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  • An erratum has been published for this article. To view the erratum, please click here. Priority health-risk behaviors contribute to the leading causes of morbidity and mortality among youth and adults.

    Population-based data on these behaviors at the national, state, and local levels can help monitor the effectiveness of public health interventions designed to protect and promote the health of youth nationwide. Description of the System: This report summarizes results for health-risk behaviors plus obesity, overweight, and asthma from the national survey, 42 state surveys, and 21 large urban school district surveys conducted among students in grades 9— Results from the national YRBS indicated that many high school students are engaged in priority health-risk behaviors associated with the leading causes of death among persons aged 10—24 years in the United States.

    During the 30 days before the survey, During the 12 months before the survey, Many high school students nationwide are engaged in sexual risk behaviors that contribute to unintended pregnancies and STIs, including HIV infection. Among currently sexually active students, Results from the national YRBS also indicate many high school students are engaged in behaviors associated with chronic diseases, such as cardiovascular disease, cancer, and diabetes.

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    During the 7 days before the survey, 5. More than one-third Many high school students engage in behaviors that place them at risk for the leading causes of morbidity and mortality. Long term temporal changes also have occurred. Since the earliest year of data collection, the prevalence of most health-risk behaviors has decreased e. YRBSS data are used widely to compare the prevalence of health-risk behaviors among subpopulations of students; assess trends in health-risk behaviors over time; monitor progress toward achieving 20 national health objectives for Healthy People and one of the 26 leading health indicators; provide comparable state and large urban school district data; and help develop and evaluate school and community policies, programs, and practices designed to decrease health-risk behaviors and improve health outcomes among youth.

    Among youth aged 15—19 years, substantial morbidity and social problems also result from the estimatedbirths 2 ;cases of chlamydia, gonorrhea, and syphilis 3 ; and 2, cases of human immunodeficiency virus HIV 4 reported annually.

    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: These behaviors frequently are interrelated and are established during childhood and adolescence and extend into adulthood.

    National, state, and large urban school district surveys have been conducted biennially since Table 1. This report summarizes results for health-risk behaviors plus obesity, overweight, and asthma from the national YRBS and overall trends in health-risk behaviors during — Data from the 42 state and 21 large urban school district surveys with weighted data for the YRBSS cycle Figure also are included in this report. Data from five states and one large urban school district survey with unweighted data are not included.

    Among those with weighted data forone state and two large urban school district surveys were conducted during fall ; the national survey, 38 states, and 18 large urban school district surveys were conducted during spring ; and three states and one large urban school district survey were conducted during fall Methods Detailed information about the methodology of the national, state, and large urban school district YRBSs has been described elsewhere 5.

    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, primary sampling units PSUsconsisting of counties, subareas of large counties, or groups of smaller, adjacent counties.

    In the second stage of sampling, schools with any of grades 9—12 were sampled with probability proportional to school enrollment size. The third stage of sampling consisted of random sampling in each of grades 9—12, one or two classrooms from either a required subject e.

    All students in sampled 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, two classes per grade, rather than one, were sampled in schools with a high minority enrollment. In the past, three strategies were used to oversample black and Hispanic students: Because of increases in the proportions of black and Hispanic students in the population, only selection of two classes per grade was needed in to achieve adequate precision with minimum variance.

    In the first sampling stage, schools with any of grades 9—12 were sampled with probability proportional to school enrollment size in 40 states and four large urban school districts; all schools with any of grades 9—12 were invited to participate in two states and 17 large urban school districts.

    In the second sampling stage, intact classes from either a required subject e. In one state and one large urban school district, all students in sampled schools were eligible to participate. Data Collection Procedures and Questionnaires Survey procedures for the national, state, and large urban school district 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. The YRBS standard questionnaire contained 86 questions.

    For the national questionnaire, the following six questions were added to the standard questionnaire: Because these questions are only on the national questionnaire, state and large urban school district data are not available for any variables based on these questions.

    In addition to four demographic questions and two questions assessing height and weight, the remaining questions on the standard questionnaire and the national questionnaire measured behaviors practiced or experienced by the student referred to as "behaviors".

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    Skip patterns, which occur when a particular response to one question indicates to the respondents that they should not answer one or more subsequent questions, 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 questionnaire. For state and large urban school districts, only data from standard questions are presented in this report. Information about the reliability of the standard questionnaire has been published elsewhere 8.

    The standard and national YRBS questionnaires are available at http: The national data set was cleaned and edited for inconsistencies. Missing data were not statistically imputed. Data from each state and large urban school district survey were cleaned and edited for inconsistencies with the same procedures used for the national data set. The percentage of completed questionnaires that failed quality control checks and were excluded from analysis ranged from.

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    The student sample sizes ranged from 1, to 53, median: For the second question, students could select more than one response option. Students who answered "no" to the first question and selected only "black or African American" to the second question were classified as "black or African American" and are referred to as "black.

    These classifications are not intended to diagnose obesity or overweight in individual students, but to provide population-level estimates of obesity and overweight. 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.

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    Therefore, weighted estimates are representative of all students in grades 9—12 attending public and private schools in the United States. Data from 42 state and 21 large urban school districts were weighted. In 39 states and all large urban school districts, weighted estimates are representative of all students in grades 9—12 attending public schools in each jurisdiction.

    In three states Ohio, South Dakota, and Vermontweighted estimates are representative of all students in grades 9—12 attending public and private schools in each jurisdiction. 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 In the results section, only statistically significant differences in prevalence estimates are reported in the following order: To identify long-term temporal changes in health-risk behaviors nationwide, prevalence estimates from the earliest year of data collection to for each variable assessed with identically worded questions in three or more survey years were examined.

    Separate regression models were used to assess linear and quadratic time trends for every variable.

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    When a significant quadratic trend was detected, Joinpoint software 13 was used to automate identification of the year or "joinpoint" where the nonlinear i.

    Cubic and higher order time effects were not assessed. A quadratic time effect indicates a significant but nonlinear trend in prevalence over time. A temporal change that includes a significant linear and quadratic time effect demonstrates nonlinear variation e. In addition, to identify 2-year temporal changes in health-risk behaviors nationwide, prevalence estimates from and were compared using t tests for each variable assessed with identically worded questions in both survey years.

    In the results section, linear and quadratic trends are described followed by results from the t tests used to assess 2-year temporal changes. Information about long term trends and more recent changes are not available due to changes in question or response option wording or because the question was asked for the first time during for the following variables: The prevalence of having never or rarely worn a bicycle helmet was higher among male The prevalence of having never or rarely worn a bicycle helmet was higher among black During —, a significant linear decrease occurred overall in the prevalence of having never or rarely worn a bicycle helmet A significant quadratic trend also was identified.

    The prevalence of having never or rarely worn a bicycle helmet decreased during — The prevalence of having never or rarely worn a bicycle helmet did not change significantly from Across 31 states, the prevalence of having never or rarely worn a bicycle helmet ranged from Across 16 large urban school districts, the prevalence ranged from The prevalence of having never or rarely worn a seat belt was higher among male 9. The prevalence of having never or rarely worn a seat belt was higher among black 9.

    During —, a significant linear decrease occurred overall in the prevalence of having never or rarely worn a seat belt A significant quadratic trend was not identified. The prevalence of having never or rarely worn a seat belt did not change significantly from 7.

    Across 40 states, the prevalence of having never or rarely worn a seat belt ranged from 5. Across 19 large urban school districts, the prevalence ranged from 4. The prevalence of having ridden with a driver who had been drinking alcohol was higher among black female The prevalence of having ridden with a driver who had been drinking alcohol was higher among Hispanic The prevalence of having ridden with a driver who had been drinking alcohol was higher among 12th-grade During —, a significant linear decrease occurred overall in the prevalence of having ridden with a driver who had been drinking alcohol The prevalence of having ridden with a driver who had been drinking alcohol did not change significantly from Across 38 states, the prevalence of having ridden with a driver who had been drinking alcohol ranged from Across 20 large urban school districts, the prevalence ranged from Drove When Drinking Alcohol Among the The prevalence of having driven a car or other vehicle when they had been drinking alcohol was higher among male The prevalence of having driven a car or other vehicle when they had been drinking alcohol was higher among white The prevalence of having driven a car or other vehicle when they had been drinking alcohol was higher among 12th-grade Across 41 states, the prevalence of having driven a car or other vehicle when they had been drinking alcohol among students who drove a car or other vehicle during the 30 days before the survey ranged from 2.

    Texted or E-mailed While Driving Among the The prevalence of having texted or e-mailed while driving was higher among Hispanic male The prevalence of having texted or e-mailed while driving was higher among white The prevalence of having texted or e-mailed while driving was higher among 10th-grade Across 37 states, the prevalence of having texted or e-mailed while driving among students who drove a car or other vehicle during the 30 days before the survey ranged from Across 15 large urban school districts, the prevalence ranged from The prevalence of having carried a weapon was higher among male The prevalence of having carried a weapon was higher among white The prevalence of having carried a weapon was higher among 10th-grade female 9.

    During —, a significant linear decrease occurred overall in the prevalence of having carried a weapon The prevalence of having carried a weapon decreased during — The prevalence of having carried a weapon did not change significantly from Across 34 states, the prevalence of having carried a weapon ranged from Across 20 large urban school districts, the prevalence ranged from 8. Carried a Gun Nationwide, 5.

    The prevalence of having carried a gun was higher among male 9. The prevalence of having carried a gun was higher among white male During —, a significant linear decrease occurred overall in the prevalence of having carried a gun 7. The prevalence of having carried a gun decreased during — 7. The prevalence of having carried a gun did not change significantly from 5. Across 26 states, the prevalence of having carried a gun ranged from 2.

    Across 20 large urban school districts, the prevalence ranged from 2. Carried a Weapon on School Property Nationwide, 5. The prevalence of having carried a weapon on school property was higher among male 7.

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    The prevalence of having carried a weapon on school property was higher among white 5. During —, a significant linear decrease occurred overall in the prevalence of having carried a weapon on school property The prevalence of having carried a weapon on school property decreased during — The prevalence of having carried a weapon on school property did not change significantly from 5. Across 34 states, the prevalence of having carried a weapon on school property ranged from 2.

    The prevalence of having been threatened or injured with a weapon on school property was higher among male 7. The prevalence of having been threatened or injured with a weapon on school property was higher among black 8.

    The prevalence of having been threatened or injured with a weapon on school property was higher among 9th-grade 8. During —, a significant linear decrease occurred overall in the prevalence of having been threatened or injured with a weapon on school property 7.

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    The prevalence of having been threatened or injured with a weapon on school property did not change significantly from — 7. The prevalence of having been threatened or injured with a weapon on school property did not change significantly from 7.

    Across 35 states, the prevalence of having been threatened or injured with a weapon on school property ranged from 4. Across 21 large urban school districts, the prevalence ranged from 4.

    In a Physical Fight Nationwide, The prevalence of having been in a physical fight was higher among male The prevalence of having been in a physical fight was higher among black The prevalence of having been in a physical fight was higher among 9th-grade During —, a significant linear decrease occurred overall in the prevalence of having been in a physical fight The prevalence of having been in a physical fight also decreased from Across 37 states, the prevalence of having been in a physical fight ranged from Across 19 large urban school districts, the prevalence ranged from Injured in a Physical Fight During the 12 months before the survey, 3.

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    The prevalence of having been injured in a physical fight was higher among male 3. The prevalence of having been injured in a physical fight was higher among black 4. During —, a significant linear decrease occurred overall in the prevalence of having been injured in a physical fight 4.

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    The prevalence of having been injured in a physical fight also decreased from 3. Across 30 states, the prevalence of having been injured in a physical fight ranged from 2. Across 18 large urban school districts, the prevalence ranged from 2.

    The prevalence of having been in a physical fight on school property was higher among male The prevalence of having been in a physical fight on school property was higher among black The prevalence of having been in a physical fight on school property was higher among 9th-grade During —, a significant linear decrease occurred overall in the prevalence of having been in a physical fight on school property The prevalence of having been in a physical fight on school property also decreased from Across 35 states, the prevalence of having been in a physical fight on school property ranged from 4.

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    Across 20 large urban school districts, the prevalence ranged from 5. The prevalence of having not gone to school because of safety concerns was higher among female 8. The prevalence of having not gone to school because of safety concerns was higher among black 7. The prevalence of having not gone to school because of safety concerns was higher among 9th-grade 7.

    During —, a significant linear increase occurred overall in the prevalence of having not gone to school because of safety concerns 4.

    The prevalence of having not gone to school because of safety concerns did not change significantly from 5. Across 39 states, the prevalence of having not gone to school because of safety concerns ranged from 3. Across 21 large urban school districts, the prevalence ranged from 3. Electronically Bullied Nationwide, Share this article Share For most Amish, even sitting for a photograph is considered prideful and not in keeping with the rules of the community.

    Social media has also allowed for massive booze-fueled parties. Noah Hershberger, 22, who recently left the Amish, says teens have gotten smart about not posting details about parties on Facebook because they know cops could be reading. Facebook has become a ubiquitous feature if Rumspringa for many Amish teens This Amish teenager shows off his new, modern haircut and sunglasses, as his family's buggy sits in the background Simple life: Smartphones have allowed for young Amish to share their daily lives - just like teens in the 'English' non-Amish world 'There are a lot of underagers, so they will forward a text message around with the address, time, and whatever of the party,' he told BuzzFeed.

    Because Facebook allows Amish teens to dramatically widen their social circles.

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    A party that might have attracted a few dozen teens from a few neighboring farm communities now draws hundreds - sometimes from different states. Everyone is connected, everyone is texting everyone,' Weber said. Sex remains to verboten topic - even on Facebook. Hershberger says teens still look at online pornography and they often troll dating sites like MeetMe. However, this is usually not talked about. As this picture reveals, some Amish teens choose to adopt modern clothes, while others choose to wear their traditional garb 'Besties': These bonnet-wearing girls took a group picture together.

    It's unclear whether the 'duck face' has made it to the Amish community yet Play hard: The rite of passage - usually between age 14 and 16 - allows young Amish to experience the outside world, including technology, and defy the rules of their parents. However, most teens never actually leave home on Rumspringa, and the vast majority decide to join the church and stay with the Amish community when Rumspringa ends.

    It is true the Amish teens often drink alcohol at parties - usually with their parents' knowledge. Some experiment with sex and illegal drugs. Most Amish boy and girls, though, live at home during Rumpsringa and only party on the weekends. When they do party, it is nearly always with other Amish on Rumspringa. Even with vast new-found freedom, many Amish teens can't bear to stray far from home or from their traditional values.