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Youth risk behavior surveillance--United States, 2003 (Abridged).

In the United States, 70.8% of all deaths among youth and young adults aged 10-24 years result from only four causes: motor-vehicle crashes (32.3%), other unintentional injuries (11.7%), homicide (15.1%), and suicide (11.7%). (1) Substantial morbidity and social problems also result from the approximately 870,000 pregnancies that occur each year among females aged 15-19 years (2) and the estimated 3 million cases of sexually transmitted diseases (STDs) that occur each year among persons aged 10-19 years. (3) Among adults aged [greater than or equal to]25 years, 62.9% of all deaths in the United States result from cardiovascular diseases (39.4%) and cancer (23.5%). (1)

The Youth Risk Behavior Surveillance System (YRBSS), (4) conducted biennially since 1991, monitors six categories of priority health-risk behaviors among youth and young adults--behaviors that contribute to unintentional injuries and violence; tobacco use; alcohol and other drug use; sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infection; unhealthy dietary behaviors; and physical inactivity--plus overweight. YRBSS includes a national school-based survey conducted by CDC as well as state and local school-based surveys conducted by education and health agencies. This report summarizes results from the national survey, 32 state surveys, and 18 local surveys conducted among students in grades 9-12 during February-December 2003.

In addition, this report summarizes trends from the national YRBS during 1991-2003 in selected risk behaviors. For the national YRBS, only statistically significant differences are reported in the Results section in the following order: sex, sex by race/ethnicity, sex by grade, race/ ethnicity, race/ethnicity by sex, grade, and grade by sex.

METHODS

National Youth Risk Behavior Survey

The sampling frame for the national YRBS consisted of all public and private schools with students in at least one of grades 9-12 in the 50 states and the District of Columbia.

A three-stage cluster sample design produced a nationally representative sample of students in grades 9-12 who attend public and private schools. For the national YRBS, 15,240 questionnaires were completed in 158 schools. The school response rate was 81%, and the student response rate was 83%. The school response rate multiplied by the student response rate produces an overall response rate of 67%.

State and Local Youth Risk Behavior Surveys

In 2003, each state and local school-based YRBS employed a two-stage cluster sample design to produce representative samples of students in grades 9-12 in their jurisdiction. In 2003, the student sample sizes for the state and local YRBS ranged from 968 to 9,320. School response rates ranged from 67% to 100%; student response rates ranged from 60% to 94%; and overall response rates ranged from 60% to 90%.

RESULTS

Behaviors That Contribute to Unintentional Injuries

Seat Belt Use. Nationwide, 18.2% of students had rarely or never worn seat belts when riding in a car driven by someone else. Overall, the prevalence of having rarely or never worn seat belts was higher among male (21.5%) than female (14.6%) students; higher among black male (25.6%) than black female (15.6%) students; and higher among 10th grade male (20.4%) and 12th grade male (21.1%) than 10th grade female (13.3%) and 12th grade female (10.9%) students, respectively. Prevalence of having rarely or never worn seat belts ranged from 5.6% to 23.2% across state surveys (median: 15.1%) and from 5.4% to 33.7% across local surveys (median: 12.1%).

Bicycle Helmet Use. Among the 62.3% of students nationwide who had ridden a bicycle during the 12 months preceding the survey, 85.9% had rarely or never worn a bicycle helmet. Overall, the prevalence of having rarely or never worn a bicycle helmet was higher among black (94.6%) than white (83.8%) and Hispanic (90.1%) students; higher among Hispanic (90.1%) than white students (83.8%); higher among black female (94.3%) than white female (82.0%) and Hispanic female (87.9%) students; and higher among black male (95.0%) and Hispanic male (91.4%) than white male (85.2%) students. Prevalence of having rarely or never worn a bicycle helmet ranged from 52.0% to 95.7% across state surveys (median: 86.6%) and from 75.2% to 97.1% across local surveys (median: 89.0%).

Rode with a Driver Who Had Been Drinking Alcohol During the 30 days preceding the survey, 30.2% of students nationwide had ridden in a car or other vehicle one or more times with a driver who had been drinking alcohol. The prevalence of having ridden with a driver who had been drinking alcohol was higher among Hispanic female (40.0%) than Hispanic male (32.8%) students. Overall, the prevalence of having ridden with a driver who had been drinking alcohol was higher among Hispanic (36.4%) than white (28.5%) and black (30.9%) students and higher among Hispanic female (40.0%) than white female (29.8%) and black female (29.8%) students. Overall, the prevalence of having ridden with a driver who had been drinking alcohol was higher among 12th grade (33.3%) than 9th grade (28.2%) students and higher among 12th grade male (34.0%) than 9th grade male (26.4%) and 10th grade male (27.6%) students. Prevalence of having ridden with a driver who had been drinking alcohol ranged from 17.9% to 42.8% across state surveys (median: 28.2%) and from 18.6% to 40.6% across local surveys (median: 28.8%).

Drove After Drinking Alcohol. During the 30 days preceding the survey, 12.1% of students nationwide had driven a car or other vehicle one or more times after drinking alcohol. Overall, the prevalence of having driven after drinking alcohol was higher among male (15.0%) than female (8.9%) students; higher among white male (15.2%), black male (13.4%), and Hispanic male (14.9%) than white female (10.3%), black female (4.6%), and Hispanic female (8.6%) students, respectively; and higher among 10th grade male (11.3%), 11th grade male (19.5%), and 12th grade male (25.6%) than 10th grade female (6.9%), 11th grade female (11.1%), and 12th grade female (13.6%) students, respectively. Overall, the prevalence of having driven after drinking alcohol was higher among white (12.9%) than black (9.1%) students and higher among white female (10.3%) and Hispanic female (8.6%) than black female students (4.6%). Overall, the prevalence of having driven after drinking alcohol was higher among 10th grade (9.2%), 11th grade (15.3%), and 12th grade (19.8%) than 9th grade (6.2%) students; higher among 11th grade (15.3%) and 12th grade (19.8%) than 10th grade (9.2%) students; higher among 12th grade (19.8%) than 11th grade (15.3%) students; higher among 11th grade female (11.1%) and 12th grade female (13.6%) than 9th grade female (5.1%) and 10th grade female (6.9%) students; higher among 10th grade male (11.3%), 11th grade male (19.5%), and 12th grade male (25.6%) than 9th grade male (7.2%) students; higher among 11th grade male (19.5%) and 12th grade male (25.6%) than 10th grade male (11.3%) students; and higher among 12th grade male (25.6%) than 11th grade male (19.5%) students. Prevalence of having driven after drinking alcohol ranged from 7.4% to 26.7% across state surveys (median: 11.3%) and from 4.5% to 12.3% across local surveys (median: 7.4%).

Behaviors That Contribute to Violence

Carried a Weapon. Nationwide, 17.1% of students had carried a weapon (eg, a gun, knife, or club) on [greater than or equal to]1 of the 30 days preceding the survey. Overall, the prevalence of having carried a weapon was higher among male (26.9%) than female (6.7%) students; higher among white male (27.1%), black male (24.9%), and Hispanic male (24.3%) than white female (5.5%), black female (9.8%), and Hispanic female (8.5%) students, respectively; and higher among 9th grade male (26.6%), 10th grade male (26.5%), 11th grade male (29.2%), and 12th grade male (25.2%) than 9th grade female (8.8%), 10th grade female (5.2%), 11th grade female (6.8%), and 12th grade female (5.2%) students, respectively. The prevalence of having carried a weapon was higher among black female (9.8%) and Hispanic female (8.5%) than white female (5.5%) students. The prevalence of having carried a weapon was higher among 9th grade female (8.8%) than 10th grade female (5.2%) and 12th grade female (5.2%) students. Prevalence of having carried a weapon ranged from 12.3% to 24.6% across state surveys (median: 16.9%) and from 11.3% to 25.0% across local surveys (median: 16.0%).

Carried a Gun. Nationwide, 6.1% of students had carded a gun on [greater than or equal to]1 of the 30 days preceding the survey. Overall, the prevalence of having carried a gun was higher among male (10.2%) than female (1.6%) students; higher among white male (10.0%), black male (10.6%), and Hispanic male (8.2%) than white female (1.5%), black female (1.4%), and Hispanic female (2.6%) students, respectively; and higher among 9th grade male (9.3%), 10th grade male (10.4%), 11th grade male (10.8%), and 12th grade male (10.0%) than 9th grade female (2.1%), 10th grade female (1.4%), 11th grade female (1.6%), and 12th grade female (1.0%) students, respectively. Prevalence of having carried a gun ranged from 3.4% to 10.5% across state surveys (median: 5.9%) and from 3.4% to 8.9% across local surveys (median: 5.7%).

Physical Fighting. Nationwide, 33.0% of students had been in a physical fight one or more times during the 12 months preceding the survey. Overall, the prevalence of having been in a physical fight was higher among male (40.5%) than female (25.1%) students; higher among white male (38.4%), black male (45.6%), and Hispanic male (42.6%) than white female (22.1%), black female (34.0%), and Hispanic female (29.5%) students, respectively; and higher among 9th grade male (44.8%), 10th grade male (41.8%), 11th grade male (38.5%), and 12th grade male (35.0%) than 9th grade female (31.9%), 10th grade female (25.0%), 11th grade female (23.0%), and 12th grade female (17.7%) students, respectively. Overall, the prevalence of having been in a physical fight was higher among black (39.7%) than white (30.5%) and Hispanic (36.1%) students; higher among Hispanic (36.1%) than white (30.5%) students; higher among black female (34.0%) and Hispanic female (29.5%) than white female (22.1%) students; higher among black female (34.0%) than Hispanic female (29.5%) students; and higher among black male (45.6%) than white male (38.4%) students. Overall, the prevalence of having been in a physical fight was higher among 9th grade (38.6%) than 10th grade (33.5%), 11th grade (30.9%), and 12th grade (26.5%) students; higher among 10th grade (33.5%) and 11th grade (30.9%) than 12th grade (26.5%) students; higher among 9th grade female (31.9%) than 10th grade female (25.0%), 11th grade female (23.0%), and 12th grade female (17.7%) students; higher among 10th grade female (25.0%) and 11th grade female (23.0%) than 12th grade female (17.7%) students; higher among 9th grade male (44.8%) than 11th grade male (38.5%) and 12th grade male (35.0%) students; and higher among 10th grade mate (41.8%) than 12th grade male (35.0%) students. Prevalence of having been in a physical fight ranged from 26.4% to 35.0% across state surveys (median: 30.3%) and from 27.2% to 44.3% across local surveys (median: 37.4%).

Injured in a Physical Fight. Among students nationwide, 4.2% had been in a physical fight one or more times during the 12 months preceding the survey that resulted in injuries that had to be treated by a doctor or nurse. Overall, the prevalence of having been injured in a physical fight was higher among male (5.7%) than female (2.6%) students; higher among white male (4.0%), black male (7.3%), and Hispanic male (6.5%) than white female (1.7%), black female (3.7%), and Hispanic female (3.9%) students, respectively; and higher among 10th grade male (6.2%), 11th grade male (4.9%), and 12th grade male (4.3%) than 10th grade female (2.2%), 11th grade female (2.4%), and 12th grade female (1.8%) students, respectively. Overall, the prevalence of having been injured in a physical fight was higher among black (5.5%) and Hispanic (5.2%) than white (2.9%) students; higher among black female (3.7%) and Hispanic female (3.9%) than white female (1.7%) students; and higher among black male (7.3%) and Hispanic male (6.5%) than white male (4.0%) students. Prevalence of having been injured in a physical fight ranged from 2.4% to 4.8% across state surveys (median: 3.4%) and from 2.3% to 8.6% across local surveys (median: 4.2%).

Dating Violence. During the 12 months preceding the survey, 8.9% of students nationwide had been hit, slapped, or physically hurt on purpose by their boyfriend or girlfriend (ie, dating violence). Overall, the prevalence of dating violence was higher among black (13.9%) than white (7.0%) and Hispanic (9.3%) students; higher among Hispanic (9.3%) than white (7.0%) students; higher among black female (14.0%) than Hispanic female (9.2%) and white female (7.5%) students; and higher among black male (13.7%) than Hispanic male (9.2%) and white male (6.6%) students. Prevalence of dating violence ranged from 6.5% to 14.0% across state surveys (median: 10.0%) and from 7.3% to 16.0% across local surveys (median: 11.7%).

Forced Sexual Intercourse. Nationwide, 9.0% of students had ever been physically forced to have sexual intercourse when they did not want to. Overall, the prevalence of having been forced to have sexual intercourse was higher among female (11.9%) than male (6.1%) students; higher among white female (11.2%) and Hispanic female (13.0%) than white male (3.7%) and Hispanic male (7.6%) students, respectively; and higher among 9th grade female (11.3%), 11th grade female (13.5%), and 12th grade female (11.6%) than 9th grade male (5.0%), 11th grade male (4.8%), and 12th grade male (6.6%) students, respectively. Overall, the prevalence of having been forced to have sexual intercourse was higher among black (12.3%) and Hispanic (10.4%) than white (7.3%) students, and higher among black male (11.7%) and Hispanic male (7.6%) than white male (3.7%) students. Prevalence of having been forced to have sexual intercourse ranged from 5.4% to 11.0% across state surveys (median: 8.7%) and from 5.5% to 12.4% across local surveys (median: 8.5%).

Carried a Weapon on School Property. Nationwide, 6.1% of students carried a weapon (eg, a gun, knife, or club) on school property on [greater than or equal to]1 of the 30 days preceding the survey. Overall, the prevalence of having carded a weapon on school property was higher among male (8.9%) than female (3.1%) students; higher among white male (8.5%) and Hispanic male (7.7%) than white female (2.2%) and Hispanic female (4.2%) students, respectively; and higher among 10th grade male (8.9%), 11th grade male (10.3%), and 12th grade male (10.2%) than 10th grade female (3.0%), 11th grade female (2.7%), and 12th grade female (2.5%) students, respectively. The prevalence of having carried a weapon on school property was higher among black female (5.5%) and Hispanic female (4.2%) than white female (2.2%) students. The prevalence of having carded a weapon on school property was higher among 10th grade male (8.9%), 11th grade male (10.3%), and 12th grade male (10.2%) than 9th grade male (6.6%) students. Prevalence of having carried a weapon on school property ranged from 3.2% to 10.1% across state surveys (median: 5.8%) and from 3.5% to 10.6% across local surveys (median: 6.1%).

Threatened or Injured with a Weapon on School Property. During the 12 months preceding the survey, 9.2% of students nationwide had been threatened or injured with a weapon (eg, a gun, knife, or club) on school property one or more times. Overall, the prevalence of having been threatened or injured with a weapon on school property was higher among male (11.6%) than female (6.5%) students; higher among white male (9.6%), black male (14.3%), and Hispanic male (11.9%) than white female (5.8%), black female (7.5%), and Hispanic female (6.9%) students, respectively; and higher among 9th grade male (15.4%), 10th grade male (11.3%), 11th grade male (9.2%), and 12th grade male (8.5%) than 9th grade female (8.3%), 10th grade female (7.0%), 11th grade female (5.4%), and 12th grade female (3.9%) students, respectively. Overall, the prevalence of having been threatened or injured with a weapon on school property was higher among black (10.9%) than white (7.8%) students and higher among black male (14.3%) than white male (9.6%) students. Overall, the prevalence of having been threatened or injured with a weapon on school property was higher among 9th grade (12.1%) than 11th grade (7.3%) and 12th grade (6.3%) students; higher among 10th grade (9.2%) than 12th grade (6.3%) students; higher among 9th grade female (8.3%) than 11th grade female (5.4%) and 12th grade female (3.9%) students; higher among 10th grade female (7.0%) than 12th grade female (3.9%) students; and higher among 9th grade male (15.4%) than 11th grade male (9.2%) and 12th grade male (8.5%) students. Prevalence of having been threatened or injured with a weapon on school property ranged from 5.2% to 9.7% across state surveys (median: 7.5%) and from 6.8% to 12.7% across local surveys (median: 9.7%).

Physical Fight on School Property. Nationwide, 12.8% of students had been in a physical fight on school property one or more times during the 12 months preceding the survey. Overall, the prevalence of having been in a physical fight on school property was higher among male (17.1%) than female (8.0%) students; higher among white male (14.3%), black male (21.5%), and Hispanic male (19.3%) than white female (5.3%), black female (12.6%), and Hispanic female (13.8%) students, respectively; and higher among 9th grade male (23.3%), 10th grade male (18.1%), 11th grade male (14.2%), and 12th grade male (9.6%) than 9th grade female (12.2%), 10th grade female (7.3%), 11th grade female (6.4%), and 12th grade female (4.7%) students, respectively. Overall, the prevalence of having been in a physical fight on school property was higher among black (17.1%) and Hispanic (16.7%) than white (10.0%) students; higher among black female (12.6%) and Hispanic female (13.8%) than white female (5.3%) students; and higher among black male (21.5%) and Hispanic male (19.3%) than white male (14.3%) students. Overall, the prevalence of having been in a physical fight on school property was higher among 9th grade (18.0%) than 10th grade (12.8%), 11th grade (10.4%), and 12th grade (7.3%) students; higher among 10th grade (12.8%) and 11th grade (10.4%) than 12th grade (7.3%) students; higher among 9th grade female (12.2%) than 10th grade female (7.3%), 11th grade female (6.4%), and 12th grade female (4.7%) students; higher among 10th grade female (7.3%) than 12th grade female (4.7%) students; higher among 9th grade male (23.3%) than 10th grade male (18.1%), 11th grade male (14.2%), and 12th grade male (9.6%) students; higher among 10th grade male (18.1%) than 11th grade mate (14.2%) and 12th grade male (9.6%) students; and higher among 11th grade male (14.2%) than 12th grade male (9.6%) students. Prevalence of having been in a physical fight on school property ranged from 8.6% to 14.6% across state surveys (median: 11.3%) and from 9.3% to 22.5% across local surveys (median: 15.3%).

Did Not Go to School Because of Safety Concerns. Among students nationwide, 5.4% had not gone to school on [greater than or equal to]1 of the 30 days preceding the survey because they felt unsafe at school or on their way to or from school. Overall, the prevalence of having not gone to school because of safety concerns was higher among black (8.4%) and Hispanic (9.4%) than white (3.1%) students; higher among black female (9.0%) and Hispanic female (10.0%) than white female (2.9%) students; and higher among black male (7.9%) and Hispanic male (8.9%) than white male (3.3%) students. Overall, the prevalence of having not gone to school because of safety concerns was higher among 9th grade (6.9%) than 10th grade (5.2%), 11th grade (4.5%), and 12th grade (3.8%) students; higher among 9th grade female (6.6%) than 11th grade female (4.6%) and 12th grade female (3.9%) students; and higher among 9th grade male (7.1%) than 11th grade male (4.3%) and 12th grade male (3,8%) students. Prevalence of having not gone to school because of safety concerns ranged from 2.8% to 8.7% across state surveys (median: 4.9%) and from 5.5% to 16.2% across local surveys (median: 9.8%).

Property Stolen or Damaged on School Property. Nationwide, 29.8% of students had their property (eg, car, clothing, or books) stolen or deliberately damaged on school property one or more times during the 12 months preceding the survey. Overall, the prevalence of having property stolen or damaged on school property was higher among male (33.1%) than female (26.2%) students; higher among white male (30.6%), black male (33.9%), and Hispanic male (37.0%) than white female (25.6%), black female (27.0%), and Hispanic female (27.6%) students, respectively; and higher among 9th grade male (37.4%), 10th grade male (34.3%), 11th grade male (30.5%), and 12th grade male (27.9%) than 9th grade female (31.9%), 10th grade female (26.6%), 11th grade female (23.9%), and 12th grade female (20.2%) students, respectively. Overall, the prevalence of having property stolen or damaged on school property was higher among Hispanic (32.3%) than white (28.2%) students and higher among Hispanic male (37.0%) than white male (30.6%) students. Overall, the prevalence of having property stolen or damaged on school property was higher among 9th grade (34.8%) than 10th grade (30.5%), 11th grade (27.2%), and 12th grade (24.2%) students; higher among 10th grade (30.5%) than 11th grade (27.2%) and 12th grade (24.2%) students; higher among 9th grade female (31.9%) than 10th grade female (26.6%), 11th grade female (23.9%), and 12th grade female (20.2%) students; higher among 10th grade female (26.6%) than 12th grade female (20.2%) students; and higher among 9th grade male (37.4%) and 10th grade male (34.3%) than 11th grade male (30.5%) and 12th grade male (27.9%) students. Prevalence of having property stolen or damaged on school property ranged from 23.0% to 35.7% across state surveys (median: 28.8%) and from 22.9% to 36.2% across local surveys (median: 29.0%).

Felt Sad or Hopeless. During the 12 months preceding the survey, 28.6% of students nationwide had felt so sad or hopeless almost every day for [greater than or equal to]2 weeks in a row that they stopped doing some usual activities. Overall, the prevalence of having felt sad or hopeless almost every day for [greater than or equal to]2 weeks was higher among female (35.5%) than male (21.9%) students; higher among white female (33.3%), black female (30.8%), and Hispanic female (44.9%) than white male (19.6%), black male (21.7%), and Hispanic male (25,9%) students, respectively; and higher among 9th grade female (35.7%), 10th grade female (36.9%), 11th grade female (35.9%), and 12th grade female (32.6%) than 9th grade male (21.0%), 10th grade male (22.7%), 11th grade male (22.1%), and 12th grade male (22.0%) students, respectively. Overall, the prevalence of having felt sad or hopeless almost every day for [greater than or equal to]2 weeks was higher among Hispanic (35.4%) than white (26.2%) and black (26.3%) students; higher among Hispanic female (44.9%) than white female (33.3%) and black female (30.8%) students; and higher among Hispanic male (25.9%) than white male (19.6%) students. Prevalence of having felt sad or hopeless almost every day for [greater than or equal to]2 weeks ranged from 20.8% to 31.9% across state surveys (median: 27.9%) and from 25.9% to 34.6% across local surveys (median: 31.1%).

Seriously Considered Attempting Suicide. Nationwide, 16.9% of students had seriously considered attempting suicide during the 12 months preceding the survey. Overall, the prevalence of having considered attempting suicide was higher among female (21.3%) than male (12.8%) students; higher among white female (21.2%), black female (14.7%), and Hispanic female (23.4%) than white male (12.0%), black male (10.3%), and Hispanic male (12.9%) students, respectively; and higher among 9th grade female (22.2%), 10th grade female (23.8%), 11th grade female (20.0%), and 12th grade female (18.0%) than 9th grade male (11.9%), 10th grade male (13.2%), 11th grade male (12.9%), and 12th grade male (13.2%) students, respectively. Overall, the prevalence of having considered attempting suicide was higher among white (16.5%) and Hispanic (18.1%) than black (12.5%) students and higher among white female (21.2%) and Hispanic female (23.4%) than black female (14.7%) students. Overall, the prevalence of having considered attempting suicide was higher among 10th grade (18.3%) than 12th grade (15.5%) students and higher among 9th grade female (22.2%) and 10th grade female (23.8%) than 12th grade female (18.0%) students. Prevalence of having considered attempting suicide ranged from 13.5% to 21.0% (median: 17.3%) across state surveys and from 11.5% to 19.4% across local surveys (median: 14.3%).

Made a Suicide Plan. During the 12 months preceding the survey, 16.5% of students nationwide had made a plan to attempt suicide. The prevalence of having made a suicide plan was higher among black female (12.4%) than black male (8.4%) students and higher among 10th grade female (19.5%) than 10th grade male (13.1%) students. Overall, the prevalence of having made a suicide plan was higher among white (16.2%) and Hispanic (17.6%) than black (10.4%) students; higher among white female (18.6%) and Hispanic female (20.7%) than black female (12.4%) students; and higher among white male (13.9%) than black male (8.4%) students. Prevalence of having made a suicide plan ranged from 10.9% to 17.2% across state surveys (median: 13.3%) and from 8.6% to 16.7% across local surveys (median: 11.7%).

Attempted Suicide. Nationwide, 8.5% of students had actually attempted suicide one or more times during the 12 months preceding the survey. Overall, the prevalence of having attempted suicide was higher among female (11.5%) than male (5.4%) students; higher among white female (10.3%) and Hispanic female (15.0%) than white male (3.7%) and Hispanic male (6.1%) students, respectively; and higher among 9th grade female (14.7%), 10th grade female (12.7%), and 11th grade female (10.0%) than 9th grade male (5.8%), 10th grade male (5.5%), and 11th grade male (4.6%) students, respectively. Overall, the prevalence of having attempted suicide was higher among Hispanic (10.6%) than white (6.9%) and black (8.4%) students; higher among Hispanic female (15.0%) than white female (10.3%) and black female (9.0%) students; and higher among black male (7.7%) and Hispanic male (6.1%) than white male (3.7%) students. Overall, the prevalence of having attempted suicide was higher among 9th grade (10.1%) than 11th grade (7.3%) and 12th grade (6.1%) students; higher among 10th grade (9.1%) than 12th grade (6.1%) students; higher among 9th grade female (14.7%) than 11th grade female (10.0%) and 12th grade female (6.9%) students; and higher among 10th grade female (12.7%) than 12th grade female (6.9%) students. Prevalence of having attempted suicide ranged from 6.6% to 11.9% across state surveys (median: 8.5%) and from 7.4% to 12.3% across local surveys (median: 9.9%).

Suicide Attempt Required Medical Attention. During the 12 months preceding the survey, 2.9% of students nationwide had made a suicide attempt that resulted in an injury, poisoning, or overdose that had to be treated by a doctor or nurse. The prevalence of having made a suicide attempt that required medical attention was higher among white female (2.4%) than white male (1.1%) students. Overall, the prevalence of having made a suicide attempt that required medical attention was higher among black (3.7%) and Hispanic (5.0%) than white (1.7%) students; higher among Hispanic female (5.7%) than white female (2.4%) and black female (2.2%) students; and higher among black male (5.2%) and Hispanic male (4.2%) than white male (1.1%) students. Prevalence of having made a suicide attempt that required medical attention ranged from 1.6% to 5.0% across state surveys (median: 2.7%) and from 1.7% to 4.8% across local surveys (median: 3.3%).

Tobacco Use

Lifetime Cigarette Use. Nationwide, 58.4% of students had ever tried cigarette smoking (even one or two puffs) (ie, lifetime cigarette use). Overall, the prevalence of lifetime cigarette use was higher among 10th grade (58.3%), 11th grade (60.0%), and 12th grade (65.4%) than 9th grade (52.0%) students; higher among 12th grade (65.4%) than 10th grade (58.3%) and 11th grade (60.0%) students; higher among 11th grade female (59.8%) and 12th grade female (65.9%) than 9th grade female (50.9%) students; higher among 12th grade female (65.9%) than 10th grade female (57.7%) and 11th grade female (59.8%) students; and higher among 12th grade male (64.7%) than 9th grade male (53.0%) students. Prevalence of lifetime cigarette use ranged from 32.8% to 71.1% across state surveys (median: 59.9%) and from 43.9% to 66.4% across local surveys (median: 53.5%).

Lifetime Daily Cigarette Use. Nationwide, 15.8% of students had ever smoked one or more cigarettes every day for 30 days (ie, lifetime daily cigarette use). The prevalence of lifetime daily cigarette use was higher among white female (20.9%) and black male (10.9%) than white male (17.1%) and black female (5.2%) students, respectively. Overall, the prevalence of lifetime daily cigarette use was higher among white (18.9%) than black (8.2%) and Hispanic (10.7%) students; higher among white female (20.9%) than black female (5.2%) and Hispanic female (9.1%) students; higher among Hispanic female (9.1%) than black female (5.2%) students; and higher among white male (17.1%) than black male (10.9%) and Hispanic male (12.2%) students. Overall, the prevalence of lifetime daily cigarette use was higher among 11th grade (18.1%) and 12th grade (19.8%) than 9th grade (11.5%) students; higher among 12th grade (19.8%) than 10th grade (15.0%) students; higher among 11th grade female (18.4%) and 12th grade female (18.3%) than 9th grade female (11.6%) students; higher among 11th grade male (17.8%) and 12th grade male (21.0%) than 9th grade male (11.4%) students; and higher among 12th grade male (21.0%) than 10th grade male (14.3%) students. Prevalence of lifetime daily cigarette use ranged from 6.0% to 26.0% (median: 17.0%) across state surveys and from 4.7% to 13.4% across local surveys (median: 7.9%).

Current Cigarette Use. Nationwide, 21.9% of students had smoked cigarettes on [greater than or equal to]1 of the 30 days preceding the survey (ie, current cigarette use). The prevalence of current cigarette use was higher among black male (19.3%) than black female (10.8%) students and higher among 12th grade male (29.0%) than 12th grade female (23.3%) students. Overall, the prevalence of current cigarette use was higher among white (24.9%) than black (15.1%) and Hispanic (18.4%) students; higher among white female (26.6%) than black female (10.8%) and Hispanic female (17.7%) students; and higher among Hispanic female (17.7%) than black female (10.8%) students. Overall, the prevalence of current cigarette use was higher among 10th grade (21.8%), 11th grade (23.6%), and 12th grade (26.2%) than 9th grade (17.4%) students; higher among 12th grade (26.2%) than 10th grade (21.8%) students; higher among 10th grade male (21.7%), 11th grade male (23.2%), and 12th grade male (29.0%) than 9th grade male (16.0%) students; and higher among 12th grade male (29.0%) than 10th grade male (21.7%) and 11th grade male (23.2%) students. Prevalence of current cigarette use ranged from 7.3% to 32.7% across state surveys (median: 23.2%) and from 9.1% to 18.1% across local surveys (median: 13.4%).

Current Frequent Cigarette Use. Approximately one-tenth (9.7%) of students nationwide had smoked cigarettes on [greater than or equal to]20 of the 30 days preceding the survey (ie, current frequent cigarette use). The prevalence of current frequent cigarette use was higher among black male (7.9%) than black female (3.1%) students. Overall, the prevalence of current frequent cigarette use was higher among white (11.8%) than black (5.5%) and Hispanic (5.5%) students; higher among white female (13.2%) than black female (3.1%) and Hispanic female (4.4%) students; and higher among white male (10.4%) than Hispanic male (6.6%) students. Overall, the prevalence of current frequent cigarette use was higher among 10th grade (9.2%), 11th grade (11.2%), and 12th grade (13.1%) than 9th grade (6.3%) students; higher among 12th grade (13.1%) than 10th grade (9.2%) students; higher among 11th grade female (11.8%) and 12th grade female (11.4%) than 9th grade female (6.9%) students; higher among 10th grade male (9.5%), 11th grade male (10.5%), and 12th grade male (14.5%) than 9th grade male (5.7%) students; and higher among 12th grade male (14.5%) than 10th grade male (9.5%) and 11th grade mate (10.5%) students. Prevalence of current frequent cigarette use ranged from 3.0% to 18.4% across state surveys (median: 11.1%) and from 1.7% to 8.2% across local surveys (median: 4.0%).

Smoked >10 Cigarettes/Day. Nationwide, 3.1% of students had smoked >10 cigarettes/day on the days they smoked during the 30 days preceding the survey. Overall, the prevalence of having smoked >10 cigarettes/day was higher among male (3.6%) than female (2.4%) students; higher among black male (2.1%) than black female (0.6%) students; and higher among 12th grade male (6.8%) than 12th grade female (2.6%) students. Overall, the prevalence of having smoked >10 cigarettes/day was higher among white (3.4%) than black (1.4%) and Hispanic (1.7%) students; higher among white female (3.1%) than black female (0.6%) and Hispanic female (1.4%) students; and higher among white male (3.6%) than black male (2.1%) and Hispanic male (2.0%) students. Overall, the prevalence of having smoked >10 cigarettes/day was higher among 12th grade (4.8%) than 9th grade (1.9%) and 10th grade (2.4%) students; higher among 11th grade female (3.1%) than 9th grade female (1.3%) students; and higher among 12th grade male (6.8%) than 9th grade male (2.4%), 10th grade male (2.4%), and 11th grade male (3.5%) students. Prevalence of having smoked >10 cigarettes/day ranged from 0.3% to 5.8% across state surveys (median: 2.8%) and from 0.2% to 2.3% across local surveys (median: 0.9%).

Purchased Cigarettes at a Store or Gas Station. Data regarding access to cigarettes are reported only for the 20.8% of students aged <18 years who reported current cigarette smoking. Nationwide, 18.9% of these students had purchased their cigarettes in a store or gas station during the 30 days preceding the survey. Overall, the prevalence of having purchased cigarettes in a store or gas station was higher among male (24.2%) than female (13.8%) students; higher among white male (24.1%) than white female (12.0%) students; and higher among 10th grade male (19.3%), 11th grade male (34.5%), and 12th grade male (33.6%) than 10th grade female (7.8%), 11th grade female (21.2%), and 12th grade female (18.9%) students, respectively. Overall, the prevalence of having purchased cigarettes in a store or gas station was higher among 11th grade (27.9%) and 12th grade (26.1%) than 9th grade (12.0%) and 10th grade (13.6%) students; higher among 11th grade female (21.2%) than 9th grade female (10.4%) and 10th grade female (7.8%) students; higher among 12th grade female (18.9%) than 10th grade female (7.8%) students; and higher among 11th grade male (34.5%) and 12th grade male (33.6%) than 9th grade male (13.8%) and 10th grade male (19.3%) students. Prevalence of having purchased cigarettes in a store or gas station ranged from 5.9% to 24.1% across state surveys (median: 16.3%) and from 13.2% to 39.9% across local surveys (median: 22.7%).

Current Smokeless Tobacco Use. Nationwide, 6.7% of students had used smokeless tobacco (eg, chewing tobacco, snuff, or dip) on [greater than or equal to]1 of the 30 days preceding the survey (ie, current smokeless tobacco use). Overall, the prevalence of current smokeless tobacco use was higher among male (11.0%) than female (2.2%) students; higher among white male (13.2%) than white female (1.6%) students; and higher among 9th grade male (9.1%), 10th grade male (9.6%), 11th grade male (13.3%), and 12th grade male (12.7%) than 9th grade female (3.8%), 10th grade female (1.0%), 11th grade female (2.0%), and 12th grade female (1.3%) students, respectively. Overall, the prevalence of current smokeless tobacco use was higher among white (7.6%) than black (3.0%) students and higher among white male (13.2%) than black male (4.1%) and Hispanic male (6.1%) students. The prevalence of current smokeless tobacco use was higher among 9th grade female (3.8%) than 10th grade female (1.0%) students and higher among 11th grade male (13.3%) than 9th grade male (9.1%) students. Prevalence of current smokeless tobacco use ranged from 3.1% to 15.3% across state surveys (median: 7.2%) and from 1.5% to 5.5% across local surveys (median: 2.7%).

Current Cigar Use. Nationwide, 14.8% of students had smoked cigars, cigarillos, or little cigars on [greater than or equal to]1 of the 30 days preceding the survey (ie, current cigar use). Overall, the prevalence of current cigar use was higher among male (19.9%) than female (9.4%) students; higher among white male (21.3%) and black male (19.5%) than white female (8.6%) and black female (10.3%) students, respectively; and higher among 10th grade male (17.0%), 11th grade male (22.2%), and 12th grade male (29.8%) than 10th grade female (9.3%), 11th grade female (10.0%), and 12th grade female (7.8%) students, respectively. The prevalence of current cigar use was higher among white male (21.3%) and black male (19.5%) than Hispanic male (14.9%) students. Overall, the prevalence of current cigar use was higher among 11th grade (16.3%) and 12th grade (19.1%) than 9th grade (11.9%) students; higher among 12th grade (19.1%) than 10th grade (13.2%) students; higher among 11th grade male (22.2%) and 12th grade male (29.8%) than 9th grade male (13.6%) and 10th grade male (17.0%) students; and higher among 12th grade male (29.8%) than 11th grade male (22.2%) students. Prevalence of current cigar use ranged from 7.3% to 18.7% across state surveys (median: 13.5%) and from 5.2% to 17.0% across local surveys (median: 10.6%).

Current Tobacco Use. Nationwide, 27.5% of students had reported current cigarette use, current smokeless tobacco use, or current cigar use on [greater than or equal to]1 of the 30 days preceding the survey (ie, current tobacco use). Overall, the prevalence of current tobacco use was higher among male (30.3%) than female (24.6%) students; higher among black male (23.7%) and Hispanic male (24.9%) than black female (14.9%) and Hispanic female (19.8%) students, respectively; and higher among 10th grade male (29.2%), 11th grade male (33.7%), and 12th grade male (40.3%) than 10th grade female (23.6%), 11th grade female (27.0%), and 12th grade female (25.7%) students, respectively. Overall, the prevalence of current tobacco use was higher among white (31.1%) than black (19.3%) and Hispanic (22.4%) students; higher among white female (28.9%) than black female (14.9%) and Hispanic female (19.8%) students; higher among Hispanic female (19.8%) than black female (14.9%) students; and higher among white male (33.2%) than black male (23.7%) and Hispanic male (24.9%) students. Overall, the prevalence of current tobacco use was higher among 10th grade (26.4%), 11th grade (30.4%), and 12th grade (33.0%) than 9th grade (22.0%) students; higher among 12th grade (33.0%) than 10th grade (26.4%) students; higher among 10th grade male (29.2%), 11th grade male (33.7%), and 12th grade male (40.3%) than 9th grade male (21.5%) students; and higher among 12th grade male (40.3%) than 10th grade male (29.2%) and 11th grade male (33.7%) students. Prevalence of current tobacco use ranged from 10.3% to 41.2% across state surveys (median: 27.7%) and from 11.8% to 22.0% across local surveys (median: 15.8%).

Alcohol and Other Drug Use

Lifetime Alcohol Use. Approximately three fourths (74.9%) of students nationwide had had one or more drinks of alcohol on [greater than or equal to]1 day during their lifetime (ie, lifetime alcohol use). Overall, the prevalence of lifetime alcohol use was higher among Hispanic (79.5%) than black (71.4%) students; higher among Hispanic female (81.4%) than black female (74.0%) students; and higher among white male (74.3%) and Hispanic male (77.5%) than black male (68.6%) students. Overall, the prevalence of lifetime alcohol use was higher among 10th grade (75.7%), 11th grade (78.6%), and 12th grade (83.0%) than 9th grade (65.0%) students; higher among 12th grade (83.0%) than 10th grade (75.7%) students; higher among 10th grade female (76.5%), 11th grade female (80.9%), and 12th grade female (83.3%) than 9th grade female (66.2%) students; higher among 12th grade female (83.3%) than 10th grade female (76.5%) students; higher among 10th grade male (74.9%), 11th grade male (76.4%), and 12th grade male (82.6%) than 9th grade male (64.0%) students; and higher among 12th grade male (82.6%) than 10th grade male (74.9%) and 11th grade male (76.4%) students. Prevalence of lifetime alcohol use ranged from 43.3% to 81.1% across state surveys (median: 75.7%) and from 63.7% to 81.5% across local surveys (median: 70.1%).

Current Alcohol Use. Nationwide, 44.9% of students had had one or more drinks of alcohol on [greater than or equal to]1 of the 30 days preceding the survey (ie, current alcohol use). The prevalence of current alcohol use was higher among Hispanic female (48.4%) than Hispanic male (42.7%) students. Overall, the prevalence of current alcohol use was higher among white (47.1%) and Hispanic (45.6%) than black (37.4%) students; higher among white female (48.4%) and Hispanic female (48.4%) than black female (37.0%) students; and higher among white male (45.9%) than black male (37.5%) students. Overall, the prevalence of current alcohol use was higher among 10th grade (43.5%), 11th grade (47.0%), and 12th grade (55.9%) than 9th grade (36.2%) students; higher among 12th grade (55.9%) than 10th grade (43.5%) and 11th grade (47.0%) students; higher among 10th grade female (44.9%), 11th grade female (46.8%), and 12th grade female (55.5%) than 9th grade female (38.5%) students; higher among 12th grade female (55.5%) than 10th grade female (44.9%) and 11th grade female (46.8%) students; higher among 10th grade male (42.2%), 11th grade male (47.3%), and 12th grade male (56.0%) than 9th grade male (33.9%) students; and higher among 12th grade male (56.0%) than 10th grade male (42.2%) and 11th grade male (47.3%) students. Prevalence of current alcohol use ranged from 21.3% to 54.2% across state surveys (median: 44.3%) and from 28.7% to 44.4% across local surveys (median: 37.6%).

Episodic Heavy Drinking. Nationwide, 28.3% of students had had [greater than or equal to]5 drinks of alcohol in a row (ie, within a couple of hours) on [greater than or equal to]1 of the 30 days preceding the survey (ie, episodic heavy drinking). The prevalence of episodic heavy drinking was higher among black male (17.9%) than black female (12.7%) students. Overall, the prevalence of episodic heavy drinking was higher among white (31.8%) and Hispanic (28.9%) than black (15.3%) students; higher among white female (31.5%) and Hispanic female (29.8%) than black female (12.7%) students; and higher among white male (32.1%) and Hispanic male (27.9%) than black male (17.9%) students. Overall, the prevalence of episodic heavy drinking was higher among 10th grade (27.4%), 11th grade (31.8%), and 12th grade (37.2%) than 9th grade (19.8%) students; higher among 11th grade (31.8%) and 12th grade (37.2%) than 10th grade (27.4%) students; higher among 12th grade (37.2%) than 11th grade (31.8%) students; higher among 10th grade female (27.2%), 11th grade female (29.4%), and 12th grade female (34.5%) than 9th grade female (20.9%) students; higher among 12th grade female (34.5%) than 10th grade female (27.2%) and 11th grade female (29.4%) students; higher among 10th grade male (27.7%), 11th grade male (34.1%), and 12th grade male (39.5%) than 9th grade male (18.8%) students; and higher among 11th grade male (34.1%) and 12th grade male (39.5%) than 10th grade male (27.7%) students. Prevalence of episodic heavy drinking ranged from 14.3% to 39.5% across state surveys (median: 27.1%) and from 10.0% to 24.5% across local surveys (median: 16.7%).

Lifetime Marijuana Use. Nationwide, 40.2% of students had used marijuana one or more times during their lifetime (ie, lifetime marijuana use). Overall, the prevalence of life-time marijuana use was higher among male (42.7%) than female (37.6%) students; higher among black male (49.0%) and Hispanic male (46.7%) than black female (37.6%) and Hispanic female (38.5%) students, respectively; and higher among 10th grade male (44.2%) and 12th grade male (51.7%) than 10th grade female (36.4%) and 12th grade female (44.9%) students, respectively. The prevalence of lifetime marijuana use was higher among black male (49.0%) and Hispanic male (46.7%) than white male (40.5%) students. Overall, the prevalence of lifetime marijuana use was higher among 10th grade (40.4%), 11th grade (44.5%), and 12th grade (48.5%) than 9th grade (30.7%) students; higher among 12th grade (48.5%) than 10th grade (40.4%) students; higher among 10th grade female (36.4%), 11th grade female (43.5%), and 12th grade female (44.9%) than 9th grade female (28.1%) students; higher among 11th grade female (43.5%) and 12th grade female (44.9%) than 10th grade female (36.4%) students; higher among 10th grade male (44.2%), 11th grade male (45.4%), and 12th grade male (51.7%) than 9th grade male (33.1%) students; and higher among 12th grade male (51.7%) than 10th grade male (44.2%) students. Prevalence of lifetime marijuana use ranged from 21.6% to 49.6% across state surveys (median: 42.5%) and from 29.8% to 52.2% across local surveys (median: 40.9%).

Current Marijuana Use. Nationwide, 22.4% of students had used marijuana one or more times during the 30 days preceding the survey (ie, current marijuana use). Overall, the prevalence of current marijuana use was higher among male (25.1%) than female (19.3%) students; higher among black male (29.8%) and Hispanic male (27.1%) than black female (18.1%) and Hispanic female (20.4%) students, respectively; and higher among 10th grade male (25.7%), 11th grade male (27.3%), and 12th grade male (30.0%) than 10th grade female (18.2%), 11th grade female (20.9%), and 12th grade female (21.3%) students, respectively. The prevalence of current marijuana use was higher among black male (29.8%) than white male (23.3%) students. Overall, the prevalence of current marijuana use was higher among 11th grade (24.1%) and 12th grade (25.8%) than 9th grade (18.5%) students; higher among 12th grade (25.8%) than 10th grade (22.0%) students; anti higher among 10th grade male (25.7%), 11th grade male (27.3%), and 12th grade male (30.0%) than 9th grade male (19.6%) students. Prevalence of current marijuana use ranged from 11.4% to 30.6% across state surveys (median: 21.9%) and from 15.3% to 28.7% across local surveys (median: 22.3%).

Lifetime Cocaine Use, Nationwide, 8.7% of students had used a form of cocaine (eg, powder, "crack," [Pellet-sized pieces of highly purified cocaine] or "freebase" [A process whereby cocaine is dissolved in ether or sodium hydroxide and the precipitate filtered off]) one or more times during their lifetime (ie, lifetime cocaine use). The prevalence of lifetime cocaine use was higher among black male (4.8%) than black female (1.4%) students and higher among 12th grade male (12.9%) than 12th grade female (7.9%) students. Overall, the prevalence of lifetime cocaine use was higher among white (8.7%) and Hispanic (12.5%) than black (3.2%) students; higher among Hispanic (12.5%) than white (8.7%) students; higher among white female (8.0%) and Hispanic female (13.0%) than black female (1.4%) students; higher among Hispanic female (13.0%) than white female (8.0%) students; and higher among white male (9.3%) and Hispanic male (12.0%) than black male (4.8%) students. Overall, the prevalence of lifetime cocaine use was higher among 11th grade (9.0%) and 12th grade (10.5%) than 9th grade (6.8%) students; and higher among 10th grade male (9.7%), 11th grade male (10.2%), and 12th grade male (12.9%) than 9th grade male (6.1%) students. Prevalence of lifetime cocaine use ranged from 5.7% to 12.7% across state surveys (median: 8.4%) and from 2.3% to 11.9% across local surveys (median: 6.0%).

Current Cocaine Use. Nationwide, 4.1% of students had used a form of cocaine one or more times during the 30 days preceding the survey (ie, current cocaine use). The prevalence of current cocaine use was higher among black male (3.3%) than black female (0.9%) students and higher among 12th grade male (5.8%) than 12th grade female (3.5%) students. Overall, the prevalence of current cocaine use was higher among white (3.8%) and Hispanic (5.7%) than black (2.2%) students; higher among Hispanic (5.7%) than white (3.8%) students; higher among white female (3.7%) and Hispanic female (5.8%) than black female (0.9%) students; higher among Hispanic female (5.8%) than white female (3.7%) students; and higher among Hispanic male (5.5%) than black male (3.3%) students. The prevalence of current cocaine use was higher among 12th grade male (5.8%) than 9th grade male (3.1%) students. Prevalence of current cocaine use ranged from 2.0% to 5.8% across state surveys (median: 3.8%) and from 0.8% to 4.9% across local surveys (median: 2.8%).

Lifetime Illegal Injection-Drug Use. Nationwide, 3.2% of students had used a needle to inject any illegal drug into their body one or more times during their lifetime (ie, lifetime illegal injection-drug use). Students were classified as injection-drug users only if they 1) reported injecting-drug use and 2) answered "one or more times" to any of the following questions: "During your life, how many times have you used any form of cocaine including powder, crack, or freebase?" "During your life, how many times have you used heroin (also called smack, junk, or China white)?" "During your life, how many times have you used methamphetamines (also called speed, crystal, crank, or ice)?" or "During your life, how many times have you taken steroid pills or shots without a doctor's prescription?" The prevalence of lifetime illegal injection-drug use was higher among black male (3.4%) than black female (1.5%) students. Prevalence of lifetime illegal injection-drug use ranged from 1.3% to 3.3% across state surveys (median: 2.3%) and from 0.7% to 3.9% across local surveys (median: 1.7%).

Lifetime Inhalant Use. Nationwide, 12.1% of students had sniffed glue, breathed the contents of aerosol spray cans, or inhaled any paints or sprays to get high one or more times during their lifetime (ie, lifetime inhalant use). Overall, the prevalence of lifetime inhalant use was higher among white (12.8%) and Hispanic (12.7%) than black (7.0%) students; higher among white female (12.2%) and Hispanic female (13.9%) than black female (6.4%) students; and higher among white male (13.3%) and Hispanic male (11.6%) than black male (7.5%) students. Overall, the prevalence of lifetime inhalant use was higher among 9th grade (13.6%) than 10th grade (11.1%) students and higher among 9th grade female (14.6%) than 10th grade female (10.3%), 11th grade female (9.4%), and 12th grade female (10.3%) students. Prevalence of lifetime inhalant use ranged from 9.6% to 15.4% across state surveys (median: 12.4%) and from 5.1% to 13.5% across local surveys (median: 9.2%).

Current Inhalant Use. Nationwide, 3.9% of students had used inhalants one or more times during the 30 days preceding the survey (ie, current inhalant use). The prevalence of current inhalant use was higher among 10th grade male (4.3%) and 11th grade male (4.1%) than 10th grade female (2.6%) and 11th grade female (2.0%) students, respectively. The prevalence of current inhalant use was higher among Hispanic female (4.7%) than black female (2.2%) students. Overall, the prevalence of current inhalant use was higher among 9th grade (5.4%) than 10th grade (3.5%), 11th grade (3.1%), and 12th grade (2.7%) students and higher among 9th grade female (5.7%) than 10th grade female (2.6%), 11th grade female (2.0%), and 12th grade female (2.3%) students. Prevalence of current inhalant use ranged from 2.4% to 5.5% across state surveys (median: 3.8%) and from 1.4% to 5.0% across local surveys (median: 3.6%).

Lifetime Illegal Steroid Use. Nationwide, 6.1% of students had taken steroid pills or shots without a doctor's prescription one or more times during their lifetime (ie, lifetime illegal steroid use). The prevalence of lifetime illegal steroid use was higher among black male (5.4%) than black female (1.9%) students and higher among 12th grade male (6.4%) than 12th grade female (3.3%) students. Overall, the prevalence of lifetime illegal steroid use was higher among white (6.2%) and Hispanic (7.2%) than black (3.6%) students and higher among white female (5.6%) and Hispanic female (6.6%) than black female (1.9%) students. The prevalence of lifetime illegal steroid use was higher among 9th grade female (7.3%) than 12th grade female (3.3%) students. Prevalence of lifetime illegal steroid use ranged from 3.2% to 7.1% across state surveys (median: 4.8%) and from 2.3% to 7.4% across local surveys (median: 3.1%).

Lifetime Heroin Use. Nationwide, 3.3% of students had used heroin one or more times during their lifetime (ie, lifetime heroin use). Overall, the prevalence of lifetime heroin use was higher among male (4.3%) than female (2.0%) students; higher among white male (3.3%) and black male (4.4%) than white female (1.8%) and black female (0.8%) students, respectively; and higher among 10th grade male (4.0%), 11th grade male (3.9%), and 12th grade male (4.1%) than 10th grade female (1.7%), 11th grade female (1.9%), and 12th grade female (1.4%) students, respectively. Overall, the prevalence of lifetime heroin use was higher among Hispanic (3.9%) than white (2.6%) students; higher among white female (1.8%) and Hispanic female (3.4%) than black female (0.8%) students; and higher among Hispanic female (3.4%) than white female (1.8%) students. Prevalence of lifetime heroin use ranged from 1.7% to 3.8% across state surveys (median: 2.8%) and from 1.4% to 5.4% across local surveys (median: 2.3%).

Lifetime Methamphetamine Use. Nationwide, 7.6% of students had used methamphetamines one or more times during their lifetime (ie, lifetime methamphetamine use). The prevalence of lifetime methamphetamine use was higher among black male (4.6%) than black female (1.7%) students and higher among 11th grade male (9.4%) and 12th grade male (9.8%) than 11th grade female (6.7%) and 12th grade female (5.9%) students, respectively. Overall, the prevalence of lifetime methamphetamine use was higher among white (8.1%) and Hispanic (8.3%) than black (3.1%) students; higher among white female (7.8%) and Hispanic female (8.1%) than black female (1.7%) students; and higher among white male (8.4%) and Hispanic male (8.5%) than black male (4.6%) students. The prevalence of lifetime methamphetamine use was higher among 11th grade male (9.4%) and 12th grade male (9.8%) than 9th grade male (6.3%) students. Prevalence of lifetime methamphetamine use ranged from 4.7% to 12.5% across state surveys (median: 7.5%) and from 1.7% to 8.5% across local surveys (median: 4.5%).

Lifetime Ecstasy Use. Nationwide, 11.1% of students had used ecstasy one or more times during their lifetime (ie, lifetime ecstasy use). The prevalence of lifetime ecstasy use was higher among black male (8.3%) than black female (3.8%) students. Overall, the prevalence of lifetime ecstasy use was higher among Hispanic (13.0%) than black (6.0%) students; higher among white female (11.4%) and Hispanic female (11.5%) than black female (3.8%) students; and higher among Hispanic male (14.4%) than black male (8.3%) students. Prevalence of lifetime ecstasy use ranged from 4.9% to 10.3% across states (median: 7.6%) and from 3.1% to 12.1% across local surveys (median: 6.3%).

Age of Initiation of Risk Behaviors

Cigarette Smoking Before Age 13 Years. Nationwide, 18.3% of students had smoked a whole cigarette for the first time before age 13 years. Overall, the prevalence of having smoked a whole cigarette before age 13 years was higher among male (20.0%) than female (16.4%) students; higher among black male (19.2%) than black female (11.5%) students; and higher among 11th grade male (18.0%) than 11th grade female (14.1%) students. Overall, the prevalence of having smoked a whole cigarette before age 13 years was higher among white (18.9%) and Hispanic (18.3%) than black (15.3%) students and higher among white female (18.4%) and Hispanic female (16.1%) than black female (11.5%) students. Overall, the prevalence of having smoked a whole cigarette before age 13 years was higher among 10th grade (20.1%) than 11th grade (16.0%) and 12th grade (16.5%) students and higher among 10th grade female (18.4%) than 11th grade female (14.1%) students. Prevalence of having smoked a whole cigarette before age 13 years ranged from 9.1% to 29.4% across state surveys (median: 19.2%) and from 12.4% to 18.8% across local surveys (median: 15.0%).

Alcohol Use Before Age 13 Years. Nationwide, 27.8% of students had drunk alcohol (other than a few sips) for the first time before age 13 years. Overall, the prevalence of having drunk alcohol before age 13 years was higher among male (32.0%) than female (23.3%) students; higher among white male (30.0%), black male (35.7%), and Hispanic male (34.1%) than white female (21.2%), black female (26.8%), and Hispanic female (26.3%) students, respectively; and higher among 10th grade male (33.3%), 11th grade male (27.6%), and 12th grade male (25.1%) than 10th grade female (23.5%), 11th grade female (18.2%), and 12th grade female (15.2%) students, respectively. Overall, the prevalence of having drunk alcohol before age 13 years was higher among black (31.2%) and Hispanic (30.2%) than white (25.7%) students; higher among black female (26.8%) and Hispanic female (26.3%) than white female (21.2%) students: and higher among black male (35.7%) than white male (30.0%) students. Overall, the prevalence of having drunk alcohol before age 13 years was higher among 9th grade (36.4%) than 10th grade (28.5%), 11th grade (23.0%), and 12th grade (20.3%) students; higher among 10th grade (28.5%) than 11th grade (23.0%) and 12th grade (20.3%) students; higher among 9th grade female (33.3%) than 10th grade female (23.5%), 11th grade female (18.2%), and 12th grade female (15.2%) students; higher among 10th grade female (23.5%) than 11th grade female (18.2%) and 12th grade female (15.2%) students; higher among 9th grade male (39.4%) than 10th grade male (33.3%), 11th grade male (27.6%), and 12th grade male (25.1%) students; and higher among 10th grade male (33.3%) than 12th grade male (25.1%) students. Prevalence of having drunk alcohol before age 13 years ranged from 17.4% to 34.7% across state surveys (median: 26.4%) and from 24.4% to 32.9% across local surveys (median: 28.9%).

Marijuana Use Before Age 13 Years. One-tenth (9.9%) of students nationwide had tried marijuana for the first time before age 13 years. Overall, the prevalence of having tried marijuana before age 13 years was higher among male (12.6%) than female (6.9%) students; higher among white male (10.5%), black male (18.5%), and Hispanic male (13.0%) than white female (6.8%), black female (5.8%), and Hispanic female (8.5%) students, respectively; and higher among 9th grade male (13.6%), 10th grade male (14.3%), 11th grade male (10.9%), and 12th grade male (11.0%) than 9th grade female (9.7%), 10th grade female (7.3%), 11th grade female (5.2%), and 12th grade female (4.3%) students, respectively. Overall, the prevalence of having tried marijuana before age 13 years was higher among black (12.1%) than white (8.7%) students and higher among black male (18.5%) than white male (10.5%) and Hispanic male (13.0%) students. Overall, the prevalence of having tried marijuana before age 13 years was higher among 9th grade (11.7%) and 10th grade (10.8%) than 11th grade (8.1%) and 12th grade (7.8%) students; higher among 9th grade female (9.7%) than 11th grade female (5.2%) and 12th grade female (4.3%) students; higher among 10th grade female (7.3%) than 12th grade female (4.3%) students; and higher among 10th grade male (14.3%) than 12th grade male (11.0%) students. Prevalence of having tried marijuana before age 13 years ranged from 5.8% to 13.4% across state surveys (median: 10.4%) and from 6.8% to 14.4% across local surveys (median: 11.0%).

Tobacco, Alcohol, and Other Drug Use on School Property

Cigarette Use on School Property. Nationwide, 8.0% of students had smoked cigarettes on school property on [greater than or equal to]1 of the 30 days preceding the survey. The prevalence of having smoked cigarettes on school property was higher among black male (8.4%) than black female (3.5%) students and higher among 12th grade male (10.5%) than 12th grade female (5.9%) students. Overall, the prevalence of having smoked cigarettes on school property was higher among white (8.9%) than black (5.9%) and Hispanic (6.0%) students; higher among white female (9.6%) and Hispanic female (5.8%) than black female (3.5%) students; and higher among white female (9.6%) than Hispanic female (5.8%) students. The prevalence of having smoked cigarettes on school property was higher among 12th grade male (10.5%) than 9th grade male (7.3%) and 10th grade male (7.5%) students. Prevalence of having smoked cigarettes on school property ranged from 2.7% to 14.3% across state surveys (median: 7.7%) and from 2.5% to 8.7% across local surveys (median: 5.1%).

Smokeless Tobacco Use on School Property. Nationwide, 5.9% of students had used smokeless tobacco on school property on [greater than or equal to]1 of the 30 days preceding the survey. Overall, the prevalence of having used smokeless tobacco on school property was higher among male (8.5%) than female (3.3%) students; higher among white male (9.9%) than white female (3.3%) students; and higher among 10th grade male (7.7%), 11th grade male (10.8%), and 12th grade male (10.1%) than 10th grade female (2.6%), 11th grade female (3.2%), and 12th grade female (2.3%) students, respectively. The prevalence of having used smokeless tobacco on school property was higher among white male (9.9%) than black male (3.2%) students. The prevalence of having used smokeless tobacco on school property was higher among 11th grade male (10.8%) than 9th grade male (6.0%) students. Prevalence of having used smokeless tobacco on school property ranged from 1.5% to 9.3% across state surveys (median: 4.1%) and from 0.4% to 3.5% across local surveys (median: 1.6%).

Alcohol Use on School Property. Nationwide, 5.2% of students had had one or more drinks of alcohol on school property on [greater than or equal to]1 of the 30 days preceding the survey. Overall, the prevalence of having drunk alcohol on school property was higher among male (6.0%) than female (4.2%) students; higher among black male (7.9%) than black female (3.8%) students; and higher among 11th grade male (6.4%) and 12th grade male (6.5%) than 11th grade female (3.5%) and 12th grade female (2.6%) students, respectively. Overall, the prevalence of having drunk alcohol on school property was higher among black (5.8%) and Hispanic (7.6%) than white (3.9%) students; higher among Hispanic female (7.9%) than white female (3.2%) and black female (3.8%) students; and higher among black male (7.9%) and Hispanic male (7.4%) than white male (4.5%) students. The prevalence of having drunk alcohol on school property was higher among 9th grade female (5.2%) and 10th grade female (5.0%) than 12th grade female (2.6%) students. Prevalence of having drunk alcohol on school property ranged from 2.6% to 7.4% across state surveys (median: 4.6%) and from 3.1% to 8.8% across local surveys (median: 5.7%).

Marijuana Use on School Property. Nationwide, 5.8% of students had used marijuana on school property one or more times during the 30 days preceding the survey. Overall, the prevalence of having used marijuana on school property was higher among male (7.6%) than female (3.7%) students; higher among white male (5.8%), black male (9.7%), and Hispanic male (10.4%) than white female (3.1%), black female (3.6%), and Hispanic female (6.0%) students; and higher among 10th grade male (7.2%), 11th grade male (7.9%), and 12th grade male (7.1%) than 10th grade female (3.0%), 11th grade female (3.3%), and 12th grade female (2.6%) students, respectively. Overall, the prevalence of having used marijuana on school property was higher among Hispanic (8.2%) than white (4.5%) students; higher among Hispanic female (6.0%) than white female (3.1%) and black female (3.6%) students; and higher among black male (9.7%) and Hispanic male (10.4%) than white male (5.8%) students. The prevalence of having used marijuana on school property was higher among 9th grade female (5.1%) than 12th grade female (2.6%) students. Prevalence of having used marijuana on school property ranged from 2.6% to 8.0% across state surveys (median: 4.5%) and from 3.3% to 8.2% across local surveys (median: 6.7%).

Offered, Sold, or Given an Illegal Drug on School Property. Nationwide, 28.7% of students had been offered, sold, or given an illegal drug on school property during the 12 months preceding the survey. Overall, the prevalence of having been offered, sold, or given an illegal drug on school property was higher among male (31.9%) than female (25.0%) students; higher among black male (27.7%) and Hispanic male (40.6%) than black female (18.3%) and Hispanic female (32.5%) students, respectively; and higher among 11th grade male (33.5%) and 12th grade male (29.7%) than 11th grade female (26.1%) and 12th grade female (19.6%) students, respectively. Overall, the prevalence of having been offered, sold, or given an illegal drug on school property was higher among Hispanic (36.5%) than white (27.5%) and black (23.1%) students; higher among Hispanic female (32.5%) than white female (24.5%) and black female (18.3%) students; and higher among Hispanic male (40.6%) than white male (30.2%) and black male (27.7%) students. The prevalence of having been offered, sold, or given an illegal drug on school property was higher among 9th grade female (26.7%) and 10th grade female (26.5%) than 12th grade female (19.6%) students. Prevalence of having been offered, sold, or given an illegal drug on school property ranged from 18.1% to 34.5% across state surveys (median: 26.7%) and from 18.3% to 41.1% across local surveys (median: 31.2%).

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

Sexual Intercourse. Nationwide, 46.7% of students had had sexual intercourse during their lifetime. The prevalence of having had sexual intercourse was higher among black male (73.8%) and Hispanic male (56.8%) than black female (60.9%) and Hispanic female (46.4%) students, respectively, and higher among 9th grade male (37.3%) than 9th grade female (27.9%) students. Overall, the prevalence of having had sexual intercourse was higher among black (67.3%) than white (41.8%) and Hispanic (51.4%) students; higher among Hispanic (51.4%) than white (41.8%) students; higher among black female (60.9%) than white female (43.0%) and Hispanic female (46.4%) students; higher among black male (73.8%) than white male (40.5%) and Hispanic male (56.8%) students; and higher among Hispanic male (56.8%) than white male (40.5%) students. Overall, the prevalence of having had sexual intercourse was higher among 10th grade (44.1%), 11th grade (53.2%), and 12th grade (61.6%) than 9th grade (32.8%) students; higher among 11th grade (53.2%) and 12th grade (61.6%) than 10th grade (44.1%) students; higher among 12th grade (61.6%) than 11th grade (53.2%) students; higher among 10th grade female (43.1%), 11th grade female (53.1%), and 12th grade female (62.3%) than 9th grade female (27.9%) students; higher among 11th grade female (53.1%) and 12th grade female (62.3%) than 10th grade female (43.1%) students; higher among 12th grade female (62.3%) than 11th grade female (53.1%) students; higher among 10th grade male (45.1%), 11th grade male (53.4%), and 12th grade male (60.7%) than 9th grade male (37.3%) students; and higher among 11th grade male (53.4%) and 12th grade male (60.7%) than 10th grade male (45.1%) students. Prevalence of having had sexual intercourse ranged from 36.4% to 61.0% across state surveys (median: 44.3%) and from 38.8% to 63.9% across local surveys (median: 53.7%).

Sexual Intercourse Before Age 13 Years. Nationwide, 7.4% of students had sexual intercourse for the first time before age 13 years. Overall, the prevalence of having sexual intercourse before age 13 years was higher among male (10.4%) than female (4.2%) students; higher among black male (31.8%) and Hispanic male (11.6%) than black female (6.9%) and Hispanic female (5.2%) students, respectively; and higher among 9th grade male (13.2%), 10th grade male (11.2%), 11th grade male (7.5%), and 12th grade male (8.8%) than 9th grade female (5.3%), 10th grade female (5.7%), 11th grade female (3.2%), and 12th grade female (1.9%) students, respectively. Overall, the prevalence of having sexual intercourse before age 13 years was higher among black (19.0%) and Hispanic (8.3%) than white (4.2%) students; higher among black (19.0%) than Hispanic (8.3%) students; higher among black female (6.9%) than white female (3.4%) students; higher among black male (31.8%) and Hispanic male (11.6%) than white male (5.0%) students; and higher among black male (31.8%) than Hispanic male (11.6%) students. Overall, the prevalence of having sexual intercourse before age 13 years was higher among 9th grade (9.3%) and 10th grade (8.5%) than 11th grade (5.4%) and 12th grade (5.5%) students; higher among 9th grade female (5.3%) and 10th grade female (5.7%) than 12th grade female (1.9%) students; higher among 10th grade female (5.7%) than 11th grade female (3.2%) students; and higher among 9th grade male (13.2%) than 11th grade male (7.5%) and 12th grade male (8.8%) students. Prevalence of having sexual intercourse before age 13 years ranged from 2.8% to 11.4% across state surveys (median: 5.8%) and from 5.9% to 18.2% across local surveys (median: 11.1%).

Four or More Sex Partners. Nationwide, 14.4% of students had had sexual intercourse during their lifetime with [greater than or equal to]4 sex partners. Overall, the prevalence of having had [greater than or equal to]4 sex partners was higher among male (17.5%) than female (11.2%) students; higher among black male (41.7%) and Hispanic male (20.5%) than black female (16.3%) and Hispanic female (11.2%) students, respectively; and higher among 9th grade male (14.2%), 10th grade male (16.4%), 11th grade male (18.6%), and 12th grade male (22.2%) than 9th grade female (6.4%), 10th grade female (8.8%), 11th grade female (13.4%), and 12th grade female (17.9%) students, respectively. Overall, the prevalence of having had [greater than or equal to]4 sex partners was higher among black (28.8%) and Hispanic (15.7%) than white (10.8%) students; higher among black (28.8%) than Hispanic (15.7%) students; higher among black female (16.3%) than white female (10.1%) and Hispanic female (11.2%) students; higher among black male (41.7%) and Hispanic male (20.5%) than white male (11.5%) students; and higher among black male (41.7%) than Hispanic male (20.5%) students. Overall, the prevalence of having had [greater than or equal to]4 sex partners was higher among 12th grade (20.3%) than 9th grade (10.4%), 10th grade (12.6%), and 11th grade (16.0%) students; higher among 11th grade (16.0%) than 9th grade (10.4%) students; higher among 10th grade female (8.8%), 11th grade female (13.4%), and 12th grade female (17.9%) than 9th grade female (6.4%) students; higher among 11th grade female (13.4%) and 12th grade female (17.9%) than 10th grade female (8.8%) students; higher among 12th grade female (17.9%) than 11th grade female (13.4%) students; and higher among 12th grade male (22.2%) than 9th grade male (14.2%) and 10th grade male (16.4%) students. Prevalence of having had [greater than or equal to]4 sex partners ranged from 8.9% to 23.6% across state surveys (median: 13.8%) and from 9.5% to 28.0% across local surveys (median: 20.2%).

Currently Sexually Active. Approximately one-third (34.3%) of students nationwide had had sexual intercourse during the 3 months preceding the survey (ie, currently sexually active). The prevalence of being currently sexually active was higher among white female (33.1%) and black male (54.0%) than white male (28.5%) and black female (44.2%) students, respectively, and higher among 9th grade male (24.0%) than 9th grade female (18.3%) students. Overall, the prevalence of being currently sexually active was higher among black (49.0%) than white (30.8%) and Hispanic (37.1%) students; higher among Hispanic (37.1%) than white (30.8%) students; higher among black female (44.2%) than white female (33.1%) and Hispanic female (35.8%) students; higher among black male (54.0%) and Hispanic male (38.5%) than white male (28.5%) students; and higher among Hispanic male (38.5%) than white male (28.5%) students. Overall, the prevalence of being currently sexually active was higher among 10th grade (30.6%), 11th grade (41.1%), and 12th grade (48.9%) than 9th grade (21,2%) students; higher among 11th grade (41.1%) and 12th grade (48.9%) than 10th grade (30.6%) students; higher among 12th grade (48.9%) than 11th grade (41.1%) students; higher among 10th grade female (31.2%), 11th grade female (42.9%), and 12th grade female (51.0%) than 9th grade female (18.3%) students; higher among 11th grade female (42.9%) and 12th grade female (51.0%) than 10th grade female (31.2%) students; higher among 12th grade female (51.0%) than 11th grade female (42.9%) students; higher among 10th grade male (30.0%), 11th grade male (39.2%), and 12th grade male (46.5%) than 9th grade male (24.0%) students; higher among 11th grade male (39.2%) and 12th grade male (46.5%) than 10th grade male (30.0%) students; and higher among 12th grade male (46.5%) than 11th grade male (39.2%) students. Prevalence of being currently sexually active ranged from 26.5% to 46.3% across state surveys (median: 31.6%) and from 25.0% to 47.6% across local surveys (median: 39.0%).

Condom Use During Last Sexual Intercourse. Among the 34.3% of currently sexually active students nationwide, 63.0% reported that either they or their partner had used a condom during last sexual intercourse. Overall, the prevalence of having used a condom during last sexual intercourse was higher among male (68.8%) than female (57.4%) students; higher among white male (69.0%), black male (81.2%), and Hispanic male (62.5%) than white female (56.5%), black female (63.6%), and Hispanic female (52.3%) students, respectively; and higher among 11th grade male (66.7%) and 12th grade male (67.0%) than 11th grade female (55.5%) and 12th grade female (48.5%) students, respectively. Overall, the prevalence of having used a condom during last sexual intercourse was higher among black (72.8%) than white (62.5%) and Hispanic (57.4%) students; higher among black female (63.6%) than white female (56.5%) and Hispanic female (52.3%) students; higher among black male (81.2%) and white male (69.0%) than Hispanic male (62.5%) students; and higher among black male (81.2%) than white male (69.0%) students. Overall, the prevalence of having used a condom during last sexual intercourse was higher among 9th grade (69.0%) and 10th grade (69.0%) than 11th grade (60.8%) and 12th grade (57.4%) students; higher among 9th grade female (66.1%) and 10th grade female (66,4%) than 12th grade female (48.5%) students; and higher among 10th grade female (66.4%) than 11th grade female (55.5%) students. Prevalence of having used a condom during last sexual intercourse ranged from 55.4% to 70.4% across state surveys (median: 62.0%) and from 52.7% to 77.5% (median: 70.2%) across local surveys.

Birth Control Pill Use Before Last Sexual Intercourse. Among the 34.3% of currently sexually active students nationwide, 17.0% reported either they or their partner had used birth control pills to prevent pregnancy before last sexual intercourse. Overall, the prevalence of having used birth control pills before last sexual intercourse was higher among female (20.6%) than male (13.1%) students; higher among white female (26.5%) and black female (11.7%) than white male (17.3%) and black male (4.4%) students, respectively; and higher among 11th grade female (24.1%) and 12th grade female (27.2%) than 11th grade male (14.8%) and 12th grade male (17.5%) students, respectively. Overall, the prevalence of having used birth control pills before last sexual intercourse was higher among white (22.3%) than black (7.9%) and Hispanic (11.2%) students; higher among white female (26.5%) than black female (11.7%) and Hispanic female (12.1%) students; higher among white male (17.3%) and Hispanic male (10.3%) than black male (4.4%) students; and higher among white male (17.3%) than Hispanic male (10.3%) students. Overall, the prevalence of having used birth control pills before last sexual intercourse was higher among 11th grade (19.6%) and 12th grade (22.6%) than 9th grade (8.7%) and 10th grade (12.7%) students; higher among 11th grade female (24.1%) and 12th grade female (27.2%) than 9th grade female (11.6%) and 10th grade female (13.5%) students; and higher among 11th grade male (14.8%) and 12th grade male (17.5%) than 9th grade male (6.6%) students. Prevalence of having used birth control pills before last sexual intercourse ranged from 11.9% to 36.7% across state surveys (median: 21.6%) and from 5.5% to 16.1% across local surveys (median: 8.6%).

Alcohol or Drug Use Before Last Sexual Intercourse. Among the 34.3% of currently sexually active students nationwide, 25.4% had drunk alcohol or used drugs before last sexual intercourse. Overall, the prevalence of having drunk alcohol or used drugs before last sexual intercourse was higher among male (29.8%) than female (21.0%) students; higher among white male (30.5%), black male (23.8%), and Hispanic male (29.5%) than white female (23.6%), black female (14.6%), and Hispanic female (18.8%) students, respectively; and higher among 11th grade male (28.8%) and 12th grade male (33.5%) than 11th grade female (21.0%) and 12th grade female (17.6%) students, respectively. Overall, the prevalence of having drunk alcohol or used drugs before last sexual intercourse was higher among white (26.8%) and Hispanic (24.1%) than black (19.5%) students; higher among white female (23.6%) than black female (14.6%) students; and higher among white male (30.5%) than black male (23.8%) students. The prevalence of having drunk alcohol or used drugs before last sexual intercourse was higher among 10th grade female (23.1%) than 12th grade female (17.6%) students. Prevalence of having drunk alcohol or used drugs before last sexual intercourse ranged from 18.1% to 33.7% across state surveys (median: 24.4%) and from 13.2% to 25.5% across local surveys (median: 18.4%).

Pregnancy. Nationwide, 4.2% of students had been pregnant or had gotten someone pregnant. Overall, the prevalence of having been pregnant or having gotten someone pregnant was higher among female (4.9%) than male (3.5%) students; higher among white female (2.8%) than white male (1.7%) students; and higher among 11th grade female (5.3%) and 12th grade female (7.6%) than 11th grade male (3.2%) and 12th grade male (4.7%) students, respectively. Overall, the prevalence of having been pregnant or having gotten someone pregnant was higher among black (9.1%) and Hispanic (6.4%) than white (2.3%) students; higher among black (9.1%) than Hispanic (6.4%) students; higher among black female (10.4%) and Hispanic female (7.3%) than white female (2.8%) students; higher among black male (7.6%) and Hispanic male (5.2%) than white male (1.7%) students; and higher among black male (7.6%) than Hispanic male (5.2%) students. Overall, the prevalence of having been pregnant or having gotten someone pregnant was higher among 10th grade (4.3%), 11th grade (4.3%), and 12th grade (6.2%) than 9th grade (2.6%) students; higher among 10th grade female (5.0%), 11th grade female (5.3%), and 12th grade female (7.6%) than 9th grade female (2.3%) students; and higher among 12th grade female (7.6%) than 10th grade female (5.0%) students. Prevalence of having been pregnant or having gotten someone pregnant ranged from 2.3% to 7.7% across state surveys (median: 4.1%) and from 2.4% to 10.3% across local surveys (median: 7.7%).

AIDS or HIV Infection Education. Nationwide 87.9% of students had been taught in school about acquired immunodeficiency syndrome (AIDS) or HIV infection. Overall, the prevalence of having been taught in school about AIDS or HIV infection was higher among white (90.3%) than black (85.1%) and Hispanic (83.4%) students; higher among white female (90.6%) than Hispanic female (83.9%) students; and higher among white male (90.1%) than black male (82.5%) and Hispanic male (82.8%) students. Overall, the prevalence of having been taught in school about AIDS or HIV infection was higher among 10th grade (89.2%), 11th grade (89.3%), and 12th grade (90.3%) than 9th grade (84.3%) students; higher among 10th grade female (90.5%) and 12th grade female (90.3%) than 9th grade female (85.4%) students; and higher among 10th grade male (88.0%), 11th grade male (88.9%), and 12th grade male (90.3%) than 9th grade male (83.2%) students. Prevalence of having been taught in school about AIDS or HIV infection ranged from 77.9% to 93.6% across state surveys (median: 88.4%) and from 78.8% to 92.7% across local surveys (median: 84.6%).

Dietary Behaviors

Consumption of Fruits and Vegetables. Approximately one-fifth (22.0%) of students nationwide had eaten fruits and vegetables [greater than or equal to]5 times/day during the 7 days preceding the survey. Consumption of fruits and vegetables includes 100% fruit juice, fruit, green salad, potatoes (excluding French fries, fried potatoes, or potato chips), carrots, or other vegetables. Overall, the prevalence of having eaten fruits and vegetables [greater than or equal to]5 times/day was higher among male (23.6%) than female (20.3%) students; higher among black male (26.1%) than black female (20.3%) students; and higher among 9th grade male (25.3%) and 11th grade male (24.5%) than 9th grade female (21.2%) and 11th grade female (18.3%) students, respectively. Overall, the prevalence of having eaten fruits and vegetables [greater than or equal to]5 times/day was higher among Hispanic (24.4%) than white (20.5%) students and higher among black male (26.1%) and Hispanic male (27.4%) than white male (21.2%) students. Overall, the prevalence of having eaten fruits and vegetables [greater than or equal to]5 times/day was higher among 9th grade (23.3%) and 10th grade (23.0%) than 12th grade (19.5%) students. Prevalence of having eaten fruits and vegetables [greater than or equal to]5 times/day ranged from 13.2% to 28.4% across state surveys (median: 18.4%) and from 14.5% to 29.1% across local surveys (median: 18.8%).

Consumption of Milk. Nationwide, 17.1% of students had drunk [greater than or equal to]3 glasses/day of milk during the 7 days preceding the survey. Overall, the prevalence of having drunk [greater than or equal to]3 glasses/day of milk was higher among male (22.7%) than female (11.2%) students; higher among white male (26.8%), black male (16.0%), and Hispanic male (17.0%) than white female (12.8%), black female (7.5%), and Hispanic female (9.0%) students, respectively; and higher among 9th grade male (25.1%), 10th grade male (23.8%), 11th grade male (22.6%), and 12th grade male (18.1%) than 9th grade female (13.5%), 10th grade female (11.8%), 11th grade female (9.8%), and 12th grade female (8.9%) students, respectively. Overall, the prevalence of having drunk [greater than or equal to]3 glasses/day of milk was higher among white (20.0%) than black (11.6%) and Hispanic (13.1%) students; higher among white female (12.8%) than black female (7.5%) students; and higher among white male (26.8%) than black male (16.0%) and Hispanic male (17.0%) students. Overall, the prevalence of having drunk [greater than or equal to]3 glasses/day of milk was higher among 9th grade (19.5%) than 12th grade (13.6%) students; higher among 9th grade female (13.5%) than 12th grade female (8.9%) students; and higher among 9th grade male (25.1%) than 12th grade male (18.1%) students. Prevalence of having drunk [greater than or equal to]3 glasses/day of milk ranged from 8.4% to 28.2% across state surveys (median: 16.7%) and from 5.7% to 11.9% across local surveys (median: 10.5%).

Physical Activity

Sufficient Vigorous Physical Activity. Nationwide, 62.6% of students had exercised or participated in physical activities that made them sweat and breathe hard (eg, basketball, soccer, running, swimming laps, fast bicycling, fast dancing, or similar aerobic activity) for [greater than or equal to]20 minutes on [greater than or equal to]3 of the 7 days preceding the survey (ie, sufficient vigorous physical activity). Overall, the prevalence of having participated in sufficient vigorous physical activity was higher among male (70.0%) than female (55.0%) students; higher among white male (71.9%), black male (65.0%), and Hispanic male (66.7%) than white female (58.1%), black female (44.9%), and Hispanic female (51.8%) students, respectively; and higher among 9th grade male (73.1%), 10th grade male (71.5%), 11th grade male (70.4%), and 12th grade male (63.7%) than 9th grade female (63.6%), 10th grade female (58.2%), 11th grade female (49.4%), and 12th grade female (46.4%) students, respectively. Overall, the prevalence of having participated in sufficient vigorous physical activity was higher among white (65.2%) than black (54.8%) and Hispanic (59.3%) students; higher among white female (58.1%) and Hispanic female (51.8%) than black female (44.9%) students; higher among white female (58.1%) than Hispanic female (51.8%) students; and higher among white male (71.9%) than black male (65.0%) and Hispanic male (66.7%) students. Overall, the prevalence of having participated in sufficient vigorous physical activity was higher among 9th grade (68.5%) and 10th grade (64.9%) than 11th grade (60.1%) and 12th grade (55.0%) students; higher among 11th grade (60.1%) than 12th grade (55.0%) students; higher among 9th grade female (63.6%) and 10th grade female (58.2%) than 11th grade female (49.4%) and 12th grade female (46.4%) students; and higher among 9th grade male (73.1%), 10th grade male (71.5%), and 11th grade male (70.4%) than 12th grade male (63.7%) students. Prevalence of having participated in sufficient vigorous physical activity ranged from 53.3% to 71.1% across state surveys (median: 62.8%) and from 40.1% to 65.8% across local surveys (median: 54.0%).

Sufficient Moderate Physical Activity. One-fourth (24.7%) of students nationwide had participated in physical activities that did not make them sweat or breathe hard (eg, fast walking, slow bicycling, skating, pushing a lawn mower, or mopping floors) for [greater than or equal to]30 minutes on [greater than or equal to]5 of the 7 days preceding the survey (ie, sufficient moderate physical activity). Overall, the prevalence of having participated in sufficient moderate physical activity was higher among male (27.2%) than female (22.1%) students; higher among white male (28.9%) and black male (25.8%) than white female (23.3%) and black female (17.5%) students, respectively; and higher among 9th grade male (28.3%), 11th grade male (28.1%), and 12th grade male (26.3%) than 9th grade female (22.3%), 11th grade female (20.0%), and 12th grade female (20.0%) students, respectively. Overall, the prevalence of having participated in sufficient moderate physical activity was higher among white (26.2%) than black (21.7%) and Hispanic (22.0%) students; higher among white female (23.3%) than black female (17.5%) students; and higher among white male (28.9%) than Hispanic male (23.3%) students. The prevalence of having participated in sufficient moderate physical activity was higher among 10th grade female (25.3%) than 11th grade female (20.0%) and 12th grade female (20.0%) students. Prevalence of having participated in sufficient moderate physical activity ranged from 18.0% to 29.5% across state surveys (median: 25.6%) and from 14.9% to 27.2% across local surveys (median: 21.0%).

Insufficient Amount of Physical Activity. Nationwide, 33.4% of students had not participated in sufficient vigorous physical activity and had not participated in sufficient moderate physical activity during the 7 days preceding the survey (ie, insufficient amount of physical activity). Overall, the prevalence of having participated in an insufficient amount of physical activity was higher among female (40.1%) than male (26.9%) students; higher among white female (37.5%), black female (50.4%), and Hispanic female (42.6%) than white male (24.8%), black male (31.8%), and Hispanic male (30.3%) students, respectively; and higher among 9th grade female (32.7%), 10th grade female (35.9%), 11th grade female (46.2%), and 12th grade female (48.4%) than 9th grade male (23.8%), 10th grade male (25.6%), 11th grade male (27.0%), and 12th grade male (32.1%) students, respectively. Overall, the prevalence of having participated in an insufficient amount of physical activity was higher among black (41.2%) and Hispanic (36.5%) than white (31.0%) students; higher among black (41.2%) than Hispanic (36.5%) students; higher among black female (50.4%) than white female (37.5%) and Hispanic female (42.6%) students; and higher among black male (31.8%) and Hispanic male (30.3%) than white male (24.8%) students. Overall, the prevalence of having participated in an insufficient amount of physical activity was higher among 11th grade (36.5%) and 12th grade (40.2%) than 9th grade (28.1%) and 10th grade (30.8%) students; higher among 11th grade female (46.2%) and 12th grade female (48.4%) than 9th grade female (32.7%) and 10th grade female (35.9%) students; and higher among 12th grade male (32.1%) than 9th grade male (23.8%), 10th grade male (25.6%), and 11th grade male (27.0%) students. Prevalence of having participated in an insufficient amount of physical activity ranged from 24.8% to 41.9% across state surveys (median: 32.0%) and from 30.3% to 55.3% across local surveys (median: 41.5%).

No Vigorous or Moderate Physical Activity. Nationwide, 11.5% of students had not participated in either vigorous physical activity or moderate physical activity during the 7 days preceding the survey. The prevalence of no vigorous or moderate physical activity was higher among black female (20.0%) and Hispanic female (15.4%) than black male (12.6%) and Hispanic male (10.6%) students, respectively, and higher among 11th grade female (16.7%) and 12th grade female (17.0%) than 11th grade male (10.8%) and 12th grade male (10.9%) students, respectively. Overall, the prevalence of no vigorous or moderate physical activity was higher among black (16.3%) than white (10.2%) and Hispanic (13.0%) students and higher among black female (20.0%) than white female (11.1%) and Hispanic female (15.4%) students. Overall, the prevalence of no vigorous or moderate physical activity was higher among 11th grade (13.7%) and 12th grade (14.0%) than 9th grade (9.1%) students; and higher among 11th grade female (16.7%) and 12th grade female (17.0%) than 9th grade female (9.7%) and 10th grade female (10.2%) students. Prevalence of no vigorous or moderate physical activity ranged from 5.3% to 15.3% across state surveys (median: 9.1%) and from 9.4% to 26.1% across local surveys (median: 14.0%).

Enrolled in Physical Education Class. Nationwide, 55.7% of students went to physical education (PE) classes on one or more days in an average week when they were in school (ie, enrolled in PE class). The prevalence of having been enrolled in PE class was higher among black male (63.1%) than black female (49.3%) students. Overall, the prevalence of having been enrolled in PE class was higher among 9th grade (71.0%) and 10th grade (60.7%) than 11th grade (45.7%) and 12th grade (39.5%) students; higher among 9th grade female (71.2%) and 10th grade female (58.3%) than 11th grade female (40.8%) and 12th grade female (34.6%) students; and higher among 9th grade male (70.8%) and 10th grade male (63.0%) than 11th grade male (50.5%) and 12th grade male (44.5%) students. Prevalence of having been enrolled in PE class ranged from 27.3% to 93.7% across state surveys (median: 44.9%) and from 32.6% to 88.0% across local surveys (median: 48.1%).

Attended PE Class Daily. Nationwide, 28.4% of students went to PE classes 5 days in an average week when they were in school (ie, dally PE class attendance). Overall, the prevalence of daily PE class attendance was higher among Hispanic (36.7%) than white (24.9%) students and higher among black male (37.1%) and Hispanic male (39.5%) than white male (26.8%) students. Overall, the prevalence of daily PE class attendance was higher among 9th grade (37.9%) and 10th grade (31.3%) than 12th grade (18.2%) students; higher among 9th grade (37.9%) than 11th grade (22.6%) students; higher among 9th grade female (38.0%) and 10th grade female (29.1%) than 12th grade female (15.2%) students; higher among 9th grade female (38.0%) than 11th grade female (19.2%) students; higher among 9th grade male (37.7%) and 10th grade male (33.5%) than 12th grade male (21.4%) students; and higher among 9th grade male (37.7%) than 11th grade male (26.0%) students. Prevalence of dally PE class attendance ranged from 8.2% to 37.2% across state surveys (median: 27.5%) and from 9.2% to 51.0% across local surveys (median: 24.5%).

Exercised or Played Sports >20 Minutes During PE Class. Among the 55.7% of students nationwide enrolled in PE class, 80.3% actually exercised or played sports >20 minutes during an average PE class. Overall, the prevalence of having exercised or played sports >20 minutes during an average PE class was higher among male (84.5%) than female (75.3%) students; higher among white male (85.8%), black male (80.0%), and Hispanic male (82.5%) than white female (76.6%), black female (66.7%), and Hispanic female (73.5%) students, respectively; and higher among 9th grade male (84.8%), 10th grade male (83.2%), 11th grade male (83.7%), and 12th grade male (87.2%) than 9th grade female (75.7%), 10th grade female (77.0%), 11th grade female (71.6%), and 12th grade female (74.9%) students, respectively. Overall, the prevalence of having exercised or played sports >20 minutes during an average PE class was higher among white (81.5%) than black (74.0%) students; higher among white female (76.6%) than black female (66.7%) students; and higher among white male (85.8%) than black male (80.0%) students. Prevalence of having exercised or played sports >20 minutes during an average PE class ranged from 76.2% to 91.1% across state surveys (median: 84.5%) and from 55.7% to 82.0% across local surveys (median: 72.4%).

Participated in Strengthening Exercises. Nationwide, 51.9% of students had done exercises to strengthen or tone their muscles (eg, push-ups, sit-ups, or weightlifting) on [greater than or equal to]3 of the 7 days preceding the survey. Overall, the prevalence of having done strengthening exercises was higher among male (60.1%) than female (43.4%) students; higher among white male (60.6%), black male (59.6%), and Hispanic male (59.4%) than white female (46.1%), black female (31.3%), and Hispanic female (43.6%) students, respectively; and higher among 9th grade male (63.1%), 10th grade male (60.1%), 11th grade male (62.3%), and 12th grade male (54.6%) than 9th grade female (47.9%), 10th grade female (49.2%), 11th grade female (39.8%), and 12th grade female (34.4%) students, respectively. Overall, the prevalence of having done strengthening exercises was higher among white (53.6%) and Hispanic (51.5%) than black (45.4%) students and higher among white female (46.1%) and Hispanic female (43.6%) than black female (31.3%) students. Overall, the prevalence of having done strengthening exercises was higher among 9th grade (55.8%), 10th grade (54.7%), and 11th grade (51.2%) than 12th grade (44.6%) students; higher among 9th grade female (47.9%) and 10th grade female (49.2%) than 11th grade female (39.8%) and 12th grade female (34.4%) students; and higher among 9th grade male (63.1%) and 11th grade male (62.3%) than 12th grade male (54.6%) students. The prevalence of having done strengthening exercises ranged from 42.6% to 58.4% across state surveys (median: 51.0%) and from 37.2% to 56.8% across local surveys (median: 44.9%).

Played on Sports Teams. Nationwide, 57.6% of students had played on one or more sports teams (run by their school or community groups) during the 12 months preceding the survey. Overall, the prevalence of having played on one or more sports teams was higher among male (64.0%) than female (51.0%) students; higher among white male (65.4%), black male (67.5%), and Hispanic male (56.2%) than white female (55.9%), black female (39.6%), and Hispanic female (42.8%) students, respectively; and higher among 9th grade male (65.0%), 10th grade male (62.0%), 11th grade male (66.3%), and 12th grade male (62.3%) than 9th grade female (55.2%), 10th grade female (53.9%), 11th grade female (47.8%), and 12th grade female (45.9%) students, respectively. Overall, the prevalence of having played on one or more sports teams was higher among white (60.8%) than black (53.2%) and Hispanic (49.5%) students; higher among white female (55.9%) than black female (39.6%) and Hispanic female (42.8%) students; and higher among white male (65.4%) and black male (67.5%) than Hispanic male (56.2%) students. Overall, the prevalence of having played on one or more sports teams was higher among 9th grade (60.3%) than 12th grade (54.0%) students; and higher among 9th grade female (55.2%) and 10th grade female (53.9%) than 11th grade female (47.8%) and 12th grade female (45.9%) students. Prevalence of having played on one or more sports teams ranged from 50.7% to 64.9% across state surveys (median: 56.3%) and from 44.1% to 55.8% across local surveys (median: 47.9%).

Watched Television. Nationwide, 38.2% of students had watched television [greater than or equal to]3 hours/day on an average school day. The prevalence of having watched television [greater than or equal to]3 hours/day was higher among white male (31.7%) than white female (26.8%) students. Overall, the prevalence of having watched television [greater than or equal to]3 hours/day was higher among black (67.2%) and Hispanic (45.9%) than white (29.3%) students; higher among black (67.2%) than Hispanic (45.9%) students; higher among black female (70.0%) and Hispanic female (45.1%) than white female (26.8%) students; higher among black female (70.0%) than Hispanic female (45.1%) students; higher among black male (64.3%) and Hispanic male (46.8%) than white male (31.7%) students; and higher among black male (64.3%) than Hispanic male (46.8%) students. Overall. the prevalence of having watched television [greater than or equal to]3 hours/day was higher among 9th grade (44.0%) and 10th grade (41.0%) than 11th grade (34.4%) and 12th grade (30.6%) students; higher among 9th grade female (41.2%) and 10th grade female (39.0%) than 12th grade female (31.3%) students; higher among 9th grade female (41.2%) than 11th grade female (34.7%) students; and higher among 9th grade male (46.5%) and 10th grade male (42.9%) than 11th grade male (34.1%) and 12th grade male (29.9%) students. Prevalence of having watched television [greater than or equal to]3 hours/day ranged from 21.3% to 54.1% across state surveys (median: 32.2%) and from 41.8% to 65.5% across local surveys (median: 53.7%).

Overweight And Weight Control

At Risk for Overweight. Nationwide, 15.4% of students were at risk for becoming overweight. The prevalence of being at risk for overweight was higher among black female (21.2%) than black male (15.5%) students. Overall, the prevalence of being at risk for overweight was higher among black (18.3%) and Hispanic 07.3%) than white (14.1%) students; higher among black female (21.2%) than white female (13.8%) and Hispanic female (15.7%) students; and higher among Hispanic male (19.0%) than white male (14.3%) students. Prevalence of being at risk for overweight ranged from 11.0% to 16.7% across state surveys (median: 14.5%) and from 14.2% to 20.6% across local surveys (17.4%).

Overweight. Nationwide, 13.5% of students were overweight. Overall, the prevalence of being overweight was higher among male (17.4%) than female (9.4%) students; higher among white male (16.2%) and Hispanic male (21.7%) than white female (7.8%) and Hispanic female (11.8%) students, respectively; and higher among 9th grade male (19.0%), 10th grade male (17.9%), 11th grade male (17.0%), and 12th grade male (14.7%) than 9th grade female (11.2%), 10th grade female (9.3%), 11th grade female (8.6%), and 12th grade female (8.0%) students, respectively. Overall, the prevalence of being overweight was higher among black (17.6%) than white (12.2%) students and higher among black female (15.6%) than white female (7.8%) students. Prevalence of being overweight ranged from 7.0% to 15.7% across state surveys (median: 11.1%) and from 9.3% to 19.9% across local surveys (median: 13.8%).

Described Themselves as Overweight. Nationwide, 29.6% of students described themselves as slightly or very overweight. Overall, the prevalence of describing themselves as overweight was higher among female (36.1%) than male (23.5%) students; higher among white female (38.5%), black female (26.4%), and Hispanic female (36.1%) than white male (23.5%), black male (17.9%), and Hispanic male (27.1%) students, respectively; and higher among 9th grade female (33.1%), 10th grade female (36.1%), 11th grade female (36.9%), and 12th grade female (38.7%) than 9th grade male (22.6%), 10th grade male (23.2%), 11th grade male (24.3%), and 12th grade male (24.1%) students, respectively. Overall, the prevalence of describing themselves as overweight was higher among white (30.8%) and Hispanic (31.6%) than black (22.3%) students; higher among white female (38.5%) and Hispanic female (36.1%) than black female (26.4%) students; and higher among white male (23.5%) and Hispanic male (27.1%) than black male (17.9%) students. Overall, the prevalence of describing themselves as overweight was higher among 12th grade (31.4%) than 9th grade (27.7%) students; and higher among 12th grade female (38.7%) than 9th grade female (33.1%) students. Prevalence of describing themselves as overweight ranged from 26.5% to 34.9% across state surveys (median: 31.0%) and from 21.0% to 36.1% across local surveys (27.4%).

Trying To Lose Weight. Nationwide, 43.8% of students were trying to lose weight. Overall, the prevalence of trying to lose weight was higher among female (59.3%) than male (29.1%) students; higher among white female (62.6%), black female (46.7%), and Hispanic female (61.7%) than white male (27.9%), black male (22.7%), and Hispanic male (37.4%) students, respectively; and higher among 9th grade female (54.1%), 10th grade female (62.2%), 11th grade female (60.4%), and 12th grade female (61.7%) than 9th grade male (31.2%), 10th grade male (28.3%), 11th grade male (28.3%), and 12th grade male (28.0%) students, respectively. Overall, the prevalence of trying to lose weight was higher among white (44.8%) and Hispanic (49.4%) than black (34.7%) students; higher among white female (62.6%) and Hispanic female (61.7%) than black female (46.7%) students; higher among white male (27.9%) and Hispanic male (37.4%) than black male (22.7%) students; and higher among Hispanic male (37.4%) than white male (27.9%) students. The prevalence of trying to lose weight was higher among 10th grade female (62.2%) and 12th grade female (61.7%) than 9th grade female (54.1%) students. Prevalence of trying to lose weight ranged from 41.6% to 51.0% across state surveys (median: 44.7%) and from 30.5% to 53.0% across local surveys (median: 43.0%).

Ate Less Food To Lose Weight or To Keep From Gaining Weight. During the 30 days preceding the survey, 42.2% of students nationwide had eaten less food, fewer calories, or foods low in fat to lose weight or to keep from gaining weight. Overall, the prevalence of having eaten less food, fewer calories, or foods low in fat to lose weight or to keep from gaining weight was higher among female (56.2%) than male (28.9%) students; higher among white female (61.1%), black female (39.0%), and Hispanic female (54.9%) than white male (29.1%), black male (21.8%), and Hispanic male (33.7%) students, respectively; and higher among 9th grade female (53.0%), 10th grade female (58.1%), 11th grade female (56.4%), and 12th grade female (57.9%) than 9th grade male (28.8%), 10th grade male (27.8%), 11th grade male (29.4%), and 12th grade male (29.8%) students, respectively. Overall, the prevalence of having eaten less food, fewer calories, or foods low in fat to lose weight or to keep from gaining weight was higher among white (44.6%) and Hispanic (44.2%) than black (30.5%) students; higher among white female (61.1%) and Hispanic female (54.9%) than black female (39.0%) students; higher among white female (61.1%) than Hispanic female (54.9%) students; and higher among white male (29.1%) and Hispanic male (33.7%) than black male (21.8%) students. Overall, the prevalence of having eaten less food, fewer calories, or foods low in fat to lose weight or to keep from gaining weight was higher among 12th grade (43.7%) than 9th grade (40.4%) students and higher among 12th grade female (57.9%) than 9th grade female (53.0%) students. Prevalence of having eaten less food, fewer calories, or foods low in fat to lose weight or to keep from gaining weight ranged from 37.6% to 46.9% across state surveys (median: 41.1%) and from 27.3% to 41.1% across local surveys (median: 37.2%).

Exercised To Lose Weight or To Keep From Gaining Weight. Nationwide, 57.1% of students had exercised to lose weight or to keep from gaining weight during the 30 days preceding the survey. Overall, the prevalence of having exercised to lose weight or to keep from gaining weight was higher among female (65.7%) than male (49.0%) students; higher among white female (69.6%) and Hispanic female (64.1%) than white male (48.1%) and Hispanic male (53.7%) students, respectively; and higher among 9th grade female (65.7%), 10th grade female (68.9%), 11th grade female (64.5%), and 12th grade female (63.2%) than 9th grade male (50.2%), 10th grade male (49.8%), 11th grade male (49.4%), and 12th grade male (46.4%) students, respectively. Overall, the prevalence of having exercised to lose weight or to keep from gaining weight was higher among white (58.5%) and Hispanic (58.9%) than black (47.5%) students; higher among white female (69.6%) and Hispanic female (64.1%) than black female (49.2%) students; and higher among Hispanic male (53.7%) than black male (46.1%) students. Prevalence of having exercised to lose weight or to keep from gaining weight ranged from 53.2% to 63.8% across state surveys (median: 59.5%) and from 38.7% to 64.1% across local surveys (median: 56.5%).

Went Without Eating for [greater than or equal to]24 Hours To Lose Weight or To Keep From Gaining Weight. Nationwide, 13.3% of students had gone without eating for [greater than or equal to]24 hours to lose weight or to keep from gaining weight during the 30 days preceding the survey. Overall, the prevalence of having gone without eating for [greater than or equal to]24 hours to lose weight or to keep from gaining weight was higher among female (18.3%) than male (8.5%) students; higher among white female (18.4%), black female (14.5%), and Hispanic female (18.2%) than white male (7.1%), black male (10.5%), and Hispanic male (9.2%) students, respectively; and higher among 9th grade female (18.8%), 10th grade female (18.5%), 11th grade female (19.6%), and 12th grade female (15.7%) than 9th grade male (10.7%), 10th grade male (7.0%), 11th grade male (8.2%), and 12th grade male (6.9%) students, respectively. The prevalence of having gone without eating for [greater than or equal to]24 hours to lose weight or to keep from gaining weight was higher among white female (18.4%) and Hispanic female (18.2%) than black female (14.5%) students and higher among black male (10.5%) than white male (7.1%) students. Overall, the prevalence of having gone without eating for [greater than or equal to]24 hours to lose weight or to keep from gaining weight was higher among 9th grade (14.6%) than 12th grade (11.2%) students; higher among 11th grade female (19.6%) than 12th grade female (15.7%) students; and higher among 9th grade male (10.7%) than 10th grade male (7.0%) and 12th grade male (6.9%) students. Prevalence of having gone without eating for [greater than or equal to]24 hours to lose weight or to keep from gaining weight ranged from 9.1% to 17.3% across state surveys (median: 12.3%) and from 9.8% to 14.7% across local surveys (median: 11.9%).

Took Diet Pills, Powders, or Liquids To Lose Weight or To Keep From Gaining Weight. Nationwide, 9.2% of students had taken diet pills, powders, or liquids without a doctor's advice to lose weight or to keep from gaining weight during the 30 days preceding the survey. Overall, the prevalence of having taken diet pills, powders, or liquids without a doctor's advice to lose weight or to keep from gaining weight was higher among female (11.3%) than male (7.1%) students; higher among white female (13.0%) than white male (6.8%) students; and higher among 10th grade female (10.9%), 11th grade female (12.6%), and 12th grade female (13.0%) than 10th grade male (5.8%), 11th grade male (7.7%), and 12th grade male (8.5%) students, respectively. Overall, the prevalence of having taken diet pills, powders, or liquids without a doctor's advice to lose weight or to keep from gaining weight was higher among white (9.8%) and Hispanic (10.5%) than black (5.0%) students and higher among white female (13.0%) and Hispanic female (11.7%) than black female (5.1%) students. Prevalence of having taken diet pills, powders, or liquids without a doctor's advice to lose weight or to keep from gaining weight ranged from 5.3% to 11.8% across state surveys (median: 7.7%) and from 4.5% to 9.0% across local surveys (median: 6.8%). Vomited or Took Laxatives To Lose Weight or To Keep From Gaining Weight. Nationwide, 6.0% of students had

vomited or taken laxatives to lose weight or to keep from gaining weight during the 30 days preceding the survey. Overall, the prevalence of having vomited or taken laxatives to lose weight or to keep from gaining weight was higher among female (8.4%) than male (3.7%) students; higher among white female (8.5%) than white male (2.7%) students; and higher among 10th grade female (9.3%), 11th grade female (8.8%), and 12th grade female (7.3%) than 10th grade male (3.5%), 11th grade male (2.6%), and 12th grade male (3.8%) students, respectively. The prevalence of having vomited or taken laxatives to lose weight or to keep from gaining weight was higher among white female (8.5%) and Hispanic female (9.7%) than black female (5.6%) students. Prevalence of having vomited or taken laxatives to lose weight or to keep from gaining weight ranged from 3.1% to 7.5% across state surveys (median: 5.3%) and from 4.0% to 7.5% across local surveys (median: 5.1%).

Trends During 1991-2003

During 1991-2003, significant decreases occurred in the percentage of students who had never or who had rarely worn seat belts (25.9%-18.2%), rode with a driver who had been drinking alcohol (39.9%-30.2%), drove after drinking alcohol (16.7%-12.1%), had been in a physical fight (42.5%-33.0%), and made a plan to attempt suicide (18.6%-16.5%). The percentage of students who carried a weapon decreased significantly from 1991-1997 (26.1%-18.3%) and then remained constant from 1997-2003 (18.3%-17.1%).

The percentage of students who ever tried cigarette smoking remained constant from 1991-1999 (70.1%-70.4%) and then decreased significantly from 1999-2003 (70.4%-58.4%). The percentage of students who reported current cigarette use increased significantly from 1991-1997 (27.5%-36.4%) and then decreased significantly from 1997-2003 (36.4%-21.9%). During 1995-2003, current smokeless tobacco use decreased significantly (11.4%-6.7%), and during 1997-2003 current cigar use also decreased significantly (22.0%-14.8%).

The percentage of students who reported lifetime alcohol use decreased significantly from 1991-2003 (81.6%-74.9%). The percentage of students who reported lifetime and current marijuana use increased significantly from 1991-1997 (31.3%-47.1% and 14.7%-26.2%, respectively) and then decreased significantly from 1997-2003 (47.1%-40.2% and 26.2%-22.4%, respectively). The percentage of students who reported lifetime and current cocaine use increased significantly from 1991-1999 (5.9%-9.5% and 1.7%-4.0%, respectively) and then leveled off from 1999-2003 (9.5%-8.7% and 4.0%-4.1%, respectively).

During 1991-2003, the percentage of students who had had sexual intercourse and had [greater than or equal to]4 sex partners decreased significantly (54.1%-46.7% and 18.7%-14.4%, respectively). During 1991-2003, the percentage of currently sexually active students who used a condom during last sexual intercourse increased significantly (46.2%-63.0%). During 1991-2003, the percentage of currently sexually active students who had drunk alcohol or used drugs before last sexual intercourse also increased significantly (21.6%-25.4%).

Although the percentage of students enrolled in PE class remained constant from 1991-2003 (48.9%-55.7%), the percentage of students with daily PE class attendance decreased significantly from 1991-1995 (41.6%-25.4%) and then remained stable from 1995-2003 (25.4%-28.4%).

DISCUSSION

Since 1991, selected risk behaviors associated with unintentional injuries and violence; tobacco, alcohol, and marijuana use; and HIV infection, other STDs, and unintended pregnancy have decreased among high school students nationwide. However, risk for chronic health problems might have increased. Even with improvements in certain behaviors over time, too many high school students continue to engage in health risk behaviors. For example, during the 30 days preceding the survey, 2.6 million high school students rarely or never wore seat belts, 2.4 million carried a weapon, 3.1 million smoked cigarettes, 6.4 million drank alcohol, and 3.2 million used marijuana. During the 12 months preceding the survey 4.7 million high school students were in a physical fight. In addition, 6.6 million high school student had ever had sexual intercourse, and 1.9 million were overweight.

Certain risk behaviors are more likely to occur among particular subpopulations of students defined by sex, race/ethnicity, and grade. However, this analysis could not isolate the effects of sex, race/ethnicity, or grade from those measures of socioeconomic status (SES) or culture on risk behaviors with substantial disparities. In a 1992 national study, after controlling for age, sex, race/ethnicity, and school enrollment status (in or out of school), adolescents aged 12-17 years were less likely to report selected risk behaviors (eg, smoking, physical inactivity, eating too little fruit and vegetables, and episodic heavy drinking) as the SES (education or family income) of the responsible adult increased. (5) Additional research is needed to assess the effect of specific educational, socioeconomic, cultural, and racial/ethnic factors on the prevalence of health-risk behaviors among high school students.

For the majority of risk behaviors, limited variability in their prevalence occurs from state to state and from city to city. However, across state surveys, a range of [greater than or equal to]25 percentage points was identified for the following risk behaviors: rarely or never wearing a bicycle helmet (minimum: 52.0%; maximum: 95.7%); lifetime cigarette use (minimum: 32.8%; maximum: 71.1%); current cigarette use (minimum: 7.3%; maximum: 32.7%); current tobacco use (minimum: 10.3%; maximum: 41.2%); lifetime alcohol use (minimum: 43.3%; maximum: 81.1%); current alcohol use (minimum: 21.3%; maximum: 54.2%); episodic heavy drinking (minimum: 14.3%; maximum: 39.5%); lifetime marijuana use (minimum: 21.6%; maximum: 49.6%); enrolled in PE class (minimum: 27.3%; maximum: 93.7%); attended PE class daily (minimum: 8.2%; maximum: 37.2%); and watched television [greater than or equal to]3 hours/day (minimum: 21.3%; maximum: 54.1%).

Across local surveys, a range of [greater than or equal to]25 percentage points was identified for the following risk behaviors: rarely or never wearing seat belts (minimum: 5.4%; maximum: 33.7%); purchasing cigarettes in a store or gas station (minimum: 13.2%; maximum: 39.9%); ever had sexual intercourse (minimum: 38.8%; maximum: 63.9%); reported sufficient vigorous physical activity (minimum: 40.1%; maximum: 65.8%); reported insufficient amounts of physical activity (minimum: 30.3%; maximum: 55.3%); enrolled in PE class (minimum: 32.6%; maximum: 88.0%); attended PE class daily (minimum: 9.2%; maximum: 51.0%); exercised or played sports >20 minutes during an average PE class (minimum: 55.7%; maximum: 82.0%); and exercised to lose weight or keep from gaining weight (minimum: 38.7%; maximum: 64.1%).

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

CONCLUSION

The national YRBS data are used routinely by CDC and other federal agencies. As examples, CDC uses YRBS data to: assess trends in priority health-risk behaviors among high school students; monitor progress toward 15 Healthy People 2010 health objectives and three leading health indicators; (6) evaluate components of CDC's Performance Plan in compliance with the Government Performance and Results Act; (7) and evaluate the contribution of HIV prevention efforts in schools toward helping the nation reach HIV prevention objectives for youth.

State and local agencies and nongovernmental organizations use YRBS data to set health education and health promotion goals, support curricula or program modifications, support legislation that promotes health, and seek funding for new initiatives. Continued support for YRBSS will help monitor and ensure the effectiveness of these and other public health and school health programs for youth.

References

(1.) Arias E, Anderson RN, Kung HC, Murphy SL, Kochanek KS. Deaths: final data for 2001. Natl Vital Star Rep. 2003;52(3):1-100.

(2.) Ventura SJ, Abma JC, Mosher WD, Henshaw S. Revised pregnancy rates, 1990-97, and new rates for 1998-99: United States. Natl Vital Stat Rep. 2003;52(7): 1-16.

(3.) Institute of Medicine, Committee on Prevention and Control of Sexually Transmitted Diseases. Eng TR, Butler WT, eds. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: National Academy Press; 1997.

(4.) Kolbe LJ, Kann L, Collins JL. Overview of the Youth Risk Behavior Surveillance System. Public Health Rep. 1993;108(Suppl 1):2-10.

(5.) Lowry R, Kann L, Collins JL, Kolbe LJ. The effect of socioeconomic status on chronic disease risk behaviors among US adolescents. JAMA. 1996;276:792-797.

(6.) US Dept of Health and Human Services. With understanding and improving health and objectives for improving health. In: Healthy People 2010. Washington, DC: US Dept of Health and Human Services; November 2000.

(7.) Centers for Disease Control and Prevention. FY 2002 Performance Plan. Atlanta, Ga: US Dept of Health and Human Services; 2001.

Jo Anne Grunbaum, EdD; Laura Kann, PhD; Steve Kinchen; Richard Lowry, MD. MS; William A. Harris, MM; Tim McManus, MS; David Chyen; and Janet Collins, PhD. Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention 4770 Buford Highway, NE, MS-K33, Atlanta, GA 30341; James Ross, MS, ORC Macro, 11785 Belisville Drive, Calverton, MD 20705; and Joseph Hawkins, MA, Westat, Inc., 1650 Research Blvd., Rockville, MD 20850. This article is based on "Youth Risk Behavior Surveillance--United States, 2003," printed in MMWR, 2004;53(SS-2):1-29. Copies of the complete (unabridged) report can be obtained from: www.cdc.gov/healthyyouth/yrbs/.
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Title Annotation:Special Report
Author:Grunbaum, Jo Anne; Kann, Laura; Kinchen, Steve; Ross, James; Hawkins, Joseph; Lowry, Richard; Harris
Publication:Journal of School Health
Geographic Code:1USA
Date:Oct 1, 2004
Words:21560
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