Source: Substance Abuse and Mental Health Services Administration
Smoking is a serious public health concern that continues to be the primary cause of preventable illness and death in the United States.
Policy efforts such as increased cigarette taxes and graphic warning labels have helped reduce smoking.
According to the 2011 National Survey on Drug Use and Health, 54.9 million adults smoked cigarettes in the past month. Smoking rates decreased between 2002 and 2011 for adults in all age groups except those aged 26 to 34 (Figure). Past month smoking among adults aged 26 to 34 showed no significant change between 2002 and 2011 (32.7 vs. 31.6 percent).
Research has shown that quitting by the age of 30 prevents almost all long-term health related effects of smoking. Although the number of adults smoking has declined, this report suggests a need for immediate targeting of cessation efforts toward smokers currently in their late 20s and early 30s.
Source: RAND Corporation
Wealthier individuals engage in healthier behavior. This paper seeks to explain this phenomenon by developing a theory of health behavior, and exploiting both lottery winnings and inheritances to test the theory. It distinguishes between the direct monetary cost and the indirect health cost (value of health lost) of unhealthy consumption. The health cost increases with wealth and the degree of unhealthiness, leading wealthier individuals to consume more healthy and moderately unhealthy, but fewer severely unhealthy goods. The empirical evidence presented suggests that differences in health costs may indeed provide an explanation for behavioral differences, and ultimately health outcomes, between wealth groups.
Source: Preventing Chronic Disease (CDC)
Tanning beds used according to the manufacturer’s instructions expose the user to health risks, including melanoma and other skin cancers. Applying the MPOWER model (monitor, protect, offer alternatives, warn, enforce, and raise taxes), which has been used in tobacco control, to tanning bed reform could reduce the number of people at risk of diseases associated with tanning bed use. Among the tactics available to government are restricting the use of tanning beds by people under age 18 and those with fair skin, increasing the price of tanning bed services through taxation, licensing tanning bed operators, and banning unsupervised tanning bed operations.
Source: Centers for Disease Control and Prevention
Cigarette smoking is the leading preventable cause of disease, disability, and death in the US. Despite overall declines in smoking, more people with mental illness smoke than people without mental illness. Because many people with mental illness smoke, many of them will get sick and die early from smoking.
Recent research has shown that, like other smokers, adults with mental illness who smoke want to quit, can quit, and benefit from proven stop-smoking treatments. Some mental health providers and facilities have made progress in this area, while others are now beginning to address tobacco use. The 2006 Surgeon General’s Report found that smoke-free policies reduce exposure to secondhand smoke and help smokers quit. Mental health facilities can benefit by making their campuses 100% smoke-free and by making stopping tobacco use part of an overall approach to treatment and wellness. It is critical that people with mental illness get the mental health services they need and are able to get help to quit smoking to improve their overall health and wellness.
Source: American Nonsmokers’ Rights Foundation
This table lists the percent of each state’s population covered by 100% smokefree air laws enacted by both the state (see state rows) and local municipalities (see local rows). Only ordinances and laws currently in effect are listed in the table.
Source: New England Journal of Medicine
The disease risks from cigarette smoking increased over most of the 20th century in the United States as successive generations of first male and then female smokers began smoking at progressively earlier ages. American men began smoking manufactured cigarettes early in the 20th century; by the 1930s, the average age at initiation fell below 18 years.1,2 Relatively few women smoked regularly before World War II; their average age at initiation continued to decrease through the 1960s. Women were not included in the earliest prospective epidemiologic studies in the 1950s,3-5 since mortality from lung cancer among women was not yet increasing in the general population.6 The landmark 1964 U.S. Surgeon General’s Report concluded only that “cigarette smoking is causally related to lung cancer in men.”7 Neither sex had yet experienced the full effects of smoking from adolescence throughout adulthood.
The first large, prospective study of smoking and mortality involving both women and men was Cancer Prevention Study I (CPS I), initiated by the American Cancer Society (ACS) in 1959.8,9 The relative risk of death from lung cancer during the first 6 years of follow-up among current smokers, as compared with persons who had never smoked, was 2.69 (95% confidence interval [CI], 2.14 to 3.37) for women and 11.35 (95% CI, 9.10 to 14.15) for men.10 In 1982, the ACS initiated the second Cancer Prevention Study (CPS II), which included nearly 1.2 million men and women nationwide.11 During the intervening 20 to 25 years, the relative risk of death from lung cancer had increased to 11.94 (95% CI, 9.99 to 14.26) for female smokers and to 22.36 (95% CI, 17.77 to 28.13) for male smokers.10,12
Several factors may have altered the health risks incurred by smokers. Smoking patterns have changed. Women who began smoking in the 1950s or thereafter have smoked more like men than they did in previous generations (i.e., starting at an earlier age and smoking more heavily).1 Daily cigarette consumption peaked during the 1970s among male smokers and during the 1980s among female smokers13; smoking prevalence in the two groups has since decreased in parallel. Contemporary smokers have spent much of their lives smoking filtered cigarettes made of blended tobacco.2,14 Women have more difficulty quitting than men; thus, for both current and former female smokers, the number of years of smoking has increased. Male and female smokers today are less educated and less affluent than smokers were 20 to 40 years ago.15 Since the 1950s, there has been a more rapid proportional decrease in the background risk of death from cardiovascular conditions among persons who have never smoked than among smokers.16,17
We calculated death rates and the relative risks associated with active cigarette smoking and smoking cessation during three time periods — 1959–1965, 1982–1988, and 2000–2010 — using data from the two historical ACS cohorts (CPS I and CPS II) and pooled data from five contemporary cohort studies in the United States.18-23 A central question is whether the hazards for women are now approaching those for men as their lifetime smoking behaviors have become increasingly similar.
Source: Preventing Chronic Disease
The objective of this study was to examine and compare 3 key health behaviors associated with chronic disease (ie, risky drinking, smoking, and sedentary lifestyle). We used data from the National Health Interview Survey from 1997 through 2010 to calculate the prevalence of these behaviors among older Americans and rank each state, and we analyzed overall trends in prevalence for each behavior over the 14 years. Older adults residing in Arkansas and Montana had the worst chronic disease risk profile compared with other states. These findings indicate the need for improved or increased targeted interventions in these states.
Risky drinking, smoking, and sedentary lifestyle are key health behaviors associated with chronic disease and increased illness and death in older adults (1). Excessive drinking is associated with cancers of the liver, head and neck, colorectum, pancreas, and breast, as well as cardiovascular disease and diabetes (2). Smoking is associated with cancer and poor cardiovascular outcomes (1). Cardiovascular disease and cancer risk are increased by sedentary behavior (1). The objective of this study was to examine the prevalence and trends of these 3 health behaviors among older Americans and rank them at the state level to determine the best allocation of public health resources.
Data were obtained from the National Health Interview Survey (NHIS), an annual, cross-sectional, multistage probability household survey of the noninstitutionalized civilian US population, from 1997 through 2010. Eligibility criteria were adults aged 65 or older (N = 79,973; representing 34,632,575 people). NHIS questions regarding the 3 variables are available online (3). Smoker was defined as “current smoker” (4). Risky drinking was defined as current drinkers having 10 or more drinks per week in men and 7 or more drinks per week in women, or having 5 or more drinks on 1 occasion, 1 or more times per year for men and women (4). Physical activity level was defined as compliance with the Healthy People 2010 goal of moderate physical activity for at least 30 minutes per day on 5 or more days per week or vigorous physical activity for at least 20 minutes per day on 3 or more days per week (5).
NHIS data were pooled and analyses were conducted using SAS version 9.2 (SAS Institute Inc, Cary, North Carolina), adjusting for sample weights and design effects (3). We calculated prevalence, standard errors (SEs), and 95% confidence intervals (CIs) and ranked states according to the prevalence of each risk factor indicator. We analyzed trends by using weighted linear regression of prevalence on year. Weight was generated with the inverse of the variance of prevalence. Some states were missing values because they did not meet the criteria for stable estimate analysis in all study years (6).
Because state-level data are not released to the public, all analyses were performed remotely at the National Center for Health Statistics Research Data Center. The study was approved by the University of Miami’s institutional review board.
The prevalence of smoking among US adults aged 65 years or older was 9.6% (Table 1). States with the highest smoking prevalence were Nevada (17.9%) and Kentucky (15.0%). States with the lowest rates of smoking were Utah (5.4%) and South Dakota (6.2%). Overall, 22% of older Americans reported risky drinking patterns; Arizona and New Hampshire had the highest prevalence, both at 29.0%, and the lowest prevalences were found in Kansas (14.4%) and Oklahoma (16.4%) (Table 2). Twenty-two percent of older Americans reported meeting physical activity recommendations; the highest prevalence was reported in Colorado (30.8%), Hawaii (34.8%), and Maine (40.1%), and the lowest prevalence was reported in Louisiana (13.4%), Mississippi (13.4%), and South Dakota (14.6%) (Table 3). Older Americans residing in Arkansas and Montana were in the top 10 worst rankings for all 3 behaviors.
A downward trend in smoking was observed during the 14 years for California (slope, −0.32; SE, 0.09; P = .004) and South Carolina (slope, −0.54; SE, 0.21; P = .046), and an increased trend for risky drinking was observed in Massachusetts (slope, 1.07; SE, 0.39; P = .026). In North Carolina (slope, 0.82; SE, 0.25; P = .007) and Texas (slope, 0.57; SE, 0.16; P = .004), an upward trend in exercise compliance was observed. Trend analysis was not conducted for 7 states and the District of Columbia due to insufficient sample sizes.
The average age of Americans is expected to increase substantially in the coming years (7). Modifying key health behaviors and creating cost-effective interventions may contribute to decreasing illness and death in this growing population demographic (8).
Lifestyle changes that occur with aging can affect chronic disease risk. Older adults who exercise regularly have a reduced mortality risk (9), but those who drink alcohol excessively are more prone to oxidative stress, which further increases the incidence of chronic disease (10). A twofold higher mortality rate was shown for older male smokers than nonsmokers (11). Risky drinking with aging has been positively associated with vigorous physical activity and negatively associated with current smoking, possibly reflecting better health among adults who engage in risky drinking as they age (12). Nevertheless, excessive alcohol consumption is associated with risk of falls (1) and adverse medication interactions in older Americans (10).
Limitations of this study included an inability to use estimates from all states due to small sample sizes or unstable estimates in some states (ie, a relative SE of ≥30%). We were unable to conduct complete trend analyses for all states given sample size limitations. The strength of this study was the access to a large set of sample data at the state level for prevalence comparisons in older Americans.
Public health resources should focus on specific interventions to affect behaviors in states with residents at high risk for developing chronic disease. These resources can include a purposeful combination of the following: 1) increasing tobacco excise taxes, proven to be the most effective means to decrease smoking (1), 2) using online and telephone substance abuse treatment facility locators and media campaigns to disseminate information on alcohol abuse (1), and 3) enhancing access to recreational and physical activity facilities in communities specific to older Americans, pursuant to the Healthy People 2010 guidelines (5). Emphasis on geographic aggregation of risk factors should be considered so that integrated and tailored prevention activities can be developed and customized to each state’s profile and funds be made appropriately available. States with the highest prevalence of 2 or 3 risky behaviors should review resource allocation to promote health more effectively.
Incorporation of cigarette butts into nests reduces nest ectoparasite load in urban birds: new ingredients for an old recipe?
Source: Biology Letters
Birds are known to respond to nest-dwelling parasites by altering behaviours. Some bird species, for example, bring fresh plants to the nest, which contain volatile compounds that repel parasites. There is evidence that some birds living in cities incorporate cigarette butts into their nests, but the effect (if any) of this behaviour remains unclear. Butts from smoked cigarettes retain substantial amounts of nicotine and other compounds that may also act as arthropod repellents. We provide the first evidence that smoked cigarette butts may function as a parasite repellent in urban bird nests. The amount of cellulose acetate from butts in nests of two widely distributed urban birds was negatively associated with the number of nest-dwelling parasites. Moreover, when parasites were attracted to heat traps containing smoked or non-smoked cigarette butts, fewer parasites reached the former, presumably due to the presence of nicotine. Because urbanization changes the abundance and type of resources upon which birds depend, including nesting materials and plants involved in self-medication, our results are consistent with the view that urbanization imposes new challenges on birds that are dealt with using adaptations evolved elsewhere.
Source: Brookings Institution
The high prevalence of tobacco use in China is not only the country’s single most serious public health problem, but also constitutes the ultimate test case for the global tobacco control campaign. While China’s remarkable economic growth over the past three decades has been one of the most amazing miracles of our time, the country has also gained a reputation as “the smoking dragon” due to its rapidly growing tobacco industry and ongoing smoking-related health crisis. The anti-smoking campaign in China, despite daunting challenges and deep-rooted institutional barriers, has the potential—and the unprecedented opportunity—to change the course of the tobacco epidemic within China and in the world. The drafting of a political map of China’s tobacco industry and its main stakeholders is essential for the next phase of the campaign.
Current Tobacco Use and Secondhand Smoke Exposure Among Women of Reproductive Age — 14 Countries, 2008–2010
Source: Morbidity and Mortality Weekly Report (CDC)
Tobacco use and secondhand smoke (SHS) exposure in reproductive-aged women can cause adverse reproductive health outcomes, such as pregnancy complications, fetal growth restriction, preterm delivery, stillbirths, and infant death (1–3). Data on tobacco use and SHS exposure among reproductive-aged women in low- and middle-income countries are scarce. To examine current tobacco use and SHS exposure in women aged 15–49 years, data were analyzed from the 2008–2010 Global Adult Tobacco Survey (GATS) from 14 low- and middle-income countries: Bangladesh, Brazil, China, Egypt, India, Mexico, Philippines, Poland, Russia, Thailand, Turkey, Ukraine, Uruguay, and Vietnam. The results of this analysis indicated that, among reproductive-aged women, current tobacco smoking ranged from 0.4% in Egypt to 30.8% in Russia, current smokeless tobacco use was <1% in most countries, but common in Bangladesh (20.1%) and India (14.9%), and SHS exposure at home was common in all countries, ranging from 17.8% in Mexico to 72.3% in Vietnam. High tobacco smoking prevalence in some countries suggests that strategies promoting cessation should be a priority, whereas low prevalence in other countries suggests that strategies should focus on preventing smoking initiation. Promoting cessation and preventing initiation among both men and women would help to reduce the exposure of reproductive-aged women to SHS.
Source: Federal Trade Commission
The amount spent on cigarette advertising and promotion by the largest cigarette companies in the United States declined from $9.94 billion in 2008 to $8.53 billion in 2009, and again to $8.05 billion in 2010, according to a report released today by the Federal Trade Commission.
The Commission has issued the Cigarette Report periodically since 1967, and another one, the Smokeless Tobacco Report, periodically since 1987.
The largest spending category in the Cigarette Report in both 2009 and 2010 was spending on price discounts paid to cigarette retailers or wholesalers in order to reduce the price of cigarettes to consumers. This category accounted for $6.67 billion, or 78.2 percent of total spending on advertising and promotion in 2009, and $6.49 billion, or 80.7 percent of that total, in 2010.
The number of cigarettes sold or given away to wholesalers and retailers in the United States declined from 322.6 billion in 2008 to 290.3 billion in 2009, and to 282.0 billion in 2010.
According to the Smokeless Tobacco Report for the major manufacturers of smokeless tobacco products in the United States:
- Their spending on advertising and promotion fell from $547.87 million in 2008 to $492.10 million in 2009, and again to $444.20 million in 2010.
- The dollar value of sales by these manufacturers fell from $2.76 billion in 2008 to $2.61 billion in 2009, then rose to $2.78 billion in 2010.
- The weight of smokeless tobacco sold fell from 119.90 million pounds in 2008 to 117.70 million pounds in 2009, and rose to 120.50 million pounds in 2010.
Tobacco Sales to Youth (PDF)
Tobacco use is the leading cause of death and disease in the United States, with 443,000 deaths annually attributed to smoking or exposure to secondhand smoke (CDC, 2008). Nearly all tobacco use begins during youth and young adulthood. In fact, among adults who have ever smoked daily, 88 percent report that they first smoked by the age of 18, with 99 percent reporting that they first smoked by the age of 26. Furthermore, more than one-third (36.7 percent) of adults who have ever smoked report trying their first cigarette by the age of 14 (USDHHS, 2012). These data suggest that if youth are prevented from smoking while they are young, they will be unlikely to begin smoking as adults.Tobacco use is also highly associated with the use of alcohol and illicit drugs. Specifically, over half (52.9 percent) of youths aged 12 to 17 who smoked cigarettes in the past month also used an illicit drug compared with 6.2 percent of youths who did not smoke cigarettes. Similarly, close to half (43.7 percent) of current cigarette users age 12 and over also report binge drinking in the past month, compared to 16.9 percent of current nonsmokers (SAMHSA, 2011).
Current Tobacco Use Among Middle and High School Students — United States, 2011
Source: Morbidity and Mortality Weekly Report (CDC)
Tobacco use continues to be the leading preventable cause of death and disease in the United States, with nearly 443,000 deaths occurring annually because of cigarette smoking and exposure to secondhand smoke (1). Moreover, nearly 90% of adult smokers begin smoking by age 18 years (2). To assess current tobacco use among youths, CDC analyzed data from the 2011 National Youth Tobacco Survey (NYTS). This report describes the results of that analysis, which indicated that, in 2011, the prevalence of current tobacco use among middle school and high school students was 7.1% and 23.2%, respectively, and the prevalence of current cigarette use was 4.3%, and 15.8%, respectively. During 2000–2011, among middle school students, a linear downward trend was observed in the prevalence of current tobacco use (14.9% to 7.1%), current combustible tobacco use (14.0% to 6.3%), and current cigarette use (10.7% to 4.3%). For high school students, a linear downward trend also was observed in these measures (current tobacco use [34.4% to 23.2%], current combustible tobacco use [33.1% to 21.0%], and current cigarette use [27.9% to 15.8%]). Interventions that are proven to prevent and reduce tobacco use among youths include media campaigns, limiting advertisements and other promotions, increasing the price of tobacco products, and reducing the availability of tobacco products for purchase by youths. These interventions should continue to be implemented as part of national comprehensive tobacco control programs and should be coordinated with Food and Drug Administration (FDA) regulations restricting the sale, distribution, and marketing of cigarettes and smokeless tobacco products to youths (2–4).
Consumption of Cigarettes and Combustible Tobacco — United States, 2000–2011
Source: Morbidity and Mortality Weekly Report (CDC)
Smoking cigarettes and other combustible tobacco products causes adverse health outcomes, particularly cancer and cardiovascular and pulmonary diseases (1). A priority of the U.S. Department of Health and Human Services is to develop innovative, rapid-response surveillance systems for assessing changes in tobacco use and related health outcomes (2). The two standard approaches for measuring smoking rates and behaviors are 1) surveying a representative sample of the public and asking questions about personal smoking behaviors and 2) estimating consumption based on tobacco excise tax data (3). Whereas CDC regularly publishes findings on national and state-specific smoking rates from public surveys (4), CDC has not reported consumption estimates. The U.S. Department of Agriculture (USDA), which previously provided such estimates, stopped reporting on consumption in 2007 (5). To estimate consumption for the period 2000–2011, CDC examined excise tax data from the U.S. Department of Treasury’s Alcohol and Tobacco Tax and Trade Bureau (TTB); consumption estimates were calculated for cigarettes, roll-your-own tobacco, pipe tobacco, and small and large cigars. From 2000 to 2011, total consumption of all combustible tobacco decreased from 450.7 billion cigarette equivalents to 326.6, a 27.5% decrease; per capita consumption of all combustible tobacco products declined from 2,148 to 1,374, a 36.0% decrease. However, while consumption of cigarettes decreased 32.8% from 2000 to 2011, consumption of loose tobacco and cigars increased 123.1% over the same period. As a result, the percentage of total combustible tobacco consumption composed of loose tobacco and cigars increased from 3.4% in 2000 to 10.4% in 2011. The data suggest that certain smokers have switched from cigarettes to other combustible tobacco products, most notably since a 2009 increase in the federal tobacco excise tax that created tax disparities between product types.
A Sensitive Approach to Studying ASDs: Teasing Out Relationships between Autism and Maternal Smoking
A Sensitive Approach to Studying ASDs: Teasing Out Relationships between Autism and Maternal Smoking
Source: Environmental Health Perspectives
Both genetic and environmental factors have been implicated in autism spectrum disorders (ASDs), which affect an estimated 1 in 88 children. One such environmental factor, prenatal exposure to tobacco smoke via maternal smoking, has been associated with ASDs in some studies but not others. A new study reports evidence of a positive association between maternal smoking during pregnancy and higher-functioning ASD subtypes [EHP 120(7):1042–1048; Kalkbrenner et al.].
The authors collected information on maternal smoking and other factors from the birth certificates for 633,989 children born in 1992, 1994, 1996, and 1998 in 11 U.S. states. They linked these data with surveillance data from the U.S. Centers for Disease Control and Prevention’s Autism and Developmental Disabilities Monitoring network and identified 3,315 of the children who were subsequently diagnosed with an ASD by age 8 years.
About 13% of all the mothers smoked during pregnancy, compared with about 11% of mothers with children diagnosed with an ASD. Maternal smoking has been associated with both lower education and reduced access to health care, factors that might increase the likelihood that ASDs go undiagnosed among children of women who smoked during pregnancy. When the authors corrected for this potential bias using outcome misclassification sensitivity analyses, a weak positive association emerged between maternal smoking and cases classified as “ASD not otherwise specified,” which were assumed to be higher-functioning ASDs such as Asperger’s disorder. The association was not found for lower-functioning (that is, more severe) ASDs.
The authors write that their findings concerning ASD subgroups should be interpreted with caution because the accuracy of subgroup classification may have varied depending upon mothers’ access to evaluation services, and because it was not bas ed on direct clinical observation. They also note that positive associations may reflect the presence in higher-functioning subgroups of children with co-occurring disorders (such as attention deficit/hyperactivity disorder) that can be affected by nicotine exposure.
Strengths of the study include the large sample size, the population-based design with standardized identification of ASD cases, and the use of sensitivity analyses to evaluate potential sources of bias. The authors conclude that the observed association between maternal smoking during pregnancy and higher-functioning ASDs warrants further research.
Youth Risk Behavior Surveillance — United States, 2011
Source: Morbidity and Mortality Weekly Report (CDC)
Problem: Priority health-risk behaviors, which are behaviors that contribute to the leading causes of morbidity and mortality among youth and adults, often are established during childhood and adolescence, extend into adulthood, and are interrelated and preventable.
Reporting Period Covered: September 2010–December 2011.
Description of the System: The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health-risk behaviors among youth and young adults: 1) behaviors that contribute to unintentional injuries and violence; 2) tobacco use; 3) alcohol and other drug use; 4) sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infection; 5) unhealthy dietary behaviors; and 6) physical inactivity. In addition, YRBSS monitors the prevalence of obesity and asthma. YRBSS includes a national school-based Youth Risk Behavior Survey (YRBS) conducted by CDC and state and large urban school district school-based YRBSs conducted by state and local education and health agencies. This report summarizes results from the 2011 national survey, 43 state surveys, and 21 large urban school district surveys conducted among students in grades 9–12.
Results: Results from the 2011 national YRBS indicated that many high school students are engaged in priority health-risk behaviors associated with the leading causes of death among persons aged 10–24 years in the United States. During the 30 days before the survey, 32.8% of high school students nationwide had texted or e-mailed while driving, 38.7% had drunk alcohol, and 23.1% had used marijuana. During the 12 months before the survey, 32.8% of students had been in a physical fight, 20.1% had ever been bullied on school property, and 7.8% had attempted suicide. Many high school students nationwide are engaged in sexual risk behaviors associated with unintended pregnancies and STDs, including HIV infection. Nearly half (47.4%) of students had ever had sexual intercourse, 33.7% had had sexual intercourse during the 3 months before the survey (i.e., currently sexually active), and 15.3% had had sexual intercourse with four or more people during their life. Among currently sexually active students, 60.2% had used a condom during their last sexual intercourse. Results from the 2011 national YRBS also indicate many high school students are engaged in behaviors associated with the leading causes of death among adults aged ≥25 years in the United States. During the 30 days before the survey, 18.1% of high school students had smoked cigarettes and 7.7% had used smokeless tobacco. During the 7 days before the survey, 4.8% of high school students had not eaten fruit or drunk 100% fruit juices and 5.7% had not eaten vegetables. Nearly one-third (31.1%) had played video or computer games for 3 or more hours on an average school day.
Interpretation: Since 1991, the prevalence of many priority health-risk behaviors among high school students nationwide has decreased. However, many high school students continue to engage in behaviors that place them at risk for the leading causes of morbidity and mortality. Variations were observed in many health-risk behaviors by sex, race/ethnicity, and grade. The prevalence of some health-risk behaviors varied substantially among states and large urban school districts.
Public Health Action: YRBS data are used to measure progress toward achieving 20 national health objectives for Healthy People 2020 and one of the 26 leading health indicators; to assess trends in priority health-risk behaviors among high school students; and to evaluate the impact of broad school and community interventions at the national, state, and local levels. More effective school health programs and other policy and programmatic interventions are needed to reduce risk and improve health outcomes among youth.