Youth Risk Behavior Surveillance -- National Alternative High School Youth Risk Behavior Survey, United States, 1998

Jo Anne Grunbaum, Ed.D.¹
Laura Kann, Ph.D.¹
Steven A. Kinchen¹
James G. Ross, M.S.²
Vani R. Gowda, M.H.S.¹
Janet L. Collins, Ph.D.³
Lloyd J. Kolbe, Ph.D.¹

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

Problem/Condition: Alternative high schools serve approximately 280,000 students nationwide who are at high risk for failing or dropping out of regular high school or who have been expelled from regular high school because of illegal activity or behavioral problems. Such settings provide important opportunities for delivering health promotion education and services to these youth and young adults. However, before this survey, the prevalence of health-risk behaviors among students attending alternative high schools nationwide was unknown.

Reporting Period: February-May 1998.

Description of System: The Youth Risk Behavior Surveillance System (YRBSS) monitors the following six categories of priority health-risk behaviors among youth and young adults: behaviors that contribute to unintentional and intentional injuries; tobacco use; alcohol and other drug use; sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases (STDs) (including human immunodeficiency virus [HIV] infection); unhealthy dietary behaviors; and physical inactivity. The national Alternative High School Youth Risk Behavior Survey (ALT-YRBS) is one component of the YRBSS; it was conducted in 1998 to measure priority health-risk behaviors among students at alternative high schools. The 1998 ALT-YRBS used a three-stage cluster sample design to produce a nationally representative sample of students in grades 9-12 in the United States who attend alternative high schools. The school response rate was 81.0%, and the student response rate was 81.9%, resulting in an overall response rate of 66.3%. This report summarizes results from the 1998 ALT-YRBS.

Results and Interpretation: In the United States, 73.6% of all deaths among youth and young adults aged 10-24 years results from only four causes -- motor vehicle crashes, other unintentional injuries, homicide, and suicide. Results from the 1998 ALT-YRBS demonstrate that many students at alternative high schools engage in behaviors that increase their likelihood of death from these four causes. During the 30 days preceding the survey, 51.9% had ridden with a driver who had been drinking alcohol, 25.1% had driven a vehicle after drinking alcohol, 32.9% had carried a weapon, 64.5% had drunk alcohol, and 53.0% had used marijuana. During the 12 months preceding the survey, 15.7% had attempted suicide, and 29.0% had rarely or never worn a seat belt. Substantial morbidity among school-aged youth and young adults also results from unintended pregnancies and STDs, including HIV infection. ALT-YRBS results indicate that in 1998, a total of 87.8% of students at alternative high schools had had sexual intercourse, 54.1% of sexually active students had not used a condom at last sexual intercourse, and 5.7% had ever injected an illegal drug. Among adults aged greater than or equal to 25 years, 66.5% of all deaths result from two causes -- cardiovascular disease and cancer. Most risk behaviors associated with these causes of death are initiated during adolescence. In 1998, a total of 64.1% of students at alternative high schools had smoked cigarettes during the 30 days preceding the survey, 38.3% had smoked a cigar during the 30 days preceding the survey, 71.2% had not eaten greater than or equal to 5 servings of fruits and vegetables during the day preceding the survey, and 81.0% had not attended physical education (PE) class daily. Comparing ALT-YRBS results with 1997 national YRBS results demonstrates that the prevalence of most risk behaviors is higher among students attending alternative high schools compared with students at regular high schools. Some risk behaviors are more common among certain sex and racial/ethnic subgroups of students.

Public Health Action: ALT-YRBS data can be used nationwide by health and education officials to improve policies and programs designed to reduce risk behaviors associated with the leading causes of morbidity and mortality among students attending alternative high schools.

Approximately 2.0% (280,000) of all high school students are enrolled in the nation's 1,390 alternative high schools, which serve students who are at risk for failing or dropping out of regular high school and students who have been removed from their regular high school because of drug use, violence, or other illegal activity or behavioral problems (1). Although these students can be at risk for serious health problems, few national data are available to describe their health risks.

Several local studies have assessed health-risk behaviors among students attending alternative high schools (2-4). Two studies compared the prevalence of risk behaviors of students attending alternative high schools with the prevalence of risk behaviors of students attending regular high schools in the same community. Both studies indicated a substantially higher prevalence of violence-related behaviors, substance use, and risky sexual behaviors among students at alternative high schools compared with students at regular high schools (2,3). Similar results were reported when survey data from students attending alternative high schools in Texas were compared with data from the 1997 national Youth Risk Behavior Survey (YRBS) (4). The prevalence of violence-related behaviors, current substance use, and sexual behaviors was higher among students at alternative high schools in Texas than among the national sample of students at regular high schools.

In the United States, 73.6% of all deaths among youth and young adults aged 10-24 years results from only four causes -- motor vehicle crashes (31.6%), other unintentional injuries (10.8%), homicide (18.6%), and suicide (12.6%) (5). Substantial morbidity and social problems also result from the approximately 1 million pregnancies that occur each year among young persons aged 15-19 years (6) and the estimated 3 million cases of sexually transmitted diseases (STDs) that occur each year among those aged 10-19 years (7).

Two thirds of all deaths among adults aged greater than or equal to 25 years in the United States result from cardiovascular disease (42.5%) and cancer (24.0%) (5). The leading causes of mortality and morbidity in all age groups in the United States are related to the following six categories of health behavior: behaviors that contribute to unintentional and intentional injuries; tobacco use; alcohol and other drug use; sexual behaviors that contribute to unintended pregnancy and STDs, including human immunodeficiency virus (HIV) infection; unhealthy dietary behaviors; and physical inactivity. These behaviors are frequently interrelated and often are established during youth and extend into adulthood.

CDC developed the Youth Risk Behavior Surveillance System (YRBSS) to monitor priority health-risk behaviors among youth and young adults (8). The national Alternative High School Youth Risk Behavior Survey (ALT-YRBS) is one component of the YRBSS and is the first national survey to measure health-risk behaviors among students at alternative high schools. The YRBSS also includes a) national, state, and local school-based surveys of high school students conducted biennially since 1991; b) a household-based survey conducted in 1992 among a national sample of youth and young adults aged 12-21 years, whether enrolled in school; and c) the National College Health Risk Behavior Survey (NCHRBS), which was conducted in 1995.

The 1998 ALT-YRBS used a three-stage cluster sample design to produce a nationally representative sample of students in grades 9-12 in the United States who attend alternative high schools. The target population consisted of 1,390 secondary schools in the 50 states and the District of Columbia. These schools included public, private, and Catholic schools that had designated themselves as alternative and a) contained at least one of the grades 9-12, b) were not a school within another school, and c) served students at risk for not graduating from regular high schools. Small schools, which make up less than 1.0% of the total enrollment of all alternative high schools, and vocational schools were excluded.

The first-stage sampling frame included 121 primary sampling units (PSUs) consisting of groups of alternative high schools in close geographic proximity. From the 121 PSUs, 48 were selected without replacement, with probabilities proportional to school enrollment size and the relative percentage of black* and Hispanic students in the PSU. For the second stage of sampling, 142 schools were selected with probability proportional to school enrollment size. To enable separate analysis of data for black and Hispanic students, schools with substantial numbers of black and Hispanic students were sampled at higher rates than all other schools. For the third stage of sampling, classes were randomly selected within each school, so that each student had an equal chance of being selected.

A weighting factor was applied to each student record to adjust for nonresponse and for the varying probabilities of selection, including those resulting from the oversampling of black and Hispanic students. Numbers of students in other racial/ethnic groups were too low for meaningful analysis in this report. The weights were scaled so that a) the weighted count of students was equal to the total sample size and b) the weighted proportions of students in each grade matched national population proportions for students at alternative high schools. To compute 95% confidence intervals (CI), Software for Survey Data Analysis (SUDAAN) was used (9). The 95% CIs were used to determine differences among subgroups at the p less than 0.05 level. Significant differences among prevalence estimates were reported for the main effect of sex, the main effect of race/ethnicity, the interaction effect of sex within race/ethnicity, the interaction effect of sex within grade, the interaction effect of race/ethnicity within sex, and the interaction effect of grade within sex. Differences were considered statistically significant if the 95% CIs did not overlap. The national data are representative of students in grades 9-12 in public and private alternative high schools in the 50 states and the District of Columbia that serve students who are at high risk for failing or dropping out of regular high school and students who have been removed from their regular high school because of drug use, violence, or other illegal activity or behavioral problems.

A total of 8,918 students completed questionnaires in 115 schools. Of these schools, five (6.0% of students) served pregnant teenagers, 13 (8.0% of students) served adjudicated students, 17 (13.0% of students) served students with emotional or behavioral problems, and 80 (74.0% of students) served multiple types of student populations. Thirteen (11.0% of students) of the 115 schools were residential facilities, one (1.0% of students) contained both residential and day treatment programs, and 101 (87.0% of students) were nonresidential.

The school response rate was 81.0%, and the student response rate was 81.9%, resulting in an overall response rate of 66.3%. After weighting, male students represented 55.7% of the sample; white** students, 42.7%; black students, 20.8%; and Hispanic students, 25.7% (Table 1). Students in grade 9 represented 14.8% of the responses, students in grade 10 represented 20.5%, students in grade 11 represented 30.4%, and students in grade 12 represented 31.7%. The age of students ranged from less than or equal to 12 years (0.3%) to greater than or equal to 21 years (0.6%), with a mean age of 16.8 years.

Survey procedures were designed to protect the students' privacy by allowing for anonymous and voluntary participation. Students completed the self-administered questionnaire in their classrooms during a regular class period, recording their responses directly onto a computer-scannable booklet. The questionnaire contained 88 multiple-choice questions. Local parental permission procedures were followed before survey administration.

Nationwide, 29.0% of students had rarely or never worn seat belts when riding in a car or truck driven by someone else (Table 2). Overall, male students (34.0%) were significantly more likely than female students (22.8%) to have rarely or never worn seat belts. This significant difference between males and females also was identified for white and Hispanic students and for students in grades 10 and 11. Overall, white students (32.3%) were significantly more likely than Hispanic students (21.8%) to have rarely or never worn seat belts. This significant difference among racial/ethnic subgroups also was identified for male students. Male students in grade 9 (44.1%) were significantly more likely than male students in grade 12 (26.2%) to have rarely or never worn seat belts.

Nationwide, 27.1% of students had ridden a motorcycle during the 12 months preceding the survey (Table 2). Among these students, 46.9% had rarely or never worn a motorcycle helmet. Male students in grade 11 (50.4%) were significantly more likely than female students in grade 11 (28.5%) to have rarely or never worn a motorcycle helmet. Overall, Hispanic students (59.8%) were significantly more likely than white students (42.1%) to have rarely or never worn a motorcycle helmet. This significant difference among racial/ethnic subgroups also was identified for male students.

Nationwide, 68.7% of students had ridden a bicycle during the 12 months preceding the survey (Table 2). Of this number, 94.7% had rarely or never worn a bicycle helmet.

During the 30 days preceding the survey, 51.9% of students nationwide had ridden greater than or equal to 1 times with a driver who had been drinking alcohol (Table 2). Male students in grade 12 (55.9%) were significantly more likely than female students in grade 12 (47.2%) to have ridden with a driver who had been drinking alcohol.

During the 30 days preceding the survey, 25.1% of students nationwide had driven a vehicle greater than or equal to 1 times after drinking alcohol (Table 2). Overall, male students (31.6%) were significantly more likely than female students (17.1%) to have driven after drinking alcohol. This significant difference between males and females also was identified for all racial/ethnic and grade subgroups. Overall, white students (28.3%) were significantly more likely than black students (19.1%) to have driven after drinking alcohol. White and Hispanic female students (20.2% and 15.2%, respectively) were significantly more likely than black female students (10.6%) to have driven after drinking alcohol. Female students in grade 11 (18.3%) were significantly more likely than female students in grades 9 and 10 (11.7% and 12.8%, respectively) to have driven after drinking alcohol. Male students in grade 12 (38.9%) were significantly more likely than male students in grades 9 and 11 (26.1% and 28.1%, respectively) to have done so.

Approximately one third (32.9%) of students nationwide had carried a weapon (i.e., a gun, knife, or club) on greater than or equal to 1 of the 30 days preceding the survey (Table 3). Overall, male students (44.8%) were significantly more likely than female students (18.4%) to have carried a weapon. This significant difference between males and females also was identified for all racial/ethnic and grade subgroups. Black female students (27.6%) were significantly more likely than white and Hispanic female students (12.6% and 16.6%, respectively) to have carried a weapon, and Hispanic male students (49.0%) were significantly more likely than black male students (38.2%) to have done so. Female students in grade 9 (29.2%) were significantly more likely than female students in grades 11 and 12 (17.4% and 14.0%, respectively) to have carried a weapon, and male students in grades 9 and 10 (51.6% and 50.1%, respectively) were significantly more likely than male students in grade 12 (39.4%) to have done so.

Nationwide, 13.8% of students had carried a gun on greater than or equal to 1 of the 30 days preceding the survey (Table 3). Overall, male students (21.3%) were significantly more likely than female students (4.7%) to have carried a gun. This significant difference between males and females also was identified for all racial/ethnic and grade subgroups. Overall, black and Hispanic students (16.4% and 17.3%, respectively) were significantly more likely than white students (9.1%) to have carried a gun. Black female students (6.7%) and black and Hispanic male students (26.1% and 27.3%, respectively) were significantly more likely than white female and male students (2.4% and 14.0%, respectively) to have carried a gun. Female students in grade 9 (8.1%) were significantly more likely than female students in grade 11 (3.8%) to have carried a gun, and male students in grades 9 and 10 (26.7% and 25.1%, respectively) were significantly more likely than male students in grade 12 (16.7%) to report this behavior.

Among students nationwide, 59.7% had been in a physical fight greater than or equal to 1 times during the 12 months preceding the survey (Table 3). Overall, male students (67.2%) were significantly more likely than female students (50.4%) to have been in a physical fight. This significant difference between males and females also was identified for all racial/ethnic and grade subgroups. Female students in grades 9, 10, and 11 (64.4%, 56.4%, and 50.1%, respectively) were significantly more likely than female students in grade 12 (38.9%) to have been in a physical fight, and female students in grade 9 (64.4%) were significantly more likely than female students in grade 11 (50.1%) to report this behavior. Male students in grades 9 and 10 (77.4% and 74.6%, respectively) were significantly more likely than male students in grades 11 and 12 (64.8% and 59.0%, respectively) to have been in a physical fight.

Nationwide, 10.6% of students had been treated by a doctor or nurse for injuries sustained in a physical fight during the 12 months preceding the survey (Table 3). Overall, male students (13.8%) were significantly more likely than female students (6.6%) to have been injured in a physical fight. This significant difference between males and females also was identified for black and Hispanic students and for students in grades 9, 10, and 12. Female students in grade 9 (8.9%) and male students in grades 9 and 10 (17.9% and 17.1%, respectively) were significantly more likely than female and male students in grade 12 (4.1% and 10.3%, respectively) to have been injured in a physical fight.

Nationwide, 10.7% of students had missed greater than or equal to 1 days of school during the 30 days preceding the survey because they felt unsafe at school or when traveling to or from school (Table 4). Overall, black and Hispanic students (13.9% and 12.2.%, respectively) were significantly more likely than white students (7.6%) to have missed school because they felt unsafe. This significant difference among racial/ethnic subgroups also was identified for male students.

Among students nationwide, 13.8% had carried a weapon on school property on greater than or equal to 1 of the 30 days preceding the survey (Table 4). Overall, male students (18.4%) were significantly more likely than female students (8.1%) to have carried a weapon on school property. This significant difference between males and females also was identified for white and Hispanic students and for students in all grade subgroups. Black female students (13.9%) were significantly more likely than white and Hispanic female students (5.6% and 5.5%, respectively) to have carried a weapon on school property. Male students in grade 9 (23.0%) were significantly more likely than male students in grade 12 (13.6%) to have engaged in this behavior.

Nationwide, 16.2% of students had been threatened or injured with a weapon on school property greater than or equal to 1 times during the 12 months preceding the survey (Table 4). Overall, male students (21.3%) were significantly more likely than female students (9.8%) to have been threatened or injured with a weapon on school property. This significant difference between males and females also was identified for all racial/ethnic subgroups and for students in grades 10, 11, and 12. Black female students (13.2%) were significantly more likely than white and Hispanic female students (7.6% and 8.2%, respectively) to have been threatened or injured with a weapon on school property. Female students in grade 9 (17.0%) were significantly more likely than female students in grades 11 and 12 (8.5% and 7.7%, respectively) to have been threatened or injured with a weapon on school property. Male students in grades 9 and 10 (26.6% and 27.6%, respectively) were significantly more likely than male students in grades 11 and 12 (17.6% and 16.8%, respectively) to have been threatened or injured with a weapon on school property.

Approximately one fourth (23.8%) of students nationwide had been in a physical fight on school property greater than or equal to 1 times during the 12 months preceding the survey (Table 4). Overall, male students (29.4%) were significantly more likely than female students (16.8%) to have been in a physical fight on school property. This significant difference between males and females also was identified for all racial/ethnic and grade subgroups. Female students in grade 9 (27.9%) were significantly more likely than female students in grades 10, 11, and 12 (17.6%, 17.9%, and 9.5%, respectively) to have been in a physical fight on school property, and female students in grades 10 and 11 (17.6% and 17.9%, respectively) were significantly more likely than female students in grade 12 (9.5%) to report this behavior. Male students in grades 9 and 10 (43.9% and 38.3%, respectively) were significantly more likely than male students in grades 11 and 12 (26.2% and 18.5%, respectively) to have been in a physical fight on school property, and male students in grade 11 (26.2%) were significantly more likely than male students in grade 12 (18.5%) to report this behavior.

Nationwide, 26.0% of students had had property (e.g., a car, clothing, or books) stolen or deliberately damaged on school property greater than or equal to 1 times during the 12 months preceding the survey (Table 4). Overall, male students (29.5%) were significantly more likely than female students (21.6%) to have had property stolen or damaged on school property. This significant difference between males and females also was identified for black and Hispanic students and for students in grades 9, 10, and 11. Overall, black students (29.0%) were significantly more likely than Hispanic students (21.5%) to have had property stolen or damaged on school property. This significant difference among racial/ethnic subgroups also was identified for female and male students.

Nationwide, 25.0% of students had seriously considered attempting suicide during the 12 months preceding the survey (Table 5). Overall, female students (31.1%) were significantly more likely than male students (20.0%) to have considered attempting suicide. This significant difference between males and females also was identified for all racial/ethnic subgroups and for students in grades 9, 10, and 11. Overall, white students (30.7%) were significantly more likely than black and Hispanic students (16.9% and 18.9%, respectively) to have considered attempting suicide. This significant difference among racial/ethnic subgroups also was identified for female and male students. Female students in grades 10 and 11 (34.6% and 35.4%, respectively) were significantly more likely than female students in grade 12 (24.5%) to have considered attempting suicide.

Nationwide, 20.5% of students had made a specific plan to attempt suicide during the 12 months preceding the survey (Table 5). Overall, female students (24.1%) were significantly more likely than male students (17.5%) to have made a suicide plan. This significant difference between males and females also was identified for white and Hispanic students and students in grade 11. Overall, white students (24.7%) were significantly more likely than black and Hispanic students (14.1% and 15.6%, respectively) to have made a suicide plan. This significant difference among racial/ethnic subgroups also was identified for female and male students. Female students in grade 11 (30.0%) were significantly more likely than female students in grade 12 (18.6%) to have made a suicide plan.

Nationwide, 15.7% of students had attempted suicide greater than or equal to 1 times during the 12 months preceding the survey (Table 5). Overall, female students (20.0%) were significantly more likely than male students (12.1%) to have attempted suicide. This significant difference between males and females also was identified for white and Hispanic students and for students in grades 9 and 11. Female students in grade 9 (24.8%) were significantly more likely than female students in grade 12 (14.8%) to have attempted suicide.

Nationwide, 7.4% of students reported that they had made a suicide attempt during the 12 months preceding the survey that resulted in an injury, poisoning, or overdose that required treatment by a doctor or nurse (Table 5). Overall, female students (9.3%) were significantly more likely than male students (5.8%) to have made a suicide attempt that required medical attention. White female students (11.4%) were significantly more likely than white male students (4.8%) and Hispanic female students (5.3%) to have made a suicide attempt that required medical attention.

Nationwide, 90.8% of students had ever tried cigarette smoking (even one or two puffs) (Table 6). Male students in grade 12 (93.0%) were significantly more likely than female students in grade 12 (86.8%) to have ever tried cigarette smoking. Overall, white students (94.9%) were significantly more likely than black and Hispanic students (82.3% and 90.1%, respectively) to have ever tried cigarette smoking, and Hispanic students (90.1%) were significantly more likely than black students (82.3%) to have done so. These significant differences among racial/ethnic subgroups also were identified for female students. White and Hispanic male students (94.6% and 91.8%, respectively) were significantly more likely than black male students (85.2%) to have ever tried cigarette smoking.

Approximately two thirds (64.1%) of students nationwide had smoked cigarettes on greater than or equal to 1 of the 30 days preceding the survey (i.e., current cigarette use) (Table 6). Black male students (52.5%) were significantly more likely than black female students (34.5%) to report current cigarette use, and male students in grade 12 (68.9%) were significantly more likely than female students in grade 12 (54.3%) to report this behavior. Overall, white students (78.6%) were significantly more likely than black and Hispanic students (43.3% and 53.0%, respectively) to report current cigarette use. This significant difference among racial/ethnic subgroups also was identified for female and male students. Hispanic female students (48.1%) were significantly more likely than black female students (34.5%) to report current cigarette use.

Nationwide, 44.8% of students had smoked cigarettes on greater than or equal to 20 of the 30 days preceding the survey (i.e., frequent cigarette use) (Table 6). Black and Hispanic male students (29.7% and 29.6%, respectively) were significantly more likely than black and Hispanic female students (17.6% and 17.6%, respectively) to report frequent cigarette use. Overall, white students (65.6%) were significantly more likely than black and Hispanic students (23.5% and 24.1%, respectively) to report frequent cigarette use. This significant difference among racial/ethnic subgroups also was identified for female and male students.

Nationwide, 8.3% of students had used smokeless tobacco (chewing tobacco or snuff) on greater than or equal to 1 of the 30 days preceding the survey (i.e., current smokeless tobacco use) (Table 6). Overall, male students (13.0%) were significantly more likely than female students (2.5%) to have used smokeless tobacco. This significant difference between males and females also was identified for all racial/ethnic and grade subgroups. Overall, white students (12.6%) were significantly more likely than black and Hispanic students (3.9% and 4.2%, respectively) to have used smokeless tobacco. This significant difference among racial/ethnic subgroups also was identified for male students.

Nationwide, 38.3% of students had smoked a cigar, cigarillo, or little cigar on greater than or equal to 1 of the 30 days preceding the survey (i.e., current cigar use) (Table 6). Overall, male students (48.2%) were significantly more likely than female students (25.9%) to have smoked cigars. This significant difference between males and females also was identified for all racial/ethnic and grade subgroups. Overall, white students (42.9%) were significantly more likely than black and Hispanic students (35.3% and 33.3%, respectively) to have smoked cigars. This significant difference among racial/ethnic subgroups also was identified for male students.

Data about access to cigarettes are reported only for the 43.3% of students aged less than 18 years who reported current cigarette use. Nationwide, 30.7% of these students reported that, during the 30 days preceding the survey, they usually obtained their own cigarettes by purchasing them in a store or gas station (Table 7). Overall, male students (36.0%) were significantly more likely than female students (23.7%) to have usually obtained their own cigarettes by purchasing them in a store or gas station. This significant difference between males and females also was identified for white and Hispanic students and for students in grades 11 and 12. Black female students (40.6%) were significantly more likely than white and Hispanic female students (19.9% and 19.2%, respectively) to have usually obtained their own cigarettes by purchasing them in a store or gas station. Male students in grade 12 (48.5%) were significantly more likely than male students in grades 9 and 10 (28.2% and 32.5%, respectively) to have done so. Of the 30.7% of students aged less than 18 years who reported current cigarette use and who usually obtained their own cigarettes by purchasing them in a store or gas station, 64.3% had not been asked to show proof of age (Table 7).

Nationwide, 92.2% of students had had at least one drink of alcohol during their lifetime (Table 8). Overall, white and Hispanic students (96.3% and 93.1%, respectively) were significantly more likely than black students (82.1%) to have had at least one drink of alcohol during their lifetime, and white students (96.3%) were significantly more likely than Hispanic students (93.1%) to report this behavior. These significant differences among racial/ethnic subgroups also were identified for female students. White and Hispanic male students (96.0% and 93.3%, respectively) were significantly more likely than black male students (83.6%) to have had at least one drink of alcohol during their lifetime. Male students in grade 12 (95.0%) were significantly more likely than male students in grade 9 (87.3%) to have had at least one drink of alcohol during their lifetime.

Approximately two thirds (64.5%) of students nationwide had had at least one drink of alcohol on greater than or equal to 1 of the 30 days preceding the survey (i.e., current alcohol use) (Table 8). Male students in grade 12 (73.5%) were significantly more likely than female students in grade 12 (60.1%) to report current alcohol use. Overall, white and Hispanic students (71.1% and 63.9%, respectively) were significantly more likely than black students (51.8%) to report current alcohol use. This significant difference among racial/ethnic subgroups also was identified for female students. White male students (74.2%) were significantly more likely than black male students (57.0%) to report current alcohol use.

One half (49.8%) of all students nationwide had had greater than or equal to 5 drinks of alcohol in a row on greater than or equal to 1 of the 30 days preceding the survey (i.e., episodic heavy drinking) (Table 8). Overall, male students (55.4%) were significantly more likely than female students (42.9%) to report episodic heavy drinking. This significant difference between males and females also was identified for black students and for students in grades 11 and 12. Overall, white and Hispanic students (58.7% and 52.4%, respectively) were significantly more likely than black students (28.4%) to report episodic heavy drinking. This significant difference among racial/ethnic subgroups also was identified for female and male students.

Nationwide, 85.4% of students had used marijuana during their lifetime (Table 8). Overall, male students (88.0%) were significantly more likely than female students (82.1%) to have ever used marijuana. Male students in grade 12 (90.8%) were significantly more likely than female students in grade 12 (82.2%) to report this behavior. Overall, white students (89.4%) were significantly more likely than black students (77.7%) to have ever used marijuana. This significant difference among racial/ethnic subgroups also was identified for female and male students. Male students in grade 12 (90.8%) were significantly more likely than male students in grade 9 (83.2%) to have ever used marijuana.

Nationwide, 53.0% of students had used marijuana greater than or equal to 1 times during the 30 days preceding the survey (i.e., current marijuana use) (Table 8). Overall, male students (58.2%) were significantly more likely than female students (46.7%) to report current marijuana use. This significant difference between males and females also was identified for Hispanic students and students in grade 12.

Nationwide, 36.1% of students had used some form of cocaine (e.g., powder, "crack,"*** or "freebase"****) during their lifetime (Table 9). Black male students (8.1%) were significantly more likely than black female students (3.3%) to have ever used cocaine. Overall, white and Hispanic students (43.8% and 46.4%, respectively) were significantly more likely than black students (5.7%) to have done so. This significant difference among racial/ethnic subgroups also was identified for female and male students.

Nationwide, 15.3% of students had used some form of cocaine greater than or equal to 1 times during the 30 days preceding the survey (i.e., current cocaine use) (Table 9). Male students in grade 10 (21.9%) were significantly more likely than female students in grade 10 (10.5%) to report current cocaine use. Overall, white and Hispanic students (17.7% and 19.4%, respectively) were significantly more likely than black students (3.6%) to report this behavior. This significant difference among racial/ethnic subgroups also was identified for female and male students.

Approximately one fifth (21.6%) of students nationwide had used "crack" or "freebase" forms of cocaine during their lifetime (Table 9). Overall, white and Hispanic students (26.2% and 26.8%, respectively) were significantly more likely than black students (3.5%) to have ever used "crack" or "freebase." This significant difference among racial/ethnic subgroups also was identified for female and male students.

Nationwide, 8.7% of students had used illegal steroids (i.e., without a doctor's prescription) during their lifetime (Table 10). White female students (9.8%) were significantly more likely than black and Hispanic female students (4.7% and 4.8%, respectively) to have ever used illegal steroids. Male students in grade 9 (12.9%) were significantly more likely than male students in grade 11 (7.1%) to report this behavior.

Nationwide, 5.7% of students had injected illegal drugs during their lifetime***** (Table 10). Hispanic male students (6.2%) were significantly more likely than Hispanic female students (2.4%) to have ever injected illegal drugs. White female students (6.4%) were significantly more likely than Hispanic female students (2.4%) to report this behavior.

Nationwide, 45.5% of students had used other illegal drugs during their lifetime (e.g., LSD [lysergic acid diethylamide], PCP [phencyclidine], "ecstasy" [Methylenedioxy-methamphetamine], mushrooms, "speed" [a stimulant, especially an amphetamine], "ice" [methamphetamine], or heroin) (Table 10). Black and Hispanic male students (16.4% and 49.7%, respectively) were significantly more likely than black and Hispanic female students (6.9% and 36.0%, respectively) to have ever used other illegal drugs. Overall, white and Hispanic students (61.4% and 43.5%, respectively) were significantly more likely than black students (11.7%) to have ever used other illegal drugs, and white students (61.4%) were significantly more likely than Hispanic students (43.5%) to have done so. This significant difference among racial/ethnic subgroups also was identified for female students. White and Hispanic male students (62.0% and 49.7%, respectively) were significantly more likely than black male students (16.4%) to have ever used other illegal drugs. Male students in grade 12 (53.8%) were significantly more likely than male students in grade 9 (40.2%) to have ever used other illegal drugs.

Nationwide, 27.3% of students had sniffed glue, breathed the contents of aerosol spray cans, or inhaled paints or sprays to become intoxicated during their lifetime (Table 10). Overall, white and Hispanic students (33.9% and 29.8%, respectively) were significantly more likely than black students (8.7%) to report inhalant use. This significant difference among racial/ethnic subgroups also was identified for female and male students.

Nationwide, 43.3% of students had smoked a whole cigarette before age 13 years (Table 11). Overall, male students (47.1%) were significantly more likely than female students (38.6%) to have smoked a whole cigarette before age 13 years. This significant difference between males and females also was identified for black and Hispanic students and students in grades 10 and 12. Overall, white and Hispanic students (55.9% and 36.9%, respectively) were significantly more likely than black students (22.7%) to have smoked a whole cigarette before age 13 years, and white students (55.9%) were significantly more likely than Hispanic students (36.9%) to have done so. These significant differences among racial/ethnic subgroups also were identified for female and male students. Female and male students in grades 9 and 10 were significantly more likely than female and male students in grade 12 to have smoked a whole cigarette before age 13 years.

Approximately one half (46.1%) of students nationwide had first drunk alcohol (more than a few sips) before age 13 years (Table 11). Overall, male students (52.5%) were significantly more likely than female students (38.0%) to have drunk alcohol before age 13 years. This significant difference between males and females also was identified for all racial/ethnic subgroups and for students in grades 10, 11, and 12. Overall, white and Hispanic students (51.0% and 47.1%, respectively) were significantly more likely than black students (33.4%) to have drunk alcohol before age 13 years. This significant difference among racial/ethnic subgroups also was identified for female and male students. White female students (44.0%) were significantly more likely than Hispanic female students (36.7%) to have drunk alcohol before age 13 years. Female students in grade 9 (49.1%) were significantly more likely than female students in grade 12 (32.3%) to have done so. Male students in grades 9 and 10 (59.6% and 61.7%, respectively) were significantly more likely than male students in grade 12 (43.9%) to have drunk alcohol before age 13 years, and male students in grade 10 (61.7%) were significantly more likely than male students in grade 11 (50.6%) to have done so.

Nationwide, 35.6% of students had tried marijuana before age 13 years (Table 11). Overall, male students (42.5%) were significantly more likely than female students (27.1%) to have tried marijuana before age 13 years. This significant difference between males and females also was identified for black and Hispanic students and students in grades 10, 11, and 12. Overall, white students (38.7%) were significantly more likely than black students (27.8%) to have tried marijuana before age 13 years. This significant difference among racial/ethnic subgroups also was identified for female students. Female students in grade 9 (41.8%) were significantly more likely than female students in grade 11 (25.4%) to have tried marijuana before age 13 years, and male students in grades 9 and 10 (52.4% and 52.4%, respectively) were significantly more likely than male students in grade 11 (41.6%) to have done so. Among female and male students, students in grades 9, 10, and 11 were significantly more likely than students in grade 12 to have tried marijuana before age 13 years.

Nationwide, 4.5% of students had tried cocaine (e.g., powder, "crack," or "freebase" forms of cocaine) before age 13 years (Table 11). Overall, male students (5.8%) were significantly more likely than female students (2.9%) to have tried cocaine before age 13 years, and Hispanic male students (8.0%) were significantly more likely than Hispanic female students (2.9%) to have done so.

Nationwide, 35.1% of students had smoked cigarettes on school property on greater than or equal to 1 of the 30 days preceding the survey (Table 12). Overall, white students (48.7%) were significantly more likely than black and Hispanic students (21.1% and 20.2%, respectively) to have smoked cigarettes on school property. This significant difference among racial/ethnic subgroups also was identified for female and male students.

Smokeless tobacco (chewing tobacco or snuff) use on school property on greater than or equal to 1 of the 30 days preceding the survey was reported by 4.7% of students nationwide (Table 12). Overall, male students (7.3%) were significantly more likely than female students (1.4%) to have used smokeless tobacco on school property. This significant difference between males and females also was identified for white and Hispanic students and for students in grades 9-12. Overall, white students (6.6%) were significantly more likely than black and Hispanic students (2.6% and 2.3%, respectively) to have used smokeless tobacco on school property. This significant difference among racial/ethnic subgroups also was identified for male students.

One in 10 students (10.1%) nationwide had had at least one drink of alcohol on school property on greater than or equal to 1 of the 30 days preceding the survey (Table 12). Overall, male students (12.7%) were significantly more likely than female students (6.9%) to have drunk alcohol on school property. This significant difference between males and females also was identified for black and Hispanic students and for students in grades 10 and 12.

Nationwide, 19.6% of students had used marijuana on school property greater than or equal to 1 times during the 30 days preceding the survey (Table 12). Overall, male students (24.6%) were significantly more likely than female students (13.4%) to have used marijuana on school property. This significant difference between males and females also was identified for black and Hispanic students and for students in grades 10, 11, and 12.

Nationwide, 39.8% of students had been offered, sold, or given an illegal drug on school property during the 12 months preceding the survey (Table 12). Overall, male students (46.8%) were significantly more likely than female students (31.0%) to have been offered, sold, or given an illegal drug on school property. This significant difference between males and females also was identified for black and Hispanic students and for students in grades 10 and 12. Overall, white and Hispanic students (44.5% and 41.1%, respectively) were significantly more likely than black students (27.5%) to have been offered, sold, or given an illegal drug on school property. This significant difference among racial/ethnic subgroups also was identified for male and female students.

Nationwide, 87.8% of students had had sexual intercourse during their lifetime (Table 13). Hispanic male students (90.3%) were significantly more likely than Hispanic female students (82.1%) to have had sexual intercourse. Overall, black students (92.2%) were significantly more likely than white and Hispanic students (86.4% and 86.6%, respectively) to have had sexual intercourse. Black female students (91.8%) were significantly more likely than Hispanic female students (82.1%) to have had sexual intercourse, and black male students (92.8%) were significantly more likely than white male students (84.4%) to have done so. Female students in grade 12 (91.2%) were significantly more likely than female students in grade 9 (83.6%) to have had sexual intercourse.

Twenty-two percent of students nationwide had initiated sexual intercourse before age 13 years (Table 13). Overall, male students (29.6%) were significantly more likely than female students (12.8%) to have initiated sexual intercourse before age 13 years. This significant difference between males and females also was identified for all racial/ethnic and grade subgroups. Overall, black students (31.4%) were significantly more likely than white and Hispanic students (18.1% and 19.6%, respectively) to have initiated sexual intercourse before age 13 years. This significant difference among racial/ethnic subgroups also was identified for male students. White and black female students (12.5% and 15.5%, respectively) were significantly more likely than Hispanic female students (7.8%) to have initiated sexual intercourse before age 13 years. Female students in grade 9 (18.9%) were significantly more likely than female students in grade 11 (10.5%) to have initiated sexual intercourse before age 13 years, and male students in grades 9 and 10 (43.4% and 38.0%, respectively) were significantly more likely than male students in grades 11 and 12 (25.1% and 21.0%, respectively) to have done so.

One half (50.4%) of students nationwide had had sexual intercourse during their lifetime with greater than or equal to 4 sexual partners (Table 13). Overall, male students (56.4%) were significantly more likely than female students (43.1%) to have had greater than or equal to 4 sexual partners during their lifetime. This significant difference between males and females also was identified for black and Hispanic students and for students in grades 9 and 10. Overall, black students (60.1%) were significantly more likely than white and Hispanic students (49.8% and 44.4%, respectively) to have had greater than or equal to 4 sexual partners during their lifetime. This significant difference among racial/ethnic subgroups also was identified for male students. Hispanic male students (59.6%) were significantly more likely than white male students (48.3%) to have had greater than or equal to 4 sexual partners during their lifetime. White and black female students (52.0% and 45.4%, respectively) were significantly more likely than Hispanic female students (26.3%) to have had greater than or equal to 4 sexual partners during their lifetime. Female students in grade 12 (48.2%) were significantly more likely than female students in grades 9 and 10 (38.0% and 37.4%, respectively) to have done so.

Approximately two thirds (68.5%) of students nationwide had had sexual intercourse during the 3 months preceding the survey (i.e., currently sexually active) (Table 13). Female students in grade 12 (77.6%) were significantly more likely than male students in grade 12 (69.2%) to be currently sexually active. Overall, black students (74.2%) were significantly more likely than Hispanic students (66.6%) to be currently sexually active. This significant difference among racial/ethnic subgroups also was identified for female students. Female students in grade 12 (77.6%) were significantly more likely than female students in grades 9 and 10 (65.5% and 63.6%, respectively) to be currently sexually active.

Among the 68.5% of currently sexually active students nationwide, 45.9% reported that either they or their partner had used a condom during last sexual intercourse (Table 14). Overall, male students (54.6%) were significantly more likely than female students (36.1%) to report condom use. This significant difference between males and females also was identified for all racial/ethnic and grade subgroups. Overall, black students (60.0%) were significantly more likely than white and Hispanic students (43.5% and 39.3%, respectively) to report condom use. This significant difference among racial/ethnic subgroups also was identified for female and male students. Male students in grade 9 (66.4%) were significantly more likely than male students in grade 12 (49.4%) to report condom use.

Among the 68.5% of currently sexually active students nationwide, 14.1% reported that either they or their partner had used birth control pills before last sexual intercourse (Table 14). Black female students (11.5%) were significantly more likely than black male students (5.8%) to report birth control pill use, and female students in grade 9 (13.2%) were significantly more likely than male students in grade 9 (5.4%) to report birth control pill use. Overall, white students (19.2%) were significantly more likely than black and Hispanic students (8.8% and 10.2%, respectively) to report birth control pill use. This significant difference among racial/ethnic subgroups also was identified for female and male students. Male students in grade 11 (11.6%) were significantly more likely than male students in grade 9 (5.4%) to report birth control pill use, and male students in grade 12 (18.9%) were significantly more likely than male students in grades 9 and 10 (5.4% and 9.7%, respectively) to report birth control pill use.

Among the 68.5% of students who were currently sexually active nationwide, 40.1% reported that they had used alcohol or drugs at last sexual intercourse (Table 14). Overall, male students (50.5%) were significantly more likely than female students (28.2%) to have used alcohol or drugs at last sexual intercourse. This significant difference between males and females also was identified for all racial/ethnic and grade subgroups. White female students (34.2%) were significantly more likely than black and Hispanic female students (22.5% and 24.0%, respectively) to report this behavior.

Nationwide, 29.5% of students reported that they had been pregnant or had gotten someone pregnant (Table 14). Overall, female students (42.3%) were significantly more likely to have been pregnant than male students (19.2%) were to have gotten someone pregnant. This significant difference between males and females also was identified for all racial/ethnic and grade subgroups. Overall, black and Hispanic students (42.4% and 31.4%, respectively) were significantly more likely than white students (22.7%) to have been pregnant or gotten someone pregnant. This significant difference among racial/ethnic subgroups also was identified for male students. Black female students (55.9%) were significantly more likely than white female students (36.7%) to have been pregnant.

Nationwide, 87.7% of students had been taught about acquired immunodeficiency syndrome (AIDS) or HIV infection in school (Table 15). Overall, white students (91.5%) were significantly more likely than black and Hispanic students (85.9% and 83.0%, respectively) to have received AIDS or HIV education in school. This significant difference among racial/ethnic subgroups also was identified for male students. White female students (91.3%) were significantly more likely than Hispanic female students (85.2%) to have received AIDS or HIV education in school. Male students in grades 11 and 12 (88.1% and 90.8%, respectively) were significantly more likely than male students in grade 9 (80.5%) to have received AIDS or HIV education in school, and male students in grade 12 (90.8%) were significantly more likely than male students in grade 10 (83.4%) to report such education.

Nationwide, 62.6% of students had talked about AIDS or HIV infection with parents or other adult family members (Table 15). Overall, female students (70.3%) were significantly more likely than male students (56.5%) to report having done so. This significant difference between males and females also was identified for all racial/ethnic and grade subgroups. Overall, black students (71.9%) were significantly more likely than white and Hispanic students (62.0% and 59.5%, respectively) to have talked with parents or other adult family members about AIDS or HIV infection. This significant difference among racial/ethnic subgroups also was identified for male students. Black female students (76.6%) were significantly more likely than Hispanic female students (66.7%) to have talked with parents or other adult family members about AIDS or HIV infection.

Nationwide, 28.8% of students had eaten greater than or equal to 5 servings of fruits and vegetables****** during the day preceding the survey (Table 16). Overall, male students (32.0%) were significantly more likely than female students (24.8%) to report this behavior. This significant difference between males and females also was identified for black and Hispanic students and for students in grade 10. Overall, black students (33.1%) were significantly more likely than white students (25.3%) to have eaten greater than or equal to 5 servings of fruits and vegetables. This significant difference among racial/ethnic subgroups also was identified for male students. Female students in grade 9 (29.1%) were significantly more likely than female students in grade 10 (20.3%) to report this behavior.

Nationwide, 57.7% of students had eaten less than or equal to 2 servings of foods typically high in fat content******* during the day preceding the survey (Table 16). Overall, female students (64.5%) were significantly more likely than male students (52.2%) to have eaten less than or equal to 2 servings of such foods. This significant difference between males and females also was identified for white and Hispanic students and for students in grades 11 and 12. Overall, white and Hispanic students (59.8% and 60.1%, respectively) were significantly more likely than black students (49.7%) to have eaten less than or equal to 2 servings of foods typically high in fat content. This difference among racial/ethnic subgroups also was identified for female students.

One fourth (25.5%) of students nationwide thought they were overweight (Table 16). Overall, female students (33.3%) were significantly more likely than male students (19.1%) to consider themselves overweight. This significant difference between males and females also was identified for all racial/ethnic and grade subgroups. Overall, Hispanic students (29.2%) were significantly more likely than black students (22.1%) to consider themselves overweight. This significant difference among racial/ethnic subgroups also was identified for male and female students. Hispanic female students (39.4%) were significantly more likely than white female students (31.7%) to consider themselves overweight.

Nationwide, 36.4% of students had been attempting to lose weight during the 30 days preceding the survey (Table 17). Overall, female students (54.5%) were significantly more likely than male students (21.8%) to be attempting to lose weight. This significant difference between males and females also was identified for all racial/ethnic and grade subgroups. Overall, white and Hispanic students (36.4% and 42.7%, respectively) were significantly more likely than black students (28.9%) to be attempting to lose weight, and Hispanic students (42.7%) were significantly more likely than white students (36.4%) to report this behavior. White and Hispanic female students (58.7% and 58.2%, respectively) were significantly more likely than black female students (42.3%) to be attempting to lose weight. Hispanic male students (29.9%) were significantly more likely than white and black male students (20.3% and 15.7%, respectively) to report this behavior.

Nationwide, 40.9% of students had exercised either to lose weight or to keep from gaining weight during the 30 days preceding the survey (Table 17). Overall, female students (48.2%) were significantly more likely than male students (34.9%) to have exercised to lose weight or to keep from gaining weight. This significant difference between males and females also was identified for white and Hispanic students and for students in grades 10, 11, and 12. Overall, white and Hispanic students (42.0% and 45.6%, respectively) were significantly more likely than black students (32.9%) to have exercised to lose weight or to keep from gaining weight. This significant difference among racial/ethnic subgroups also was identified for female students. Hispanic male students (42.4%) were significantly more likely than white and black male students (32.7% and 31.5%, respectively) to report this behavior.

One fourth (25.6%) of students nationwide had dieted either to lose weight or to keep from gaining weight during the 30 days preceding the survey (Table 17). Overall, female students (38.5%) were significantly more likely than male students (15.1%) to have dieted to lose weight or to keep from gaining weight. This significant difference between males and females also was identified for all racial/ethnic and grade subgroups. Overall, Hispanic students (30.2%) were significantly more likely than white and black students (24.0% and 21.3%, respectively) to have dieted to lose weight or to keep from gaining weight. White and Hispanic female students (41.7% and 42.8%, respectively) were significantly more likely than black female students (26.9%) to have dieted to lose weight or to keep from gaining weight, and Hispanic male students (19.9%) were significantly more likely than white male students (11.2%) to report this behavior.

Nationwide, 7.0% of students had taken diet pills either to lose weight or to keep from gaining weight during the 30 days preceding the survey (Table 17). Overall, female students (11.4%) were significantly more likely than male students (3.3%) to have taken diet pills to lose weight or to keep from gaining weight. This significant difference between males and females also was identified for white and Hispanic students and for students in grades 10, 11, and 12. White and Hispanic female students (14.7% and 10.4%, respectively) were significantly more likely than black female students (6.4%) to have taken diet pills to lose weight or to keep from gaining weight. Male students in grade 9 (6.5%) were significantly more likely than male students in grade 10 (1.9%) to report this behavior.

The percentage of students nationwide who had taken laxatives or vomited either to lose weight or to keep from gaining weight during the 30 days preceding the survey was 6.7% (Table 17). Overall, female students (10.3%) were significantly more likely than male students (3.7%) have taken laxatives or vomited to lose weight or to keep from gaining weight. This significant difference between males and females also was identified for white and Hispanic students and for students in grades 9-12. White female students (13.0%) were significantly more likely than black and Hispanic female students (6.5% and 8.5%, respectively) to have taken laxatives or vomited to lose weight or to keep from gaining weight, and black and Hispanic male students (6.4% and 4.5%, respectively) were significantly more likely than white male students (2.0%) to have done so.

Nationwide, 46.8% of students had participated in activities that made them sweat and breathe hard for at least 20 minutes on greater than or equal to 3 of the 7 days preceding the survey (i.e., vigorous physical activity) (Table 18). Overall, male students (58.8%) were significantly more likely than female students (31.8%) to have participated in vigorous physical activity. This significant difference between males and females also was identified for all racial/ethnic and grade subgroups. White female students (37.8%) were significantly more likely than black and Hispanic female students (24.9% and 28.9%, respectively) to have participated in vigorous physical activity. One fourth (25.1%) of students nationwide had walked or bicycled for at least 30 minutes on greater than or equal to 5 of the 7 days preceding the survey (i.e., moderate physical activity) (Table 18).

Nationwide, 33.9% of students had done stretching exercises (i.e., toe touching, knee bending, and leg stretching) on greater than or equal to 3 of the 7 days preceding the survey (Table 18). Black and Hispanic male students (41.6% and 40.4%, respectively) were significantly more likely than black and Hispanic female students (22.4% and 30.4%, respectively) to have participated in stretching exercises. Male students in grade 10 (38.4%) were significantly more likely than female students in grade 10 (27.1%) to report this behavior. White and Hispanic female students (34.2% and 30.4%, respectively) were significantly more likely than black female students (22.4%) to have participated in stretching exercises. Black male students (41.6%) were significantly more likely than white male students (31.1%) to report this behavior.

Nationwide, 42.3% of students had done strengthening exercises (e.g., push-ups, sit-ups, and weightlifting) on greater than or equal to 3 of the 7 days preceding the survey (Table 18). Overall, male students (55.3%) were significantly more likely than female students (26.5%) to have participated in strengthening exercises. This significant difference between males and females also was identified for all racial/ethnic and grade subgroups. White and Hispanic female students (30.0% and 26.2%, respectively) were significantly more likely than black female students (18.1%) to have participated in strengthening exercises.

Nationwide, 36.9% of students were enrolled in a physical education (PE) class (Table 19). Overall, male students (42.7%) were significantly more likely than female students (29.7%) to be enrolled in a PE class. This significant difference between males and females also was identified for black and Hispanic students and for students in grades 10 and 11. Female students in grade 9 (40.6%) were significantly more likely than female students in grades 11 and 12 (25.2% and 23.7%, respectively) to be enrolled in a PE class. Male students in grades 9 and 10 (54.3% and 50.3%, respectively) were significantly more likely than male students in grade 12 (33.7%) to be enrolled in a PE class.

Overall, 19.0% of students attended PE class daily (Table 19). Hispanic male students (26.0%) were significantly more likely than Hispanic female students (16.3%) to attend PE class daily. Male students in grade 10 (27.4%) were significantly more likely than male students in grade 12 (15.6%) to attend PE class daily.

Among the 36.9% of students enrolled in a PE class, 64.4% reported exercising greater than 20 minutes during an average PE class (Table 19). Overall, male students enrolled in a PE class (69.7%) were significantly more likely than female students enrolled in a PE class (55.0%) to report exercising greater than 20 minutes during an average PE class. This significant difference between males and females also was identified for black and Hispanic students and for students in grades 9, 10, and 12. Overall, white students enrolled in a PE class (70.8%) were significantly more likely than black students enrolled in a PE class (55.3%) to report exercising greater than 20 minutes during an average PE class. This significant difference among racial/ethnic subgroups also was identified for female students.

Nationwide, 22.0% of students had played on sports teams operated by their school during the 12 months preceding the survey (Table 19). Overall, male students (28.1%) were significantly more likely than female students (14.5%) to have played on sports teams operated by their school. This significant difference between males and females also was identified for all racial/ethnic and grade subgroups. Overall, black students (29.5%) were significantly more likely than white and Hispanic students (18.5% and 22.7%, respectively) to have played on sports teams operated by their school. This significant difference among racial/ethnic subgroups also was identified for male students.

One fourth (25.3%) of students nationwide had played on sports teams operated by organizations unaffiliated with their school during the 12 months preceding the survey (Table 19). Overall, male students (33.7%) were significantly more likely than female students (14.8%) to have played on sports teams operated by organizations unaffiliated with their school. This significant difference between males and females also was identified for all racial/ethnic and grade subgroups. Overall, black students (31.4%) were significantly more likely than white students (21.5%) to have played on sports teams operated by organizations unaffiliated with their school. Black and Hispanic male students (45.4% and 35.0%, respectively) were significantly more likely than white male students (27.4%) to have done so. Black male students (45.4%) were significantly more likely than Hispanic male students (35.0%) to have played on sports teams operated by organizations unaffiliated with their school. Female students in grade 9 (21.0%) were significantly more likely than female students in grade 10 (11.4%) to have done so.

Many students attending alternative high schools engage in behaviors that place them at risk for serious health problems. The three leading causes of death among youth and young adults aged 10-24 years are motor vehicle crashes, homicide, and suicide (5). During the 30 days preceding the survey, 51.9% of students had ridden with a driver who had been drinking alcohol, 25.1% had driven a vehicle after drinking alcohol, and 32.9% had carried a weapon. In addition, during the 12 months preceding the survey, 59.7% had been in a physical fight, and 15.7% had attempted suicide. Alcohol and other drug use contribute to these injury-related behaviors. In addition, during the 30 days preceding the survey, 49.8% of students reported episodic heavy drinking, 53.0% used marijuana, and 15.3% used cocaine.

Tobacco use is the leading preventable cause of death in the United States (10). However, 64.1% of students at alternative high schools reported current cigarette use, and 44.8% reported frequent cigarette use. This substantial cigarette use places these students at risk for long-term addiction and associated health problems (10).

Many students who attend alternative high schools are at risk for unintended pregnancy and STDs, including HIV infection. Most (87.8%) students had had sexual intercourse during their lifetime. Among students who had had sexual intercourse during the 3 months preceding the survey, only 45.9% had used a condom and only 14.1% had used birth control pills at last sexual intercourse. Programs that teach specific skills to avoid initiation of sexual intercourse and increase use of condoms and other methods of contraception are needed to reduce high rates of unintended pregnancy and STDs among youth and young adults (11).

One fourth (25.5%) of students at alternative high schools thought they were overweight. ALT-YRBS results indicated that 71.2% of students had eaten less than 5 servings of fruits and vegetables during the day preceding the survey, 42.3% had eaten greater than or equal to 3 servings of foods typically high in fat content during the day preceding the survey, and less than one half had participated in vigorous (46.8%) or moderate (25.1%) physical activity at recommended levels. These findings are consistent with data that indicate increasing overweight among youth aged 6-17 years in the United States (12).

The ALT-YRBS data are subject to two limitations. First, these data apply only to students who attend high schools that self-designated themselves as alternative high schools, so they are not representative of all students in this age group. Second, the extent of underreporting or overreporting of the behaviors the survey questions sought to address can not be determined, although the survey questions demonstrate good test-retest reliability (13).

Comparing ALT-YRBS results with 1997 national YRBS results demonstrates that the prevalence of most risk behaviors is significantly higher among students attending alternative high schools compared with students at regular high schools (14). After adjusting the ALT-YRBS data for age,******** students at alternative high schools were significantly more likely than students at regular high schools to have smoked cigarettes, drunk alcohol, used marijuana, used cocaine, or carried a weapon during the 30 days preceding the survey. They also were significantly more likely to have participated in a physical fight or attempted suicide during the 12 months preceding the survey; never or rarely worn a seat belt; driven after drinking alcohol; ever had sex; had greater than or equal to 4 sexual partners; or had sexual intercourse during the 3 months preceding the survey. Among currently sexually active students, those attending regular high schools were significantly more likely than those attending alternative high schools to have used a condom at last sexual intercourse. Students at regular high schools also were significantly more likely to have participated in vigorous physical activity. No significant difference existed between the two groups in regard to the prevalence of students who thought they were overweight or who were enrolled in a PE class.

Some risk behaviors are more common among particular subgroups of students attending alternative high schools. For example, male students were more likely than female students to report

• rarely or never wearing seat belts;
• driving after drinking alcohol;
• weapon carrying;
• gun carrying;
• participating and being injured in a physical fight;
• weapon carrying on school property;
• being threatened or injured with a weapon on school property;
• being in a physical fight on school property;
• having property stolen or deliberately damaged on school property;
• current smokeless tobacco use;
• current cigar use;
• usually obtaining cigarettes by purchasing them in a store or gas station;
• episodic heavy drinking;
• lifetime and current marijuana use;
• initiating cigarette, alcohol, marijuana, and cocaine use before age 13 years;
• current smokeless tobacco, alcohol, and marijuana use on school property;
• being offered, sold, or given an illegal drug on school property;
• initiating sexual intercourse before age 13 years;
• having greater than or equal to 4 sexual partners during their lifetime;
• alcohol or drug use at last sexual intercourse;
• not talking with parents or other adult family members about AIDS or HIV infection; and
• eating greater than 2 servings of foods typically high in fat content daily.

In contrast, female students were more likely than male students to report

• suicide ideation and related behaviors;
• not using a condom at last sexual intercourse;
• eating less than 5 servings of fruits and vegetables daily;
• using laxatives or vomiting, or taking diet pills, either to lose weight or to keep from gaining weight;
• not participating in vigorous physical activity;
• not participating in strengthening exercises;
• not being enrolled in a PE class;
• exercising for less than or equal to 20 minutes during PE class; and
• not participating on sports teams.

White students were more likely than black students to report

• driving after drinking alcohol;
• considering and planning suicide;
• ever, current, and frequent cigarette use;
• current smokeless tobacco use;
• current cigar use;
• lifetime and current alcohol use;
• episodic heavy drinking;
• lifetime marijuana use;
• lifetime and current cocaine use;
• lifetime "crack," inhalant, and other illegal drug use;
• initiating tobacco, alcohol, and marijuana use before age 13 years;
• cigarette and smokeless tobacco use on school property;
• being offered, sold, or given an illegal drug on school property;
• not using a condom at last sexual intercourse;
• not talking with parents or other adult family members about AIDS or HIV infection;
• eating less than 5 servings of fruits and vegetables daily; and
• not participating on sports teams.

White students were more likely than Hispanic students to report

• rarely or never wearing seat belts;
• considering and planning suicide;
• ever, current, and frequent cigarette use;
• current smokeless tobacco use;
• current cigar use;
• lifetime alcohol use;
• lifetime other illegal drug use;
• initiating cigarette use before age 13 years; and
• cigarette and smokeless tobacco use on school property.

Black students were more likely than white students to report

• gun carrying;
• feeling too unsafe to go to school;
• having had sexual intercourse during their lifetime;
• initiating sexual intercourse before age 13 years;
• having greater than or equal to 4 sexual partners during their lifetime;
• not using birth control pills at last sexual intercourse;
• not being taught about AIDS or HIV infection in school;
• eating greater than 2 servings of foods typically high in fat content daily; and
• exercising less than or equal to 20 minutes during PE class.

Black students were more likely than Hispanic students to report

• having property stolen or deliberately damaged on school property;
• having sexual intercourse during their lifetime;
• initiating sexual intercourse before age 13 years;
• having greater than or equal to 4 sexual partners during their lifetime;
• being currently sexually active; and
• eating greater than 2 servings of foods typically high in fat content daily.

Hispanic students were more likely than white students to report

• rarely or never wearing motorcycle helmets;
• gun carrying;
• feeling too unsafe to go to school;
• not using birth control pills at last sexual intercourse; and
• not being taught about AIDS or HIV infection in school.

Hispanic students were more likely than black students to report

• lifetime cigarette use;
• lifetime and current alcohol use;
• episodic heavy drinking;
• lifetime and current cocaine use;
• "crack," inhalant, and other illegal drug use;
• initiating cigarette and alcohol use before age 13 years;
• being offered, sold, or given an illegal drug on school property;
• not using a condom at last sexual intercourse;
• not talking with parents or other adult family members about AIDS or HIV infection; and
• not participating on a school sports team.

These subgroup findings can help identify a need for education and services based on a higher prevalence of risk behaviors. Alternative high schools that serve one sex or that have a predominant racial/ethnic group might implement programs that emphasize risk behaviors that occur most often among their students. These programs might be most effective when combined with community-based programs designed for subgroups of youth and young adults at high risk. Subgroup differences in the prevalence of health-risk behaviors could be related to different socioeconomic and cultural factors. However, these factors could not be addressed in this analysis. Some researchers have reported that the association between race/ethnicity and some risk behaviors was attenuated after controlling for socioeconomic status (15). Additional studies and surveys are needed to assess the effect of culture, socioeconomic status, and race or ethnicity on the prevalence of health-risk behaviors.

Little research exists regarding the types of intervention programs and services available for students attending alternative high schools. Characteristics of programs to reduce health-risk behaviors that have been effective for youth and young adults at high risk include a) a comprehensive, multidisciplinary focus on risk factors rather than categorical behaviors, b) training in social skills, c) individual attention, d) integrated services provided by school-community teams, and e) community-wide, multiagency collaborative approaches (16,17).

To help schools prevent HIV infection among young persons, CDC provides fiscal and technical assistance to 57 state and territorial education agencies and 18 local education agencies that serve the nation's largest cities. These agencies address both in-school and out-of-school youth, including those in situations that put them at high risk. For example, Michigan trains teachers in detention centers and alternative high schools to implement a Program That Works curriculum called Be Proud! Be Responsible! at their sites. New Hampshire also trains teachers and provides resources for alternative schools. CDC also provides support for state education agencies and state health departments in 16 states to jointly address chronic disease risk behaviors of students.

In addition, CDC provides fiscal and technical support to 13 national nongovernmental organizations (NGOs) to support HIV prevention activities aimed at youth in situations that put them at high risk. These NGOs work to design and develop programs to meet the needs of racial/ethnic subgroups; homeless, runaway, and street youth; gay, lesbian, and bisexual youth; and adjudicated youth, among others. The ALT-YRBS provides important baseline data for education and health agencies and NGOs to use in assessing and reducing health-risk behaviors among students attending alternative high schools. ALT-YRBS data can be used to describe risk behaviors, create awareness, set program goals, develop programs, and seek program resources (18).

References

1. The National Education Database Users Guide (QED Database) [Electronic dataset]. Denver, CO: Quality Education Data, Inc., 1997.
2. CDC. Sexual behaviors and drug use among youth in dropout-prevention programs--Miami, 1994. MMWR 1994;43:873-6.
3. Grunbaum JA, Basen-Engquist K. Comparison of health risk behaviors between students in a regular high school and students in an alternative high school. Journal of School Health 1993;63:421-5.
4. Weller NF, Tortolero SR, Kelder SH, Grunbaum JA, Carvajal SC, Gingiss PM. Health risk behaviors of Texas students attending dropout prevention/recovery schools in 1997. Journal of School Health 1999;69:22-8.
5. Peters KD, Kochanek KD, Murphy SL. Deaths: final data for 1996. National Vital Stat Rep 1998;47(9).
6. National Center for Health Statistics. Trends in pregnancies and pregnancy rates: estimates for the United States, 1980-92. Hyattsville, MD: US Department of Health and Human Services, CDC, 1995. (Monthly vital statistics report; vol 43, no. 11, suppl).
7. Institute of Medicine. The hidden epidemic. Confronting sexually transmitted diseases. Washington, DC: National Academy Press, 1997.
8. Kolbe LJ, Kann L, Collins JL. Overview of the Youth Risk Behavior Surveillance System. Public Health Rep 1993;108(suppl 1):2-10.
9. Shah BV, Barnwell BG, Bieler GS. SUDAAN: user's manual, release 7.5, 1997. Research Triangle Park, NC: Research Triangle Institute; 1997.
10. CDC. Preventing tobacco use among young people: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Public Health Service, CDC, 1994; DHHS publication no. S/N 017-001-00491-0.
11. CDC. State-specific pregnancy rates among adolescents--United States, 1992-1995. MMWR 1998;47:497-504.
12. Troiano RP, Flegal KM. Overweight children and adolescents: description, epidemiology, and demographics. Pediatrics 1998;101:497-504.
13. Brener ND, Collins JL, Kann L, Warren CW, Williams BI. Reliability of the Youth Risk Behavior Survey questionnaire. American Journal of Epidemiology 1995;141:575-80.
14. CDC. Youth risk behavior surveillance--United States, 1997. In: CDC surveillance summaries, August 14, 1998. MMWR 1998:47(No. SS-3).
15. Lowry R, Kann L, Collins JL, Kolbe LJ. The effect of socioeconomic status on chronic disease risk behaviors among US adolescents. JAMA 1996;276:792-7.
16. Dryfoss JG. Adolescents at risk: prevalence and prevention. New York, NY: Oxford University Press, 1990.
17. Kirby D, Short L, Collins J, et al. School-based programs to reduce sexual risk behaviors: a review of effectiveness. Public Health Rep 1994;109:339-60.
18. Everett SA, Kann L, McReynolds L. The Youth Risk Behavior Surveillance System: policy and program applications. Journal of School Health 1997;67:333-5.

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

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

*** Pellet-sized pieces of highly purified cocaine.

**** A process whereby cocaine is dissolved in ether or sodium hydroxide and the precipitate filtered off.

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

****** Fruit, fruit juice, green salad, or cooked vegetables.

******* Hamburgers, hot dogs, or sausage; french fries or potato chips; and cookies, doughnuts, pie, or cake.

******** The ALT-YRBS data were age-standardized to the 1997 national YRBS age distribution.

Thought they were overweight