median: 4.8%) (Table 58).

Nationwide, 4.5% of students had used marijuana on school property one or more times during the 30 days before the survey (Table 57). Overall, the prevalence of having used marijuana on school property was higher among male (5.9%) than female (3.0%) students; higher among white male (5.2%), black male (7.4%), and Hispanic male (6.9%) than white female (2.7%), black female (2.6%), and Hispanic female (3.9%) students, respectively; and higher among 9th-grade male (5.2%), 10th-grade male (6.5%), 11th-grade male (5.3%), and 12th-grade male (6.6%) than 9th-grade female (2.7%), 10th-grade female (3.1%), 11th-grade female (2.7%), and 12th-grade female (3.7%) students, respectively. Prevalence of having used marijuana on school property ranged from 2.5% to 7.9% across state surveys (median: 4.2%) and from 2.7% to 8.4% across local surveys (median: 5.2%) (Table 58).

Nationwide, 22.3% of students had been offered, sold, or given an illegal drug by someone on school property during the 12 months before the survey (Table 59). Overall, the prevalence of having been offered, sold, or given an illegal drug on school property was higher among male (25.7%) than female (18.7%) students; higher among white male (24.0%) and black male (25.1%) than white female (17.4%) and black female (13.4%) students, respectively; and higher among 9th-grade male (25.0%), 10th-grade male (29.5%), 11th-grade male (25.7%), and 12th-grade male (22.4%) than 9th-grade female (17.2%), 10th-grade female (21.0%), 11th-grade female (19.8%), and 12th-grade female (16.8%) students, respectively. Overall, the prevalence of having been offered, sold, or given an illegal drug on school property was higher among Hispanic (29.1%) than white (20.8%) and black (19.2%) students; higher among white female (17.4%) than black female (13.4%) students; higher among Hispanic female (27.2%) than white female (17.4%) and black female (13.4%) students; and higher among Hispanic male (30.9%) than white male (24.0%) and black male (25.1%) students. Overall, the prevalence of having been offered, sold, or given an illegal drug on school property was higher among 10th-grade (25.3%) than 9th-grade (21.2%), 11th-grade (22.8%), and 12th-grade (19.6%) students; higher among 11th-grade (22.8%) than 12th-grade (19.6%) students; higher among 10th-grade female (21.0%) than 12th-grade female (16.8%) students; and higher among 10th-grade male (29.5%) than 9th-grade male (25.0%) and 12th-grade male (22.4%) students. Prevalence of having been offered, sold, or given an illegal drug on school property ranged from 10.1% to 37.1% across state surveys (median: 25.1%) and from 13.5% to 39.2% across local surveys (median: 27.1%) (Table 60).

Sexual Behaviors that Contribute to Unintended Pregnancy and Sexually Transmitted Diseases, Including HIV Infection

Nationwide, 47.8% of students had ever had sexual intercourse (Table 61). Overall, the prevalence of having had sexual intercourse was higher among male (49.8%) than female (45.9%) students; higher among black male (72.6%) and Hispanic male (58.2%) than black female (60.9%) and Hispanic female (45.8%) students, respectively; and higher among 9th-grade male (38.1%) than 9th-grade female (27.4%) students. Overall, the prevalence of having had sexual intercourse was higher among black (66.5%) and Hispanic (52.0%) than white (43.7%) students; higher among black (66.5%) than Hispanic (52.0%) students; higher among black female (60.9%) than white female (43.7%) and Hispanic female (45.8%) students; higher among black male (72.6%) and Hispanic male (58.2%) than white male (43.6%) students; and higher among black male (72.6%) than Hispanic male (58.2%) students. Overall, the prevalence of having had sexual intercourse was higher among 10th-grade (43.8%), 11th-grade (55.5%), and 12th-grade (64.6%) than 9th-grade (32.8%) students; higher among 11th-grade (55.5%) and 12th-grade (64.6%) than 10th-grade (43.8%) students; higher among 12th-grade (64.6%) than 11th-grade (55.5%) students; higher among 10th-grade female (41.9%), 11th-grade female (53.6%), and 12th-grade female (66.2%) than 9th-grade female (27.4%) students; higher among 11th-grade female (53.6%) and 12th-grade female (66.2%) than 10th-grade female (41.9%) students; higher among 12th-grade female (66.2%) than 11th-grade female (53.6%) students; higher among 10th-grade male (45.6%), 11th-grade male (57.3%), and 12th-grade male (62.8%) than 9th-grade male (38.1%) students; and higher among 11th-grade male (57.3%) and 12th-grade male (62.8%) than 10th-grade male (45.6%) students. Prevalence of having had sexual intercourse ranged from 36.2% to 59.5% across state surveys (median: 45.9%) and from 26.4% to 67.1% across local surveys (median: 50.6%) (Table 62).

Nationwide, 7.1% of students had had sexual intercourse for the first time before age 13 years (Table 61). Overall, the prevalence of having had sexual intercourse before age 13 years was higher among male (10.1%) than female (4.0%) students; higher among white male (5.7%), black male (26.2%), and Hispanic male (11.9%) than white female (3.1%), black female (6.9%), and Hispanic female (4.5%) students, respectively; and higher among 9th-grade male (13.5%), 10th-grade male (9.1%), 11th-grade male (9.9%), and 12th-grade male (6.7%) than 9th-grade female (4.9%), 10th-grade female (4.7%), 11th-grade female (3.4%), and 12th-grade female (2.4%) students, respectively. Overall, the prevalence of having had sexual intercourse before age 13 years was higher among black (16.3%) and Hispanic (8.2%) than white (4.4%) students; higher among black (16.3%) than Hispanic (8.2%) students; higher among black female (6.9%) than white female (3.1%) and Hispanic female (4.5%) students; higher among black male (26.2%) and Hispanic male (11.9%) than white male (5.7%) students; and higher among black male (26.2%) than Hispanic male (11.9%) students. Overall, the prevalence of having had sexual intercourse before age 13 years was higher among 9th-grade (9.2%) than 10th-grade (6.9%), 11th-grade (6.6%), and 12th-grade (4.5%) students; higher among 10th-grade (6.9%) than 12th-grade (4.5%) students; higher among 9th-grade female (4.9%) and 10th-grade female (4.7%) than 12th-grade female (2.4%) students; higher among 9th-grade male (13.5%) than 10th-grade male (9.1%), 11th-grade male (9.9%), and 12th-grade male (6.7%) students; and higher among 10th-grade male (9.1%) than 12th-grade male (6.7%) students. Prevalence of having had sexual intercourse before age 13 years ranged from 3.0% to 13.3% across state surveys (median: 6.0%) and from 3.9% to 18.6% across local surveys (median: 10.3%) (Table 62).

Nationwide, 14.9% of students had had sexual intercourse with four or more persons during their life (Table 63). Overall, the prevalence of having had sexual intercourse with four or more persons was higher among male (17.9%) than female (11.8%) students; higher among black male (37.6%) and Hispanic male (23.3%) than black female (18.1%) and Hispanic female (11.3%) students, respectively; and higher among 9th-grade male (11.9%), 10th-grade male (16.7%), 11th-grade male (20.6%), and 12th-grade male (24.7%) than 9th-grade female (5.5%), 10th-grade female (10.2%), 11th-grade female (13.1%), and 12th-grade female (20.1%) students, respectively. Overall, the prevalence of having had sexual intercourse with four or more persons was higher among black (27.6%) and Hispanic (17.3%) than white (11.5%) students; higher among black (27.6%) than Hispanic (17.3%) students; higher among black female (18.1%) than white female (10.6%) and Hispanic female (11.3%) students; higher among black male (37.6%) and Hispanic male (23.3%) than white male (12.2%) students; and higher among black male (37.6%) than Hispanic male (23.3%) students. Overall, the prevalence of having had sexual intercourse with four or more persons was higher among 10th-grade (13.4%), 11th-grade (17.0%), and 12th-grade (22.4%) than 9th-grade (8.7%) students; higher among 11th-grade (17.0%) and 12th-grade (22.4%) than 10th-grade (13.4%) students; higher among 12th-grade (22.4%) than 11th-grade (17.0%) students; higher among 10th-grade female (10.2%), 11th-grade female (13.1%), and 12th-grade female (20.1%) than 9th-grade female (5.5%) students; higher among 11th-grade female (13.1%) and 12th-grade female (20.1%) than 10th-grade female (10.2%) students; higher among 12th-grade female (20.1%) than 11th-grade female (13.1%) students; higher among 10th-grade male (16.7%), 11th-grade male (20.6%), and 12th-grade male (24.7%) than 9th-grade male (11.9%) students; and higher among 11th-grade male (20.6%) and 12th-grade male (24.7%) than 10th-grade male (16.7%) students. Prevalence of having had sexual intercourse with four or more persons ranged from 6.1% to 22.5% across state surveys (median: 13.8%) and from 6.5% to 29.6% across local surveys (median: 16.6%) (Table 64).

Nationwide, 35.0% of students had had sexual intercourse with at least one person during the 3 months before the survey (i.e., currently sexually active) (Table 63). The prevalence of being currently sexually active was higher among white female (35.1%) than white male (30.6%) students and higher among 9th-grade male (22.2%) and 12th-grade female (56.7%) than 9th-grade female (18.0%) and 12th-grade male (48.3%) students, respectively. Overall, the prevalence of being currently sexually active was higher among black (46.0%) and Hispanic (37.4%) than white (32.9%) students; higher among black (46.0%) than Hispanic (37.4%) students; higher among black female (43.5%) than white female (35.1%) and Hispanic female (35.3%) students; higher among black male (48.7%) and Hispanic male (39.6%) than white male (30.6%) students; and higher among black male (48.7%) than Hispanic male (39.6%) students. Overall, the prevalence of being currently sexually active was higher among 10th-grade (30.6%), 11th-grade (41.8%), and 12th-grade (52.6%) than 9th-grade (20.1%) students; higher among 11th-grade (41.8%) and 12th-grade (52.6%) than 10th-grade (30.6%) students; higher among 12th-grade (52.6%) than 11th-grade (41.8%) students; higher among 10th-grade female (31.8%), 11th-grade female (41.5%), and 12th-grade female (56.7%) than 9th-grade female (18.0%) students; higher among 11th-grade female (41.5%) and 12th-grade female (56.7%) than 10th-grade female (31.8%) students; higher among 12th-grade female (56.7%) than 11th-grade female (41.5%) students; higher among 10th-grade male (29.4%), 11th-grade male (42.0%), and 12th-grade male (48.3%) than 9th-grade male (22.2%) students; higher among 11th-grade male (42.0%) and 12th-grade male (48.3%) than 10th-grade male (29.4%) students; and higher among 12th-grade male (48.3%) than 11th-grade male (42.0%) students. Prevalence of being currently sexually active ranged from 23.6% to 45.3% across state surveys (median: 34.1%) and from 17.5% to 49.7% across local surveys (median: 36.6%) (Table 64).

Among the 35.0% of currently sexually active students nationwide, 61.5% reported that either they or their partner had used a condom during last sexual intercourse (Table 65). Overall, the prevalence of having used a condom during last sexual intercourse was higher among male (68.5%) than female (54.9%) students; higher among white male (66.4%), black male (74.0%), and Hispanic male (69.9%) than white female (53.9%), black female (60.1%), and Hispanic female (52.1%) students, respectively; and higher among 9th-grade male (75.8%), 10th-grade male (73.2%), 11th-grade male (69.3%), and 12th-grade male (59.6%) than 9th-grade female (61.0%), 10th-grade female (59.5%), 11th-grade female (55.1%), and 12th-grade female (49.9%) students, respectively. Overall, the prevalence of having used a condom during last sexual intercourse was higher among black (67.3%) than white (59.7%) students and higher among black male (74.0%) than white male (66.4%) students. Overall, the prevalence of having used a condom during last sexual intercourse was higher among 9th-grade (69.3%) than 11th-grade (62.0%) and 12th-grade (54.2%) students; higher among 10th-grade (66.1%) and 11th-grade (62.0%) than 12th-grade (54.2%) students; higher among 9th-grade female (61.0%) and 10th-grade female (59.5%) than 12th-grade female (49.9%) students; and higher among 9th-grade male (75.8%), 10th-grade male (73.2%), and 11th-grade male (69.3%) than 12th-grade male (59.6%) students. Prevalence of having used a condom during last sexual intercourse ranged from 54.2% to 69.2% across state surveys (median: 61.5%) and from 57.0% to 74.3% across local surveys (median: 68.1%) (Table 66).

Among the 35.0% of currently sexually active students nationwide, 16.0% reported that either they or their partner had used birth control pills to prevent pregnancy before last sexual intercourse (Table 65). Overall, the prevalence of having used birth control pills before last sexual intercourse was higher among female (18.7%) than male (13.1%) students; higher among white female (24.0%) and black female (12.1%) than white male (17.0%) and black male (6.3%) students, respectively; and higher among 11th-grade female (18.9%) than 11th-grade male (11.0%) students. Overall, the prevalence of having used birth control pills before last sexual intercourse was higher among white (20.8%) than black (9.1%) and Hispanic (9.1%) students; higher among white female (24.0%) than black female (12.1%) and Hispanic female (9.1%) students; and higher among white male (17.0%) than black male (6.3%) and Hispanic male (9.0%) students. Overall, the prevalence of having used birth control pills before last sexual intercourse was higher among 11th-grade (15.0%) and 12th-grade (23.5%) than 9th-grade (8.7%) students; higher among 12th-grade (23.5%) than 10th-grade (11.6%) and 11th-grade (15.0%) students; higher among 11th-grade female (18.9%) and 12th-grade female (25.6%) than 9th-grade female (9.2%) students; higher among 12th-grade female (25.6%) than 10th-grade female (13.7%) and 11th-grade female (18.9%) students; and higher among 12th-grade male (20.8%) than 9th-grade male (8.3%), 10th-grade male (9.5%), and 11th-grade male (11.0%) students. The prevalence of having used birth control pills before last sexual intercourse ranged from 12.2% to 36.1% across state surveys (median: 18.9%) and from 6.3% to 16.9% across local surveys (median: 9.2%) (Table 66).

Among the 35.0% of currently sexually active students nationwide, 22.5% had drunk alcohol or used drugs before last sexual intercourse (Table 67). Overall, the prevalence of having drunk alcohol or used drugs before last sexual intercourse was higher among male (27.5%) than female (17.7%) students; higher among white male (30.5%), black male (19.8%), and Hispanic male (25.9%) than white female (19.8%), black female (12.9%), and Hispanic female (16.5%) students, respectively; and higher among 11th-grade male (28.3%) and 12th-grade male (29.1%) than 11th-grade female (14.8%) and 12th-grade female (17.3%) students, respectively. Overall, the prevalence of having drunk alcohol or used drugs before last sexual intercourse was higher among white (24.8%) and Hispanic (21.4%) than black (16.4%) students; higher among white female (19.8%) than black female (12.9%) students; and higher among white male (30.5%) and Hispanic male (25.9%) than black male (19.8%) students. Prevalence of having drunk alcohol or used drugs before last sexual intercourse ranged from 17.6% to 28.1% across state surveys (median: 22.5%) and from 12.2% to 25.5% across local surveys (median: 17.4%) (Table 68).

Nationwide, 89.5% of students had ever been taught in school about acquired immunodeficiency syndrome (AIDS) or human immunodeficiency virus (HIV) infection (Table 67). Overall, the prevalence of having been taught in school about AIDS or HIV infection was higher among female (90.2%) than male (88.7%) students. Overall, the prevalence of having been taught in school about AIDS or HIV infection was higher among white (91.1%) and black (90.3%) than Hispanic (85.0%) students; higher among white female (91.7%) and black female (91.8%) than Hispanic female (84.8%) students; and higher among white male (90.5%) and black male (88.8%) than Hispanic male (85.1%) students. Overall, the prevalence of having been taught in school about AIDS or HIV infection was higher among 10th-grade (89.7%), 11th-grade (91.8%), and 12th-grade (90.0%) than 9th-grade (87.1%) students; higher among 11th-grade (91.8%) than 12th-grade (90.0%) students; higher among 11th-grade female (92.6%) and 12th-grade female (90.9%) than 9th-grade female (87.7%) students; and higher among 10th-grade male (89.2%) and 11th-grade male (91.0%) than 9th-grade male (86.4%) students. Prevalence of having been taught in school about AIDS or HIV infection ranged from 79.0% to 91.7% across state surveys (median: 87.5%) and from 76.7% to 92.3% across local surveys (median: 85.6%) (Table 68).

Nationwide, 12.9% of students had been tested for HIV, not counting tests done when donating blood (Table 69). Overall, the prevalence of HIV testing was higher among female (14.8%) than male (11.1%) students; higher among white female (12.0%) and black female (27.2%) than white male (9.4%) and black male (17.3%) students, respectively; and higher among 11th-grade female (16.2%) and 12th-grade female (22.9%) than 11th-grade male (11.5%) and 12th-grade male (14.9%) students, respectively. Overall, the prevalence of HIV testing was higher among black (22.4%) than white (10.7%) and Hispanic (12.7%) students; higher among black female (27.2%) than white female (12.0%) and Hispanic female (13.8%) students; and higher among black male (17.3%) than white male (9.4%) and Hispanic male (11.5%) students. Overall, the prevalence of HIV testing was higher among 10th-grade (11.0%), 11th-grade (13.9%), and 12th-grade (18.9%) than 9th-grade (9.1%) students; higher among 12th-grade (18.9%) than 10th-grade (11.0%) and 11th-grade (13.9%) students; higher among 11th-grade female (16.2%) and 12th-grade female (22.9%) than 9th-grade female (9.9%) students; higher among 11th-grade female (16.2%) and 12th-grade female (22.9%) than 10th-grade female (11.6%) students; higher among 12th-grade female (22.9%) than 11th-grade female (16.2%) students; and higher among 12th-grade male (14.9%) than 9th-grade male (8.3%), 10th-grade male (10.5%), and 11th-grade male (11.5%) students.

Dietary Behaviors

Nationwide, 21.4% of students had eaten fruits and vegetables^§§ five or more times per day during the 7 days before the survey (Table 70). Overall, the prevalence of having eaten fruits and vegetables five or more times per day was higher among male (22.9%) than female (19.9%) students; higher among white male (20.1%) than white female (17.6%) students; and higher among 9th-grade male (25.4%) and 11th-grade male (22.6%) than 9th-grade female (22.0%) and 11th-grade female (17.2%) students, respectively. Overall, the prevalence of having eaten fruits and vegetables five or more times per day was higher among black (24.9%) and Hispanic (24.0%) than white (18.8%) students; higher among black female (23.4%) and Hispanic female (22.1%) than white female (17.6%) students; and higher among black male (26.6%) and Hispanic male (25.9%) than white male (20.1%) students. Overall, the prevalence of having eaten fruits and vegetables five or more times per day was higher among 9th-grade (23.7%) and 10th-grade (22.4%) than 11th-grade (19.9%) and 12th-grade (18.6%) students; higher among 9th-grade female (22.0%) than 11th-grade female (17.2%) and 12th-grade female (18.3%) students; higher among 10th-grade female (21.6%) than 11th-grade female (17.2%) students; and higher among 9th-grade male (25.4%) than 12th-grade male (19.0%) students. Prevalence of having eaten fruits and vegetables five or more times per day ranged from 13.2% to 23.8% across state surveys (median: 17.9%) and from 16.9% to 28.8% across local surveys (median: 20.9%) (Table 71).

Nationwide, 14.1% of students had drunk three or more glasses per day of milk during the 7 days before the survey (Table 70). Overall, the prevalence of having drunk three or more glasses per day of milk was higher among male (19.4%) than female (8.8%) students; higher among white male (22.2%), black male (13.6%), and Hispanic male (17.3%) than white female (9.9%), black female (5.7%), and Hispanic female (8.1%) students, respectively; and higher among 9th-grade male (19.0%), 10th-grade male (20.7%), 11th-grade male (19.4%), and 12th-grade male (18.4%) than 9th-grade female (10.2%), 10th-grade female (9.3%), 11th-grade female (7.6%), and 12th-grade female (7.9%) students, respectively. Overall, the prevalence of having drunk three or more glasses per day of milk was higher among white (16.1%) than black (9.7%) and Hispanic (12.7%) students; higher among Hispanic (12.7%) than black (9.7%) students; higher among white female (9.9%) and Hispanic female (8.1%) than black female (5.7%) students; higher among white male (22.2%) than black male (13.6%) and Hispanic male (17.3%) students; and higher among Hispanic male (17.3%) than black male (13.6%) students. The prevalence of having drunk three or more glasses per day of milk was higher among 9th-grade female (10.2%) than 11th-grade female (7.6%) students. Prevalence of having drunk three or more glasses per day of milk ranged from 8.0% to 25.4% across state surveys (median: 14.5%) and from 5.1% to 14.2% across local surveys (median: 8.8%) (Table 71).

Nationwide, 33.8% of students had drunk a can, bottle, or glass of soda or pop (not including diet soda or diet pop) at least one time per day during the 7 days before the survey (Table 72). Overall, the prevalence of having drunk soda or pop at least one time per day was higher among male (38.6%) than female (29.0%) students; higher among white male (40.6%) and Hispanic male (37.3%) than white female (27.3%) and Hispanic female (29.5%) students, respectively; and higher among 9th-grade male (39.5%), 10th-grade male (36.6%), 11th-grade male (39.0%), and 12th-grade male (39.2%) than 9th-grade female (31.5%), 10th-grade female (29.8%), 11th-grade female (26.5%), and 12th-grade female (27.2%) students, respectively. Overall, the prevalence of having drunk soda or pop at least one time per day was higher among higher among black (37.6%) than Hispanic (33.4%) students; and higher among black female (37.2%) than white female (27.3%) and Hispanic female (29.5%) students. The prevalence of having drunk soda or pop at least one time per day was higher among 9th-grade female (31.5%) than 11th-grade female (26.5%) students. Prevalence of having drunk soda or pop at least one time per day ranged from 16.9% to 47.0% across state surveys (median: 29.5%) and from 14.4% to 39.9% across local surveys (median: 28.6%) (Table 73).

Physical Activity

Nationwide, 34.7% of students had been physically active doing any kind of physical activity that increased their heart rate and made them breathe hard some of the time for a total of at least 60 minutes per day on 5 or more days during the 7 days before the survey (i.e., met recommended levels of physical activity) (14) (Table 74). Overall, the prevalence of having met recommended levels of physical activity was higher among male (43.7%) than female (25.6%) students; higher among white male (46.1%), black male (41.3%), and Hispanic male (38.6%) than white female (27.9%), black female (21.0%), and Hispanic female (21.9%) students, respectively; and higher among 9th-grade male (44.4%), 10th-grade male (45.1%), 11th-grade male (45.2%), and 12th-grade male (38.7%) than 9th-grade female (31.5%), 10th-grade female (24.4%), 11th-grade female (24.6%), and 12th-grade female (20.6%) students, respectively. Overall, the prevalence of having met recommended levels of physical activity was higher among white (37.0%) than black (31.1%) and Hispanic (30.2%) students; higher among white female (27.9%) than black female (21.0%) and Hispanic female (21.9%) students; and higher among white male (46.1%) than black male (41.3%) and Hispanic male (38.6%) students. Overall, the prevalence of having met recommended levels of physical activity was higher among 9th-grade (38.1%) than 10th-grade (34.8%), 11th-grade (34.8%), and 12th-grade (29.5%) students; higher among 10th-grade (34.8%) and 11th-grade (34.8%) than 12th-grade (29.5%) students; higher among 9th-grade female (31.5%) than 10th-grade female (24.4%), 11th-grade female (24.6%), and 12th-grade female (20.6%) students; and higher among 9th-grade male (44.4%), 10th-grade male (45.1%), and 11th-grade male (45.2%) than among 12th-grade male (38.7%) students. Prevalence of having met recommended levels of physical activity ranged from 30.6% to 49.9% across state surveys (median: 43.6%) and from 28.1% to 48.5% across local surveys (median: 33.6%) (Table 75).

Nationwide, 24.9% of students did not participate in 60 or more minutes of any kind of physical activity that increased their heart rate and made them breathe hard some of the time on at least 1 day during the 7 days before the survey (i.e., did not participate in 60 or more minutes of physical activity on any day) (Table 74). Overall, the prevalence of not participating in 60 or more minutes of physical activity on any day was higher among female (31.8%) than male (18.0%) students; higher among white female (28.2%), black female (42.1%), and Hispanic female (35.2%) than white male (16.7%), black male (21.8%), and Hispanic male (18.8%) students, respectively; and higher among 9th-grade female (26.1%), 10th-grade female (31.7%), 11th-grade female (34.3%), and 12th-grade female (36.2%) than 9th-grade male (17.1%), 10th-grade male (16.3%), 11th-grade male (18.0%), and 12th-grade male (21.5%) students, respectively. Overall, the prevalence of not participating in 60 or more minutes of physical activity on any day was higher among black (32.0%) and Hispanic (27.1%) than white (22.4%) students; higher among black (32.0%) than Hispanic (27.1%) students; higher among black female (42.1%) and Hispanic female (35.2%) than white female (28.2%) students; higher among black female (42.1%) than Hispanic female (35.2%) students; and higher among black male (21.8%) than white male (16.7%) students. Overall, the prevalence of not participating in 60 or more minutes of physical activity on any day was higher among 11th-grade (26.2%) and 12th-grade (28.9%) than 9th-grade (21.5%) students; higher among 12th-grade (28.9%) than 10th-grade (24.0%) students; higher among 10th-grade female (31.7%), 11th-grade female (34.3%), and 12th-grade female (36.2%) than 9th-grade female (26.1%) students; and higher among 12th-grade male (21.5%) than 9th-grade male (17.1%) and 10th-grade male (16.3%) students. Prevalence of not participating in 60 or more minutes of physical activity on any day ranged from 10.5% to 26.7% across state surveys (median: 15.9%) and from 14.4% to 32.7% across local surveys (median: 22.6%) (Table 75).

Nationwide, 24.9% of students played video or computer games or used a computer for something that was not school work for 3 or more hours per day on an average school day (i.e., used computers 3 or more hours per day) (Table 76). Overall, the prevalence of using computers 3 or more hours per day was higher among male (29.1%) than female (20.6%) students; higher among white male (26.9%), black male (34.0%), and Hispanic male (30.7%) than white female (18.2%), black female (26.7%), and Hispanic female (21.8%) students, respectively; and higher among 9th-grade male (30.5%), 10th-grade male (30.0%), 11th-grade male (29.5%), and 12th-grade male (25.6%) than 9th-grade female (24.9%), 10th-grade female (22.6%), 11th-grade female (17.9%), and 12th-grade female (14.8%) students, respectively. Overall, the prevalence of using computers 3 or more hours per day was higher among black (30.5%) and Hispanic (26.3%) than white (22.6%) students; higher among black (30.5%) than Hispanic (26.3%) students; higher among black female (26.7%) than white female (18.2%) and Hispanic female (21.8%) students; and higher among black male (34.0%) than white male (26.9%) students. Overall, the prevalence of using computers 3 or more hours per day was higher among 9th-grade (27.8%) than 11th-grade (23.7%) and 12th-grade (20.1%) students; higher among 10th-grade (26.3%) and 11th-grade (23.7%) than 12th-grade (20.1%) students; higher among 9th-grade female (24.9%) and 10th-grade female (22.6%) than 11th-grade female (17.9%) and 12th-grade female (14.8%) students; and higher among 9th-grade male (30.5%) and 11th-grade male (29.5%) than 12th-grade male (25.6%) students. Prevalence of using computers 3 or more hours per day ranged from 12.5% to 31.1% across state surveys (median: 22.7%) and from 20.2% to 38.3% across local surveys (median: 27.2%) (Table 77).

Nationwide, 35.4% of students watched television 3 or more hours per day on an average school day (Table 76). Overall, the prevalence of having watched television 3 or more hours per day was higher among male (37.5%) than female (33.2%) students; higher among white male (30.4%) than white female (24.0%) students; and higher among 11th-grade male (35.4%) than 11th-grade female (29.6%) students. Overall, the prevalence of having watched television 3 or more hours per day was higher among black (62.7%) and Hispanic (43.0%) than white (27.2%) students; higher among black (62.7%) than Hispanic (43.0%) students; higher among black female (60.6%) and Hispanic female (43.6%) than white female (24.0%) students; higher among black female (60.6%) than Hispanic female (43.6%) students; higher among black male (64.6%) and Hispanic male (42.4%) than white male (30.4%) students; and higher among black male (64.6%) than Hispanic male (42.4%) students. Overall, the prevalence of having watched television 3 or more hours per day was higher among 9th-grade (39.7%) and 10th-grade (37.0%) than 11th-grade (32.5%) and 12th-grade (30.8%) students; higher among 9th-grade female (37.2%) and 10th-grade female (35.9%) than 11th-grade female (29.6%) and 12th-grade female (28.9%) students; higher among 9th-grade male (42.0%) than 11th-grade male (35.4%) and 12th-grade male (32.8%) students; and higher among 10th-grade male (38.1%) than 12th-grade male (32.8%) students. Prevalence of having watched television 3 or more hours per day ranged from 18.2% to 47.4% across state surveys (median: 29.8%) and from 33.2% to 60.5% across local surveys (median: 45.3%) (Table 77).

Nationwide, 53.6% of students went to physical education (PE) classes on 1 or more days in an average week when they were in school (i.e., attended PE classes) (Table 78). Overall, the prevalence of attending PE classes was higher among male (57.7%) than female (49.4%) students; higher among white male (54.0%), black male (61.0%), and Hispanic male (64.7%) than white female (46.8%), black female (50.6%), and Hispanic female (57.3%) students, respectively; and higher among 10th-grade male (62.3%), 11th-grade male (51.4%), and 12th-grade male (44.6%) than 10th-grade female (51.2%), 11th-grade female (38.8%), and 12th-grade female (38.5%) students, respectively. Overall, the prevalence of attending PE classes was higher among Hispanic (61.0%) than white (50.4%) students; higher among Hispanic female (57.3%) than white female (46.8%) students; and higher among Hispanic male (64.7%) than white male (54.0%) students. Overall, the prevalence of attending PE classes was higher among 9th-grade (66.8%) than 10th-grade (56.8%), 11th-grade (45.1%), and 12th-grade (41.5%) students; higher among 10th-grade (56.8%) than 11th-grade (45.1%) and 12th-grade (41.5%) students; higher among 9th-grade female (65.1%) than 10th-grade female (51.2%), 11th-grade female (38.8%), and 12th-grade female (38.5%) students; higher among 10th-grade female (51.2%) than 11th-grade female (38.8%) and 12th-grade female (38.5%) students; higher among 9th-grade male (68.3%) than 11th-grade male (51.4%) and 12th-grade male (44.6%) students; higher among 10th-grade male (62.3%) than 11th-grade male (51.4%) and 12th-grade male (44.6%) students; and higher among 11th-grade male (51.4%) than 12th-grade male (44.6%) students. Prevalence of attending PE classes ranged from 28.4% to 90.8% across state surveys (median: 41.7%) and from 29.3% to 78.9% across local surveys (median: 44.3%) (Table 79).

Nationwide, 30.3% of students went to PE classes 5 days in an average week when they were in school (i.e., attended PE classes daily) (Table 78). Overall, the prevalence of having attended PE classes daily was higher among male (33.2%) than female (27.3%) students; higher among white male (32.2%) and black male (35.8%) than white female (25.6%) and black female (27.8%) students, respectively; and higher among 10th-grade male (35.7%), 11th-grade male (27.9%), and 12th-grade male (27.5%) than 10th-grade female (26.1%), 11th-grade female (19.8%), and 12th-grade female (20.2%) students, respectively. The prevalence of having attended PE classes daily was higher among Hispanic female (35.5%) than white female (25.6%) students. Overall, the prevalence of having attended PE classes daily was higher among 9th-grade (40.1%) than 10th-grade (30.9%), 11th-grade (23.9%), and 12th-grade (23.8%) students; higher among 10th-grade (30.9%) than 11th-grade (23.9%) and 12th-grade (23.8%) students; higher among 9th-grade female (40.4%) than 10th-grade female (26.1%), 11th-grade female (19.8%), and 12th-grade female (20.2%) students; higher among 10th-grade female (26.1%) than 11th-grade female (19.8%) students; and higher among 9th-grade male (39.7%) and 10th-grade male (35.7%) than 11th-grade male (27.9%) and 12th-grade male (27.5%) students. Prevalence of having attended PE classes daily ranged from 6.7% to 47.3% across state surveys (median: 25.2%) and from 6.5% to 54.0% across local surveys (median: 24.8%) (Table 79).

Nationwide, 56.3% of students had played on at least one sports team (run by their school or community groups) during the 12 months before the survey (Table 80). Overall, the prevalence of having played on at least one sports team was higher among male (62.1%) than female (50.4%) students; higher among white male (63.0%), black male (65.1%), and Hispanic male (58.1%) than white female (54.8%), black female (44.7%), and Hispanic female (41.8%) students, respectively; and higher among 9th-grade male (63.4%), 10th-grade male (64.7%), 11th-grade male (63.0%), and 12th-grade male (56.2%) than 9th-grade female (54.7%), 10th-grade female (50.8%), 11th-grade female (52.5%), and 12th-grade female (41.9%) students, respectively. Overall, the prevalence of having played on at least one sports team was higher among white (58.9%) than Hispanic (50.0%) students; higher among white female (54.8%) than black female (44.7%) and Hispanic female (41.8%) students; and higher among white male (63.0%) and black male (65.1%) than Hispanic male (58.1%) students. Overall, the prevalence of having played on at least one sports team was higher among 9th-grade (59.2%), 10th-grade (57.8%), and 11th-grade (57.7%) than 12th-grade (49.0%) students; higher among 9th-grade female (54.7%), 10th-grade female (50.8%), and 11th-grade female (52.5%) than 12th-grade female (41.9%) students; and higher among 9th-grade male (63.4%), 10th-grade male (64.7%), and 11th-grade male (63.0%) than 12th-grade male (56.2%) students. Prevalence of having played on at least one sports team ranged from 46.0% to 67.1% across state surveys (median: 56.8%) and from 41.7% to 54.5% across local surveys (median: 49.6%) (Table 81).

Among the 79.6% of students nationwide who exercised or played sports during the 30 days before the survey, 21.9% had had to see a doctor or nurse for an injury that happened while exercising or playing sports (Table 80). Overall, the prevalence of having been injured while exercising or playing sports was higher among male (24.1%) than female (19.3%) students; higher among white male (23.6%), black male (26.7%), and Hispanic male (24.7%) than white female (19.9%), black female (19.3%), and Hispanic female (18.7%) students, respectively; and higher among 11th-grade male (23.8%) and 12th-grade male (20.9%) than 11th-grade female (18.2%) and 12th-grade female (14.8%) students, respectively. Overall the prevalence of having been injured while exercising or playing sports was higher among 9th-grade (24.0%), 10th-grade (22.8%), and 11th-grade (21.2%) than 12th-grade (18.1%) students; higher among 9th-grade female (21.7%) and 10th-grade female (20.8%) than 12th-grade female (14.8%) students; and higher among 9th-grade male (26.0%) than 12th-grade male (20.9%) students.

Obesity, Overweight, and Weight Control

Nationwide, 13.0% of students were obese (Table 82). Overall, the prevalence of obesity was higher among male (16.3%) than female (9.6%) students; higher among white male (14.6%) and Hispanic male (20.3%) than white female (6.8%) and Hispanic female (12.7%) students, respectively; and higher among 9th-grade male (16.6%), 10th-grade male (16.4%), 11th-grade male (17.3%), and 12th-grade male (14.7%) than 9th-grade female (10.7%), 10th-grade female (9.8%), 11th-grade female (8.1%), and 12th-grade female (9.3%) students, respectively. Overall, the prevalence of obesity was higher among black (18.3%) and Hispanic (16.6%) than white (10.8%) students; higher among black female (17.8%) and Hispanic female (12.7%) than white female (6.8%) students; higher among black female (17.8%) than Hispanic female (12.7%) students; and higher among black male (18.9%) and Hispanic male (20.3%) than white male (14.6%) students. The prevalence of obesity was higher among 9th-grade female (10.7%) than 11th-grade female (8.1%) students. Prevalence of obesity ranged from 8.7% to 17.9% across state surveys (median: 12.0%) and from 8.4% to 19.3% across local surveys (median: 14.8%) (Table 83).

Nationwide, 15.8% of students were overweight (Table 82). The prevalence of overweight was higher among white male (15.7%) and black female (21.4%) than white female (12.8%) and black male (16.6%) students, respectively. Overall, the prevalence of overweight was higher among black (19.0%) and Hispanic (18.1%) than white (14.3%) students and higher among black female (21.4%) and Hispanic female (17.9%) than white female (12.8%) students. Overall, the prevalence of overweight was higher among 9th-grade (17.6%) than 12th-grade (14.0%) students and higher among 9th-grade female (18.3%) than 10th-grade female (14.2%), 11th-grade female (14.2%), and 12th-grade female (13.1%) students. Prevalence of overweight ranged from 11.4% to 18.2% across state surveys (median: 15.0%) and from 12.5% to 22.2% across local surveys (median: 17.7%) (Table 83).

Nationwide, 29.3% of students described themselves as slightly or very overweight (Table 84). Overall, the prevalence of describing themselves as overweight was higher among female (34.5%) than male (24.2%) students; higher among white female (34.0%), black female (30.1%), and Hispanic female (39.3%) than white male (23.6%), black male (19.1%), and Hispanic male (28.3%) students, respectively; and higher among 9th-grade female (33.6%), 10th-grade female (33.8%), 11th-grade female (36.2%), and 12th-grade female (34.9%) than 9th-grade male (24.3%), 10th-grade male (24.8%), 11th-grade male (25.8%), and 12th-grade male (21.6%) students, respectively. Overall, the prevalence of describing themselves as overweight was higher among white (28.8%) than black (24.6%) students; higher among Hispanic (33.8%) than white (28.8%) and black (24.6%) students; higher among white female (34.0%) than black female (30.1%) students; higher among Hispanic female (39.3%) than white female (34.0%) and black female (30.1%) students; higher among white male (23.6%) than black male (19.1%) students; and higher among Hispanic male (28.3%) than white male (23.6%) and black male (19.1%) students. The prevalence of describing themselves as overweight was higher among 11th-grade male (25.8%) than 12th-grade male (21.6%) students. Prevalence of describing themselves as overweight ranged from 22.7% to 32.7% across state surveys (median: 29.1%) and from 23.1% to 34.5% across local surveys (median: 26.8%) (Table 85).

Nationwide, 45.2% of students were trying to lose weight (Table 84). Overall, the prevalence of trying to lose weight was higher among female (60.3%) than male (30.4%) students; higher among white female (62.3%), black female (49.5%), and Hispanic female (62.1%) than white male (29.0%), black male (24.9%), and Hispanic male (38.5%) students, respectively; and higher among 9th-grade female (58.6%), 10th-grade female (60.2%), 11th-grade female (61.3%), and 12th-grade female (61.6%) than 9th-grade male (31.0%), 10th-grade male (31.6%), 11th-grade male (30.1%), and 12th-grade male (28.7%) students, respectively. Overall, the prevalence of trying to lose weight was higher among white (45.6%) than black (37.1%) students; higher among Hispanic (50.2%) than white (45.6%) and black (37.1%) students; higher among white female (62.3%) and Hispanic female (62.1%) than black female (49.5%) students; higher among white male (29.0%) than black male (24.9%) students; and higher among Hispanic male (38.5%) than white male (29.0%) and black male (24.9%) students. Prevalence of trying to lose weight ranged from 37.9% to 48.7% across state surveys (median: 45.0%) and from 38.1% to 53.1% across local surveys (median: 43.1%) (Table 85).

Ate Less Food, Fewer Calories, or Low-Fat Foods to Lose Weight or to Keep From Gaining Weight

During the 30 days before the survey, 40.6% of students nationwide had eaten less food, fewer calories, or low-fat foods to lose weight or to keep from gaining weight (Table 86). Overall, the prevalence of having eaten less food, fewer calories, or low-fat foods to lose weight or to keep from gaining weight was higher among female (53.2%) than male (28.3%) students; higher among white female (58.4%), black female (34.6%), and Hispanic female (52.0%) than white male (28.3%), black male (21.0%), and Hispanic male (32.3%) students, respectively; and higher among 9th-grade female (50.5%), 10th-grade female (53.0%), 11th-grade female (54.0%), and 12th-grade female (56.4%) than 9th-grade male (27.3%), 10th-grade male (29.1%), 11th-grade male (29.8%), and 12th-grade male (27.4%) students, respectively. Overall, the prevalence of having eaten less food, fewer calories, or low-fat foods to lose weight or to keep from gaining weight was higher among white (43.3%) and Hispanic (42.1%) than black (27.8%) students; higher among white female (58.4%) than black female (34.6%) and Hispanic female (52.0%) students; higher among Hispanic female (52.0%) than black female (34.6%) students; higher among white male (28.3%) than black male (21.0%) students; and higher among Hispanic male (32.3%) than white male (28.3%) and black male (21.0%) students. Overall, the prevalence of having eaten less food, fewer calories, or low-fat foods to lose weight or to keep from gaining weight was higher among 12th-grade (42.0%) than 9th-grade (38.6%) students and higher among 12th-grade female (56.4%) than 9th-grade female (50.5%) students. Prevalence of having eaten less food, fewer calories, or low-fat foods to lose weight or to keep from gaining weight ranged from 35.1% to 43.7% across state surveys (median: 39.1%) and from 30.6% to 41.3% across local surveys (median: 35.9%) (Table 87).

Nationwide, 60.9% of students had exercised to lose weight or to keep from gaining weight during the 30 days before the survey (Table 86). Overall, the prevalence of having exercised to lose weight or to keep from gaining weight was higher among female (67.0%) than male (55.0%) students; higher among white female (71.5%) and Hispanic female (66.4%) than white male (53.3%) and Hispanic male (60.1%) students, respectively; and higher among 9th-grade female (70.6%), 10th-grade female (67.7%), 11th-grade female (65.0%), and 12th-grade female (63.7%) than 9th-grade male (58.7%), 10th-grade male (54.2%), 11th-grade male (54.9%), and 12th-grade male (51.1%) students, respectively. Overall, the prevalence of having exercised to lose weight or to keep from gaining weight was higher among white (62.4%) and Hispanic (63.2%) than black (52.2%) students; higher among white female (71.5%) than black female (50.7%) and Hispanic female (66.4%) students; higher among Hispanic female (66.4%) than black female (50.7%) students; and higher among Hispanic male (60.1%) than white male (53.3%) and black male (53.7%) students. Overall, the prevalence of having exercised to lose weight or to keep from gaining weight was higher among 9th-grade (64.5%) than 10th-grade (60.9%), 11th-grade (59.9%), and 12th-grade (57.5%) students; higher among 10th-grade (60.9%) than 12th-grade (57.5%) students; higher among 9th-grade female (70.6%) than 11th-grade female (65.0%) and 12th-grade female (63.7%) students; higher among 10th-grade female (67.7%) than 12th-grade female (63.7%) students; higher among 9th-grade male (58.7%) than 10th-grade male (54.2%) and 12th-grade male (51.1%) students; and higher among 11th-grade male (54.9%) than 12th-grade male (51.1%) students. Prevalence of having exercised to lose weight or to keep from gaining weight ranged from 56.8% to 65.4% across state surveys (median: 61.1%) and from 50.5% to 69.3% across local surveys (median: 58.4%) (Table 87).

Did Not Eat for 24 or More Hours to Lose Weight or to Keep From Gaining Weight

Nationwide, 11.8% of students did not eat for 24 or more hours to lose weight or to keep from gaining weight during the 30 days before the survey (Table 88). Overall, the prevalence of not eating for 24 or more hours to lose weight or to keep from gaining weight was higher among female (16.3%) than male (7.3%) students; higher among white female (16.7%), black female (13.2%), and Hispanic female (17.4%) than white male (5.7%), black male (7.4%), and Hispanic male (10.7%) students, respectively; and higher among 9th-grade female (16.8%), 10th-grade female (19.1%), 11th-grade female (14.8%), and 12th-grade female (13.6%) than 9th-grade male (6.5%), 10th-grade male (6.5%), 11th-grade male (8.1%), and 12th-grade male (8.0%) students, respectively. Overall, the prevalence of not eating for 24 or more hours to lose weight or to keep from gaining weight was higher among Hispanic (14.1%) than white (11.2%) and black (10.3%) students; higher among white female (16.7%) and Hispanic female (17.4%) than black female (13.2%) students; and higher among Hispanic male (10.7%) than white male (5.7%) students. The prevalence of not eating for 24 or more hours to lose weight or to keep from gaining weight was higher among 9th-grade female (16.8%) than 12th-grade female (13.6%) students and higher among 10th-grade female (19.1%) than 11th-grade female (14.8%) and 12th-grade female (13.6%) students. Prevalence of not eating for 24 or more hours to lose weight or to keep from gaining weight ranged from 9.7% to 14.3% across state surveys (median: 12.0%) and from 8.9% to 14.0% across local surveys (median: 11.9%) (Table 89).

Took Diet Pills, Powders, or Liquids to Lose Weight or to Keep From Gaining Weight

During the 30 days before the survey, 5.9% of students nationwide had taken diet pills, powders, or liquids without a doctor's advice to lose weight or to keep from gaining weight (Table 88). Overall, the prevalence of having taken diet pills, powders, or liquids without a doctor's advice to lose weight or to keep from gaining weight was higher among female (7.5%) than male (4.2%) students; higher among white female (8.3%) and Hispanic female (7.8%) than white male (3.7%) and Hispanic male (5.1%) students, respectively; and higher among 9th-grade female (6.1%), 10th-grade female (6.9%), 11th-grade female (7.4%), and 12th-grade female (10.2%) than 9th-grade male (2.9%), 10th-grade male (3.8%), 11th-grade male (5.0%), and 12th-grade male (5.7%) students, respectively. Overall, the prevalence of having taken diet pills, powders, or liquids without a doctor's advice to lose weight or to keep from gaining weight was higher among white (6.0%) and Hispanic (6.4%) than black (3.7%) students and higher among white female (8.3%) and Hispanic female (7.8%) than black female (3.9%) students. Overall, the prevalence of having taken diet pills, powders, or liquids without a doctor's advice to lose weight or to keep from gaining weight was higher among 11th-grade (6.2%) and 12th-grade (8.0%) than 9th-grade (4.4%) students; higher among 12th-grade (8.0%) than 10th-grade (5.3%) and 11th-grade (6.2%) students; higher among 12th-grade female (10.2%) than 9th-grade female (6.1%), 10th-grade female (6.9%), and 11th-grade female (7.4%) students; and higher among 11th-grade male (5.0%) and 12th-grade male (5.7%) than 9th-grade male (2.9%) students. The prevalence of having taken diet pills, powders, or liquids without a doctor's advice to lose weight or to keep from gaining weight ranged from 3.9% to 8.6% across state surveys (median: 6.7%) and from 3.3% to 10.3% across local surveys (median: 5.4%) (Table 89).

Nationwide, 4.3% of students had vomited or taken laxatives to lose weight or to keep from gaining weight during the 30 days before the survey (Table 90). Overall, the prevalence of having vomited or taken laxatives to lose weight or to keep from gaining weight was higher among female (6.4%) than male (2.2%) students; higher among white female (6.9%) and Hispanic female (7.0%) than white male (1.3%) and Hispanic male (3.7%) students, respectively; and higher among 9th-grade female (5.5%), 10th-grade female (7.6%), 11th-grade female (5.7%), and 12th-grade female (6.6%) than 9th-grade male (2.1%), 10th-grade male (1.8%), 11th-grade male (2.1%), and 12th-grade male (2.6%) students, respectively. Overall, the prevalence of having vomited or taken laxatives to lose weight or to keep from gaining weight was higher among Hispanic (5.3%) than black (3.0%) students; higher among white female (6.9%) and Hispanic female (7.0%) than black female (3.5%) students; and higher among black male (2.5%) and Hispanic male (3.7%) than white male (1.3%) students. Prevalence of having vomited or taken laxatives to lose weight or to keep from gaining weight ranged from 3.6% to 7.9% across state surveys (median: 5.4%) and from 2.4% to 9.0% across local surveys (median: 5.2%) (Table 91).

Other Health-Related Topics

Nationwide, 20.3% of students had ever been told by a doctor or nurse that they had asthma (i.e., lifetime asthma) (Table 92). Overall, the prevalence of lifetime asthma was higher among black (24.0%) than white (19.6%) and Hispanic (18.5%) students and higher among black male (24.6%) than white male (18.9%) and Hispanic male (17.7%) students. Prevalence of lifetime asthma ranged from 15.4% to 28.7% across state surveys (median: 21.4%) and from 15.1% to 27.9% across local surveys (median: 20.9%) (Table 93).

Nationwide, 10.9% of students had lifetime asthma and still had asthma (i.e., current asthma) (Table 92). Overall, the prevalence of current asthma was higher among female (12.5%) than male (9.3%) students; higher among white female (12.2%) and Hispanic female (11.4%) than white male (8.8%) and Hispanic male (7.7%) students, respectively; and higher among 10th-grade female (13.3%) and 11th-grade female (12.3%) than 10th-grade male (9.5%) and 11th-grade male (8.3%) students, respectively. Overall, the prevalence of current asthma was higher among black (14.7%) than white (10.5%) and Hispanic (9.5%) students; higher among black female (15.6%) than white female (12.2%) and Hispanic female (11.4%) students; and higher among black male (13.6%) than white male (8.8%) and Hispanic male (7.7%) students. The prevalence of current asthma was higher among 9th-grade male (10.9%) than 11th-grade male (8.3%) and 12th-grade male (8.1%) students. Prevalence of current asthma ranged from 8.4% to 14.2% across state surveys (median: 10.9%) and from 6.8% to 19.9% across local surveys (median: 9.4%) (Table 93).

Nationwide, 10.3% of students most of the time or always wore sunscreen with an SPF of 15 or higher when outside for more than 1 hour on a sunny day (i.e., routine sunscreen use) (Table 94). Overall, the prevalence of routine sunscreen use was higher among female (13.7%) than male (6.9%) students; higher among white female (15.9%), black female (6.2%), and Hispanic female (10.6%) than white male (8.2%), black male (3.5%), and Hispanic male (5.2%) students, respectively; and higher among 9th-grade female (14.4%), 10th-grade female (13.6%), 11th-grade female (12.9%), and 12th-grade female (13.8%) than 9th-grade male (7.4%), 10th-grade male (6.4%), 11th-grade male (6.5%), and 12th-grade male (7.4%) students, respectively. Overall, the prevalence of routine sunscreen use was higher among white (12.0%) than black (4.9%) and Hispanic (7.9%) students; higher among Hispanic (7.9%) than black (4.9%) students; higher among white female (15.9%) than black female (6.2%) and Hispanic female (10.6%) students; higher among Hispanic female (10.6%) than black female (6.2%) students; and higher among white male (8.2%) than black male (3.5%) and Hispanic male (5.2%) students.

Nationwide, 17.4% of students most of the time or always stayed in the shade, wore long pants, wore a long-sleeved shirt, or wore a hat that shaded their face, ears, and neck when outside for more than 1 hour on a sunny day (i.e., routine practice of sun-safety behaviors) (Table 94). Overall, the prevalence of routine practice of sun-safety behaviors was higher among male (19.4%) than female (15.4%) students; higher among white male (18.3%) and Hispanic male (22.7%) than white female (11.4%) and Hispanic female (19.1%) students, respectively; and higher among 9th-grade male (21.0%), 11th-grade male (18.0%), and 12th-grade male (20.1%) than 9th-grade female (15.4%), 11th-grade female (14.8%), and 12th-grade female (14.8%) students, respectively. Overall, the prevalence of routine practice of sun-safety behaviors was higher among black (21.1%) and Hispanic (20.9%) than white (14.9%) students; higher among black female (23.3%) and Hispanic female (19.1%) than white female (11.4%) students; and higher among Hispanic male (22.7%) than white male (18.3%) students.

Nationwide, 31.1% of students had 8 or more hours of sleep on an average school night (Table 95). Overall, the prevalence of having had 8 or more hours of sleep was higher among male (33.4%) than female (28.7%) students; higher among white male (34.2%) than white female (27.5%) students; and higher among 10th-grade male (35.6%) and 11th-grade male (27.3%) than 10th-grade female (29.2%) and 11th-grade female (22.6%) students, respectively. Overall, the prevalence of having had 8 or more hours of sleep was higher among Hispanic (34.4%) than black (28.8%) students; higher among Hispanic female (33.4%) than white female (27.5%) students; and higher among white male (34.2%) and Hispanic male (35.4%) than black male (28.0%) students. Overall, the prevalence of having had 8 or more hours of sleep was higher among 9th-grade (42.3%) than 10th-grade (32.4%), 11th-grade (24.9%), and 12th-grade (21.8%) students; higher among 10th-grade (32.4%) than 11th-grade (24.9%) and 12th-grade (21.8%) students; higher among 9th-grade female (39.4%) than 10th-grade female (29.2%), 11th-grade female (22.6%), and 12th-grade female (21.9%) students; higher among 10th-grade female (29.2%) than 11th-grade female (22.6%) and 12th-grade female (21.9%) students; higher among 9th-grade male (45.0%) than 10th-grade male (35.6%), 11th-grade male (27.3%), and 12th-grade male (21.6%) students; higher among 10th-grade male (35.6%) than 11th-grade male (27.3%) and 12th-grade male (21.6%) students; and higher among 11th-grade male (27.3%) than 12th-grade male (21.6%) students.

Trends During 1991--2007

During 1991--2007, a significant linear decrease occurred in the percentage of students who rarely or never wore a seat belt (25.9%--11.1%), who rarely or never wore a motorcycle helmet (42.9%--33.9%), and who rode with a driver who had been drinking alcohol (39.9%--29.1%). The percentage of students who rarely or never wore a bicycle helmet decreased during 1991--2001 (96.2%--84.7%) and then did not change significantly during 2001--2007 (84.7%--85.1%). The percentage of students who drove when they had been drinking alcohol did not change significantly during 1991--1997 (16.7%--16.9%) and then decreased during 1997--2007 (16.9%--10.5%). During 2005--2007, no significant changes occurred in any of these variables.

The percentage of students who carried a weapon decreased during 1991--1999 (26.1%--17.3%) and then did not change significantly during 1999--2007 (17.3%--18.0%); the percentage of students who carried a gun decreased during 1993--1999 (7.9%--4.9%) and then did not change significantly during 1999--2007 (4.9%--5.2%). The percentage of students who had been in a physical fight decreased during 1991--2003 (42.5%--33.0%) and then increased during 2003--2007 (33.0%--35.5%). During 2005--2007, no significant changes occurred in any of these behaviors that contribute to violence.

The percentage of students who carried a weapon on school property decreased during 1993--2003 (11.8%--6.1%) and then did not change significantly during 2003--2007 (6.1%--5.9%). The percentage of students who had been in a physical fight on school property decreased during 1993--2001 (16.2%--12.5%) and then did not change significantly during 2001--2007 (12.5%--12.4%). During 2003--2007, a significant linear decrease occurred in the percentage of students who had property stolen or damaged on school property (29.8%--27.1%). The percentage of students who had property stolen or damaged on school property also decreased during 2005--2007 (29.8%--27.1%). During 1993--2007, a significant linear increase occurred in the percentage of students who did not go to school because of safety concerns (4.4%--5.5%).

During 1991--2007, a significant linear decrease occurred in the percentage of students who seriously considered attempting suicide (29.0%--14.5%) and in the percentage of students who made a suicide plan (18.6%--11.3%). The percentage of students who attempted suicide did not change significantly during 1991--2001 (7.3%--8.8%) and then decreased during 2001--2007 (8.8%--6.9%). The percentage of students who made a suicide attempt that had to be treated by a doctor or nurse did not change significantly during 1991-- 2003 (1.7%--2.9%) and then decreased during 2003--2007 (2.9%--2.0%). During 2005--2007, significant decreases also occurred in the percentage of students who seriously considered attempting suicide (16.9%--14.5%), who made a suicide plan (13.0%--11.3%), and who attempted suicide (8.4%--6.9%).

The percentage of students who reported lifetime cigarette use did not change significantly during 1991--1999 (70.1%--70.4%) and then decreased during 1999--2007 (70.4%--50.3%). During 2001--2007, significant linear decreases occurred in the percentage of students who reported lifetime daily cigarette use (20.0%--12.4%), who reported trying to quit smoking cigarettes (57.4%--49.7%), and who reported buying cigarettes in a store or gas station (19.0%--16.0%). The percentage of students who reported trying to quit smoking cigarettes also decreased from 2005--2007 (54.6%--49.7%). The percentage of students who reported current cigarette use increased during 1991--1997 (27.5%--36.4%) and then decreased during 1997--2007 (36.4%--20.0%), and the percentage of students who reported current frequent cigarette use increased during 1991--1999 (12.7%--16.8%) and then decreased during 1999--2007 (16.8%--8.1%). During 1991--2007, a significant linear decrease occurred in the percentage of students who reported smoking more than 10 cigarettes per day (18.0%--10.7%). The percentage of students who reported current smokeless tobacco use decreased during 1995--2003 (11.4%--6.7%) and then did not change significantly during 2003--2007 (6.7%--7.9%). The percentage of students who reported current cigar use decreased during 1997--2005 (22.0%--14.0%) and then did not change significantly during 2005--2007 (14.0%--13.6%). During 1997--2007, a significant linear decrease occurred in the percentage of students who reported current tobacco use (43.4%--25.7%).

During 1991--2007, a significant linear decrease occurred in the percentage of students who reported lifetime alcohol use (81.6%--75.0%). The percentage of students who reported current alcohol use did not change significantly during 1991--1999 (50.8%--50.0%) and then decreased during 1999--2007 (50.0%--44.7%), and the percentage of students who reported episodic heavy drinking did not change significantly during 1991--1997 (31.3%--33.4%) and then decreased during 1997--2007 (33.4%--26.0%). The percentage of students who reported lifetime marijuana use increased during 1991--1999 (31.3%--47.2%) and then decreased during 1999--2007 (47.2%--38.1%), and the percentage of students who reported current marijuana use increased during 1991--1999 (14.7%--26.7%) and then decreased during 1999--2007 (26.7%--19.7%). The percentage of students who reported lifetime cocaine use increased during 1991--1999 (5.9%--9.5%) and then decreased during 1999--2007 (9.5%--7.2%), and the percentage of students who reported current cocaine use increased during 1991--2001 (1.7%--4.2%) and then decreased during 2001--2007 (4.2%--3.3%). The percentage of students who reported lifetime inhalant use decreased during 1995--2003 (20.3%--12.1%) and then did not change significantly during 2003--2007 (12.1%--13.3%). The percentage of students who reported lifetime illegal steroid use increased during 1991--2003 (2.7%--6.1%) and then decreased during 2003--2007 (6.1%--3.9%). During 2001--2007, a significant linear decrease occurred in the percentage of students who reported lifetime hallucinogenic drug use (13.3%--7.8%) and lifetime ecstasy use (11.1%--5.8%). The percentage of students who reported lifetime heroine use did not change significantly during 1999--2003 (2.4%--3.3%) and then decreased during 2003--2007 (3.3%--2.3%). The percentage of students who reported lifetime methamphetamine use did not change significantly during 1999--2001 (9.1%--9.8%) and then decreased during 2001--2007 (9.8%--4.4%). The percentage of students who reported lifetime methamphetamine use also decreased during 2005--2007 (6.2%--4.4%).

The percentage of students who reported smoking a whole cigarette for the first time before age 13 years increased during 1991--1993 (23.8%--26.9%) and then decreased during 1993--2007 (26.9%--14.2%). The percentage of students who reported having drunk alcohol for the first time before age 13 years did not change significantly 1991--1999 (32.7%--32.2%) and then decreased during 1999--2007 (32.2%--23.8%). The percentage of students who reported having tried marijuana for the first time before age 13 years increased during 1991--1999 (7.4%--11.3%) and then decreased during 1999--2007 (11.3%--8.3%). During 2005--2007, no significant changes occurred in any of these age of initiation variables.

The percentage of students who smoked cigarettes on school property did not change significantly during 1993--1995 (13.2%--16.0%) and then decreased during 1995--2007 (16.0%--5.7%). During 1993--2007, a significant linear decrease occurred in the percentage of students who drank alcohol on school property (5.2%--4.1%). The percentage of students who used marijuana on school property increased during 1993--1995 (5.6%--8.8%) and then decreased during 1995--2007 (8.8%--4.5%). The percentage of students who were offered, sold, or given an illegal drug on school property increased during 1993--1995 (24.0%--32.1%) and then decreased during 1995--2007 (32.1%--22.3%). The percentage of students who were offered, sold, or given an illegal drug on school property also decreased during 2005--2007 (25.4%--22.3%).

Sexual Behaviors that Contribute to Unintended Pregnancy and Sexually Transmitted Diseases, Including HIV Infection

During 1991--2007, significant linear decreases occurred in the percentage of students who ever had sexual intercourse (54.1%--47.8%), who had sexual intercourse with four or more persons during their lifetime (18.7%--14.9%), and who were currently sexually active (37.5%--35.0%). The percentage of students who had sexual intercourse for the first time before age 13 years decreased during 1991--2005 (10.2%--6.2%) and then did not change significantly during 2005--2007 (6.2%--7.1%). The percentage of sexually active students who used a condom at last sexual intercourse increased during 1991--2003 (46.2%--63.0%) and then did not change significantly during 2003--2007 (63.0%--61.5%). The percentage of students who drank alcohol or used drugs before last sexual intercourse increased during 1991--2001 (21.6--25.6) and then decreased during 2001--2007 (25.6%--22.5%). The percentage of students who were taught in school about AIDS or HIV infection increased during 1991--1997 (83.3%--91.5%) and then decreased during 1997--2007 (91.5%--89.5%). During 2005--2007, no significant changes occurred in any of these sexual behavior variables.

During 1999--2007, significant linear decreases occurred in the percentage of students who ate fruits and vegetables five or more times per day (23.9%--21.4%) and who drank three or more glasses per day of milk (18.0%--14.1%). During 2005--2007, no significant changes occurred in either of these dietary behavior variables.

No significant linear change occurred in the percentage of students who used computers 3 or more hours per day during 2003--2007 (22.1%--24.9%). The percentage of students who used computers 3 or more hours per day increased during 2005--2007 (21.1%--24.9%). During 1999--2007, a significant linear decrease occurred in the percentage of students who watched 3 or more hours per day of television (42.8%--35.4%). The percentage of students who attended PE classes daily decreased during 1991--1995 (41.6%--25.4%) and then did not change significantly during 1995--2007 (25.4%--30.3%).

During 1999--2007, significant linear increases occurred in the percentage of students who were obese (10.7%--13.0%) and who were overweight (14.4%--15.8%). The percentage of students who described themselves as overweight decreased during 1991--1997 (31.8%--27.3%) and then increased during 1997--2007 (27.3%--29.3%). The percentage of students who described themselves as overweight also decreased during 2005--2007 (31.5%--29.3%). During 1991--2007, a significant linear increase occurred in the percentage of students who were trying to lose weight (41.8%--45.2%). During 1995--2007, a significant linear increase occurred in the percentage of students who exercised to lose weight or to keep from gaining weight (51.0%--60.9%). The percentage of students who ate less food, fewer calories, or low-fat foods to lose weight or to keep from gaining weight increased during 1999--2001 (40.4%--43.8%) and then decreased during 2001--2007 (43.8%--40.6%). The percentage of students who took diet pills, powders, or liquids to lose weight or to keep from gaining weight increased during 1999--2001 (7.6%--9.2%) and then decreased during 2001--2007 (9.2%--5.9%). The percentage of students who vomited or took laxatives to lose weight or to keep from gaining weight did not change significantly during 1995--2003 (4.8%--6.0%) and then decreased during 2003--2007 (6.0%--4.3%).

Discussion

Certain risk behaviors are more likely to occur among subpopulations of students defined by sex, race/ethnicity, and grade. However, this analysis could not isolate the effects of sex, race/ethnicity, or grade from the effects of socioeconomic status (SES) or culture on risk behaviors with substantial disparities. In a 1992 national study, after controlling for age, sex, race/ethnicity, and school enrollment status (i.e., in school or out of school), adolescents aged 12--17 years were less likely to report selected risk behaviors (e.g., smoking, physical inactivity, eating too little fruit and vegetables, and episodic heavy drinking) as the SES (education or family income) of the responsible adult in their family increased (15). Additional research is needed to assess the effect of specific educational, socioeconomic, cultural, and racial/ethnic factors on the prevalence of health-risk behaviors among high school students.

For the majority of risk behaviors, prevalence does not vary substantially across states or across cities. However, across state surveys, a range of 25 or more percentage points or a fivefold variation or greater was identified for the following risk behaviors:

Across local surveys, a range of 25 or more percentage points or a fivefold variation or greater was identified for the following risk behaviors:

These variations might occur, in part, because of differences in state and local laws and policies, enforcement practices, access to illegal drugs, availability of effective school and community interventions, prevailing behavioral and social norms, demographic characteristics of the population, and adult practices. Longitudinal research is needed to better understand the effect of these factors on the development and prevalence of risk behaviors.

Healthy People 2010

The national YRBS is the primary source of data to measure 15 Healthy People 2010 objectives and three leading health indicators (16). The Healthy People 2010 objectives provide a comprehensive agenda for improving the health of all persons in the United States during the first decade of the 21st century. This report provides the 2010 target and data from the 2007 national YRBS for all 15 objectives (Table 96).

Limitations

The findings in this report are subject to at least three limitations. First, these data apply only to youth who attend school and, therefore, are not representative of all persons in this age group. Nationwide, in 2005, of persons aged 16--17 years, approximately 3% were not enrolled in a high school program and had not completed high school (17). Second, the extent of underreporting or overreporting of behaviors cannot be determined, although the survey questions demonstrate good test-retest reliability (8). Third, BMI is calculated on the basis of self-reported height and weight, and, therefore, tends to underestimate the prevalence of obesity and overweight (18).

Conclusion

The national YRBS data are used routinely by CDC and other federal agencies. For example, CDC uses YRBS data for the following:

State and local agencies and nongovernmental organizations use YRBS data to set school health and health promotion program goals, support modification of school health curricula or other programs, support new legislation and policies that promote health, and seek funding for new initiatives. For example, Hillsborough County, Florida, used YRBS data to enhance health education, physical education, and health science education programs and to create a guide for high school science teachers to use when discussing specific topics related to HIV, STDs, and unintended pregnancies. In Michigan, YRBS data are used to plan and advocate for coordinated school health programs and other health-related initiatives in their state. The San Francisco Unified School District (SFUSD) developed the SFUSD Family Guide, which combines its YRBS data in an easy-to-read form with information on related school health programs, national research, and strategies for promoting health at home. The family guides are available to parents, students, and community organizations. In Utah, YRBS data on sedentary activities were used in developing the "Unplug and Play Program" to promote physical activity. This program was implemented for the first time in 2007.

Seventy six percent of all states have YRBS data representative of their high school students attending public schools. Continued support for and expansion of YRBSS will help monitor and ensure effectiveness of public health and school health programs for youth.

References

^§§ 100% fruit juice, fruit, green salad, potatoes (excluding French fries, fried potatoes, or potato chips), carrots, or other vegetables.

State and Local Youth Risk Behavior Survey Coordinators

States: Alaska, Patricia Owen, Dept of Health and Social Svcs; Arizona, Catherine Osborn, MPA, Dept of Education; Arkansas, Kathleen Courtney, MS, Dept of Education; Connecticut, Diane Aye, PhD, Dept of Public Health; Delaware, Janet Arns Ray, MS, Dept of Education; Florida, Jamie Weitz, MS, Dept of Health; Georgia, Dafna Kanny, PhD, Dept of Human Resources; Hawaii, Dave Randall, MEd, Dept of Education; Idaho, Patricia Stewart, State Dept of Education; Illinois, Glenn Steinhausen, PhD, State Board of Education; Indiana, Katherine Newland, MPH, Dept of Health; Iowa, Sara A. Peterson, MA, Dept of Education; Kansas, Mark Thompson, PhD, Dept of Education; Kentucky, Stephanie Bunge, MEd, Dept of Education; Maine, Jean Zimmerman, MS, Dept of Education; Maryland, Richard D. Scott, DMin, State Dept of Education; Massachusetts, Chiniqua Milligan, MPH, Dept of Elementary and Secondary Education; Michigan, Kim Kovalchick, MPH, Dept of Education; Mississippi, Stephanie N. Robinson, MS, Dept of Education; Missouri, Kevin Miller, MA, Dept of Elementary and Secondary Education; Montana, Susan Court, Office of Public Instruction; Nevada, Robinette Bacon, Dept of Education; New Hampshire, Mary Bubnis, MEd, Dept of Education; New Mexico, Kristine M. Meurer, PhD, Public Education Dept; New York, Owen M. Donovan, MSE, State Education Dept; North Carolina, Sarah Langer, MPH, Dept of Public Instruction; North Dakota, Andrea Peña, MA, Dept of Public Instruction; Ohio, Angela Smith, MSA, Dept of Health; Oklahoma, Tyler Whitehead, Dept of Health; Rhode Island, Donald K. Perry, MPA, Dept of Health; South Carolina, Elaine Maney, MPH, Dept of Education; South Dakota, April Hodges, Dept of Education; Tennessee, Jerry Swaim, MS, Dept of Education; Texas, Michelle L. Cook, MPH, Dept of State Health Services; Utah, Frank Wojtech, MS, State Office of Education; Vermont, Jennifer K. Hicks, Dept of Health; West Virginia, Rick Deem, Dept of Education; Wisconsin, Brian Weaver, MPH, Dept of Public Instruction; and Wyoming, Gerald M. Maas, PhD, Dept of Education.
Cities: Baltimore, Maryland, Patricia Brownlee, MS, Baltimore City Public School System; Boston, Massachusetts, Barbara A. Huscher, MEd, Boston Public Schools; Broward County, Florida, Patrick Chalmers, MS, Broward County Public Schools; Charlotte-Mecklenburg, North Carolina, Nancy Langenfeld, MS, Charlotte-Mecklenburg Schools; Chicago, Illinois, Vicki Pittman, MS, Chicago Public Schools; Dallas, Texas, Angelica Duran, LMSW, Dallas Independent School District; DeKalb County, Georgia, Shannon L. Williams, EdS, DeKalb County School System; Detroit, Michigan, Arlene Richardson, EdD, Detroit Public Schools; District of Columbia, Marc D. Clark, PhD, District of Columbia Public Schools; Hillsborough County, Florida, Lloyd Zimet, PhD, Hillsborough County Public Schools; Houston, Texas, Rose Haggerty, MEd, Houston Independent School District; Los Angeles, California, Ric Loya, Los Angeles Unified School District; Memphis, Tennessee, Patricia Bafford, MEd, Memphis City Schools; Miami-Dade County, Florida, Rodolfo Abella, PhD, Miami-Dade County Public Schools; Milwaukee, Wisconsin, Brett A. Fuller, MEd, Milwaukee Public Schools; New York City, New York, Donna Eisenhower, PhD, New York City Dept of Health and Mental Hygiene; Orange County, Florida, Brenda Christopher-Muench, Orange County Public Schools; Palm Beach County, Florida, Dannette Fitzgerald, MS, School District of Palm Beach County; Philadelphia, Pennsylvania, Brian P. Daly, Temple University, College of Health Professions; San Bernardino, California, Charlene Davis-Long, San Bernardino City Unified School District; San Diego, California, Marge Kleinsmith-Hildebrand, MS, San Diego Unified School District; and San Francisco, California, Phong Pham, MA, San Francisco Unified School District.

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