Youth Risk Behavior Surveillance — United States, 2015

Introduction

In the United States in 2014, 71% of all deaths among persons aged 10–24 years resulted from four causes: motor vehicle crashes (23%), other unintentional injuries (17%), homicide (14%), and suicide (17%) (1). Among persons aged 15–19 years, 273,105 births (2); 451,208 cases of chlamydia, gonorrhea, and syphilis (3); and 1,828 diagnoses of human immunodeficiency virus (HIV) (4) are reported annually. Among persons aged =25 years, 54% of all deaths in the United States result from cardiovascular disease (31%) and cancer (23%) (1). These leading causes of mortality, morbidity, and social problems among youth and adults in the United States are related to six categories of priority health behaviors: 1) behaviors that contribute to unintentional injuries and violence; 2) tobacco use; 3) alcohol and other drug use; 4) sexual behaviors that related to unintended pregnancy and sexually transmitted infections (STIs), including HIV infection; 5) unhealthy dietary behaviors; and 6) physical inactivity. These behaviors frequently are interrelated and are established during childhood and adolescence and extend into adulthood. To monitor priority health behaviors in each of these six categories, the prevalence of obesity, overweight, and asthma, and other priority health behaviors among youth and young adults, CDC developed the Youth Risk Behavior Surveillance System (YRBSS) (5). YRBSS includes school-based national, state, and large urban school district Youth Risk Behavior Surveys (YRBS) conducted among representative samples of students in grades 9–12. National, state, and large urban school distr ict surveys have been conducted biennially since 1991 ( Table 1). Additional information about YRBSS is available at http://www.cdc.gov/healthyyouth/data/yrbs/index.htm.

This report summarizes results for 118 health behaviors plus obesity, overweight, and asthma from the 2015 national YRBS and overall trends in health behaviors during 1991–2015. Results from the 37 state and 19 large urban school district surveys with weighted data for the 2015 YRBSS cycle ( Figure) also are included in this report. Data from 10 state and two large urban school district surveys with unweighted data are not included. Among those with weighted data for 2015, three state and one large urban school district surveys were conducted during fall 2014; the national survey, 29 state, and 16 large urban school district surveys were conducted during spring 2015; and five state and two large urban school district surveys were conducted during fall 2015.

Methods

Detailed information about the methodology of the national, state, and large urban school district YRBSs has been described elsewhere (5).

Sampling

National Youth Risk Behavior Survey

The sampling frame for the 2015 national YRBS consisted of all regular public* and private^† schools with students in at least one of grades 9–12 in the 50 states and the District of Columbia. The sampling frame was based on the Market Data Retrieval (MDR) database (6), which includes information on both public and private schools and the most recent data from the Common Core of Data from the National Center for Education Statistics (7). A three-stage cluster sample design produced a nationally representative sample of students in grades 9–12 who attend public and private schools. The first-stage sampling frame consisted of 1,259 primary sampling units (PSUs), consisting of counties, subareas of large counties, or groups of smaller, adjacent counties. The 1,259 PSUs were categorized into 16 strata according to their metropolitan statistical area (MSA) status (e.g., urban city) and the percentages of black and Hispanic students in the PSUs. From the 1,259 PSUs, 54 were sampled with probability proportional to overall school enrollment size for the PSU.

In the second stage of sampling, 180 schools with any of grades 9–12 were sampled with probability proportional to school enrollment size from within the 54 PSUs. The third stage of sampling consisted of random sampling in each of grades 9–12, one or two classrooms from either a required subject (e.g., English or social studies) or a required period (e.g., homeroom or second period). All students in sampled classes were eligible to participate. Schools, classes, and students that refused to participate were not replaced.

To enable a separate analysis of data for black and Hispanic students, two classes per grade, rather than one, were sampled in schools with a high minority enrollment. Before the 2013 national YRBS, three strategies were used to oversample black and Hispanic students: 1) larger sampling rates were used to select PSUs that were in high-black and high-Hispanic strata; 2) a modified measure of size was used to increase the probability of sampling schools with a disproportionately high minority enrollment; and 3) two classes per grade, rather than one, were sampled in schools with a high minority enrollment. Because of increases in the proportions of black and Hispanic students in the population, only selection of two classes per grade was needed in 2013 and 2015 to balance the precision needed for subgroup estimates with minimum variance for overall estimates.

State and Large Urban School District Youth Risk Behaviors

In 2015, a two-stage cluster sample design was used to produce a representative sample of public^§ school students in grades 9–12 in 36 states and 19 large urban school districts and of public and private^¶ school students in grades 9–12 in one state (South Dakota). In the first sampling stage, schools with any of grades 9–12 were sampled with probability proportional to school enrollment size in 34 states and three large urban school districts; all schools with any of grades 9–12 were invited to participate in three states and 16 large urban school districts. In the second sampling stage, intact classes from either a required subject (e.g., English or social studies) or a required period (e.g., homeroom or second period) were sampled randomly in 36 states and 18 large urban school districts, and all students in the sampled classes were el igible to participate. In one state and one large urban school district, all students in sampled schools were eligible to participate.

Data Collection Procedures and Questionnaires

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

The 2015 YRBS standard questionnaire contained 89 questions. This questionnaire was used as the starting point for the state and large urban school district questionnaires. States and large urban school districts could add and/or delete questions from the standard questionnaire. Only one state and three large urban school districts included in this report used the 2015 YRBS standard questionnaire without modifications. This report presents state and large urban school district results only from selected questions on the 2015 standard questionnaire.

The 2015 national YRBS questionnaire contained 99 questions, including all 89 questions on the standard questionnaire. This report presents national results (along with state and large urban school district results) for selected questions on the 2015 standard questionnaire plus national only results from eight additional questions measuring usual method of marijuana use, ever use of hallucinogenic drugs, consumption of sports drinks, consumption of water, muscle strengthening exercises, indoor tanning device use, having had a sunburn, and avoidance of foods because eating the food could cause an allergic reaction.

Except for six demographic questions (sex, grade in school, age, Hispanic ethnicity, race, and sexual identity) and three questions assessing height, weight, and asthma, all the remaining questions on the standard questionnaire and the national questionnaire measured behaviors practiced or experienced by the student (referred to as “behaviors”). Skip patterns, which occur when a particular response to one question indicates to the respondents that they should not answer one or more subsequent questions, were not included in any YRBS questionnaire to protect students’ privacy by ensuring all students took about the same amount of time to complete the questionnaire. All questions (except for two questions assessing height and weight and the race question) were multiple choice with a maximum of eight mutually exclusive response options and only one possible answer per respondent. Information about the reliability of the standard questionnaire has been pub lished elsewhere (8). The 2015 standard and national YRBS questionnaires are available at http://www.cdc.gov/healthyyouth/data/yrbs/index.htm.

Results from two new standard questions measuring sexual minority status (i.e., sexual identity and sex of sexual contacts) used by 25 states and 19 large urban school districts and included on the national questionnaire are not described in this report.

Data Processing Procedures and Response Rates

For the 2015 national YRBS, 15,713 questionnaires were completed in 125 public and private schools. The national data set was cleaned and edited for inconsistencies. Missing data were not statistically imputed. Among the 15,713 completed questionnaires, 89 failed quality control** and were excluded from analysis, resulting in 15,624 usable questionnaires ( Table 2). The school response rate was 69%, the student response rate was 86%, and the overall response rate was 60%^†† (Table 2).

Data from each state and large urban school district survey were cleaned and edited for inconsistencies with the same procedures used for the national data set. The percentage of completed questionnaires that failed quality control checks and were excluded from analysis ranged from 0.2% to 5.3% (median: 0.8%) across the 37 states and from 0.3% to 6.4% (median: 1.6%) across the 19 large urban school districts. The student sample sizes ranged from 1,313 to 55,596 (median: 2,777) across the states and from 1,052 to 10,419 (median: 2,181) across the large urban school districts (Table 2). Among the states, the school response rates ranged from 70% to 100%, student response rates ranged from 64% to 90%, and overall response rates ranged from 60% to 84%. Among the large urban school districts, the school response rates ranged from 90% to 100%, student response rates ranged from 66% to 88%, and overall response rates ranged from 64% to 88% ( Table 2).

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

Students were classified as having obesity or being overweight based on their body mass index (kg/m²) (BMI), which was calculated from self-reported height and weight. BMI values were compared with sex- and age-specific reference data from the 2000 CDC growth charts (9). Obesity was defined as a BMI of =95th percentile for age and sex. Overweight was defined as a BMI of =85th percentile and <95th percentile for age and sex. These classifications are not intended to diagnose obesity or overweight in individual students, but to provide population-level estimates of obesity and overweight.

Weighting

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

Data from states and large urban school districts that had a representative sample of students, appropriate documentation, and an overall response rate of =60% were weighted. A weight was applied to each record to adjust for school and student nonresponse and the distribution of students by grade, sex, and race/ethnicity in each jurisdiction, such that the weighted count of students equals the student population in each jurisdiction. Data from 37 states and 19 large urban school districts were weighted. In 36 states and all large urban school districts, weighted estimates are representative of all students in grades 9–12 attending public schools in each jurisdiction. In one state (South Dakota), weighted estimates are representative of all students in grades 9–12 attending public and private schools.

Analytic Methods

Statistical analyses were conducted on weighted data using SAS (10) and SUDAAN (11) software to account for the complex sampling designs. Prevalence estimates and confidence intervals were computed for all variables and all data sets. In addition, for the national YRBS data, t tests were used to determine pairwise differences between subpopulations (12). Differences between prevalence estimates were considered statistically significant if the t test p value was <0.05 for main effects (sex, race/ethnicity, and grade) and for interactions (sex by race/ethnicity, sex by grade, race/ethnicity by sex, and grade by sex). In the results section, only statistically significant differences in national YRBS prevalence estimates are reported in the following order: sex, sex by race/ethnicity, sex by grade, race/et hnicity, race/ethnicity by sex, grade, and grade by sex.

To identify long-term temporal trends in health behaviors nationwide, prevalence estimates from the earliest year of data collection to 2015 for each variable assessed with identically worded questions in three or more survey years were examined. Logistic regression analyses were used to account for all available estimates; control for sex, grade, and racial/ ethnic changes over time; and assess long-term linear and quadratic trends (12). A p value associated with the regression coefficient that was <0.05 was considered statistically significant. Linear and quadratic time variables were treated as continuous and were coded using orthogonal coefficients calculated with PROC IML in SAS. Separate regression models were used to assess linear and quadratic trends for every variable. When a significant quadratic trend was identified, Joinpoint software (13) was used to automate identification of the year or “joinpoint” where the nonlinear (i.e., quadratic) trend changed and then regression models were used to identify linear trends occurring in each segment. Cubic and higher order trends were not assessed. A quadratic trend indicates a significant but nonlinear trend in prevalence over time. A long-term temporal change that includes a significant linear and quadratic trend demonstrates nonlinear variation (e.g., leveling off or change in direction) in addition to an overall increase or decrease over time.

To identify 2-year temporal changes in health behaviors nationwide, prevalence estimates from 2013 and 2015 were compared using t tests for each variable assessed with identically worded questions in both survey years. Prevalence estimates were considered statistically different if the t test p value was <0.05.

In the results section, long-term linear and quadratic trends are described first followed by results from the t tests used to assess 2-year temporal changes. Information about long-term temporal trends and 2-year temporal changes are not available because of changes in question or response option wording or because the question was asked for the first time during 2015 for the following variables: usually obtained their own cigarettes by buying them on the Internet; ever use of electronic vapor products; current use of electronic vapor products; current use of cigarettes, cigars, smokeless tobacco, or electronic vapor products; usual method of marijuana use; ever use of synthetic marijuana; sports drink consumption; water consumption; had a sunburn; having seen a dentist; and avoidance of foods because eating the food could cause an allergic reaction.

Results

Behaviors that Contribute to Unintentional Injuries

Rarely or Never Wore a Bicycle Helmet

Among the 68.0% of students nationwide who had ridden a bicycle during the 12 months before the survey, 81.4% had rarely or never worn a bicycle helmet ( Table 3). The prevalence of having rarely or never worn a bicycle helmet was higher among 11th-grade male (85.4%) than 11th-grade female (78.5%) students. The prevalence of having rarely or never worn a bicycle helmet was higher among black (88.2%) and Hispanic (90.1%) than white (76.4%) students, higher among Hispanic female (90.3%) than white female (75.3%) students, and higher among black male (91.6%) and Hispanic male (90.0%) than white male (77.5%) students. The prevalence of having rarely or never worn a bicycle helmet was higher among 12th-grade (83.5%) than 9th-grade (79.4%) students, higher among 11th-grade male (85.4%) and 12th-grade male (84.9%) than 9th-grade male (80.2%) students, and higher among 11th-grade male (85.4%) than 10th-grade male (80.4%) students.

During 1991–2015, a significant linear decrease occurred overall in the prevalence of having rarely or never worn a bicycle helmet (96.2%–81.4%). A significant quadratic trend also was identified. The prevalence of having rarely or never worn a bicycle helmet decreased during 1991–2001 (96.2%–84.7%) and then did not change significantly during 2001–2015 (84.7%–81.4%). The prevalence of having never or rarely worn a bicycle helmet decreased significantly from 2013 (87.9%) to 2015 (81.4%).

Across 28 states, the prevalence of having rarely or never worn a bicycle helmet ranged from 53.0% to 94.1% (median: 84.6%) ( Table 4). Across 16 large urban school districts, the prevalence ranged from 55.1% to 95.6% (median: 87.3%).

Rarely or Never Wore a Seat Belt

Nationwide, 6.1% of students rarely or never wore a seat belt when riding in a car driven by someone else (Table 3). The prevalence of having rarely or never worn a seat belt was higher among male (7.2%) than female (4.9%) students; higher among white male (5.3%) and black male (12.4%) than white female (3.5%) and black female (7.6%) students, respectively; and higher among 10th-grade male (7.6%) and 11th-grade male (7.1%) than 10th-grade female (4.5%) and 11th-grade female (4.1%) students, respectively. The prevalence of having rarely or never worn a seat belt was higher among black (10.1%) and Hispanic (6.5%) than white (4.4%) students, higher among black (10.1%) than Hispanic (6.5%) students, higher among black female (7.6%) and Hispanic female (6.3%) than white female (3.5%) students, and higher among black male (12.4%) than white male (5.3%) and Hispanic male (6.8%) students.

During 1991–2015, a significant linear decrease occurred overall in the prevalence of having rarely or never worn a seat belt (25.9%–6.1%). A significant quadratic trend was not identified. The prevalence of having rarely or never worn a seat belt did not change significantly from 2013 (7.6%) to 2015 (6.1%).

Across 32 states, the prevalence of having rarely or never wore a seat belt ranged from 3.6% to 14.6% (median: 8.1%) (Table 4). Across 17 large urban school districts, the prevalence ranged from 4.5% to 21.7% (median: 8.2%).

Rode with a Driver Who Had Been Drinking Alcohol

During the 30 days before the survey, 20.0% of students nationwide had ridden in a car or other vehicle one or more times with a driver who had been drinking alcohol ( Table 5). The prevalence of having ridden with a driver who had been drinking alcohol was higher among Hispanic (26.2%) than white (17.7%) and black (21.1%) students, higher among Hispanic female (27.3%) than white female (17.5%) students, and higher among Hispanic male (25.3%) than white male (17.7%) and black male (20.6%) students.

During 1991–2015, a significant linear decrease occurred overall in the prevalence of having ridden with a driver who had been drinking alcohol (39.9%–20.0%). A significant quadratic trend also was identified. The prevalence of having ridden with a driver who had been drinking alcohol decreased during 2009–2011 (39.9%–28.3%) and then decreased more gradually from 2009–2015 (28.3%–20.0%). The prevalence of having ridden with a driver who had been drinking alcohol did not change significantly from 2013 (21.9%) to 2015 (20.0%).

Across 33 states, the prevalence of having ridden with a driver who had been drinking alcohol ranged from 14.2% to 25.5% (median: 18.3%) ( Table 6). Across 18 large urban school districts, the prevalence ranged from 13.4% to 31.6% (median: 22.0%).

Drove When Drinking Alcohol

Among the 61.4% of students nationwide who drove a car or other vehicle during the 30 days before the survey,^§§ 7.8% had driven a car or other vehicle one or more times when they had been drinking alcohol during the 30 days before the survey (Table 5). The prevalence of having driven a car or other vehicle when they had been drinking alcohol was higher among male (9.5%) than female (6.0%) students, higher among white male (9.4%) than white female (5.4%) students, and higher among 10th-grade male (8.2%) than 10th-grade female (2.2%) students. The prevalence of having driven a car or other vehicle when they had been drinking alcohol was higher among 12th-grade (9.9%) than 9th-grade (5.6%) students; higher among 11th-grade (8.7%) and 12th-grade (9.9%) than 10th-grade (5.3%) students; higher among 9th-grade female (5.5%), 11th-grade female (6.8%), and 12th-grade female (8.0%) t han 10th-grade female (2.2%) students; and higher among 12th-grade male (11.7%) than 9th-grade male (5.7%) students.

Because of changes in response options starting in 2013, long-term temporal trends are not available for the prevalence of having driven a car or other vehicle when they had been drinking. The prevalence of having driven a car or other vehicle when they had been drinking alcohol decreased significantly from 2013 (10.0%) to 2015 (7.8%).

Across 35 states, the prevalence of having driven a car or other vehicle when they had been drinking alcohol among students who drove a car or other vehicle during the 30 days before the survey ranged from 4.3% to 10.9% (median: 7.1%) (Table 6). Across 18 large urban school districts, the prevalence ranged from 4.4% to 9.7% (median: 7.0%).

Texted or E-Mailed While Driving

Among the 61.3% of students nationwide who drove a car or other vehicle during the 30 days before the survey,^§§ 41.5% had texted or e-mailed while driving a car or other vehicle on at least 1 day during the 30 days before the survey ( Table 7). The prevalence of having texted or e-mailed while driving was higher among Hispanic male (42.2%) than Hispanic female (28.2%) students. The prevalence of having texted or e-mailed while driving was higher among white (45.2%) than black (32.8%) and Hispanic (35.8%) students, higher among white female (45.3%) than black female (33.1%) and Hispanic female (28.2%) students, and higher among white male (45.0%) and Hispanic male (42.2%) than black male (33.0%) students. The prevalence of having texted or e-mailed while driving was higher among 10th-grade (25.0%), 11th-grade (47.9%), and 12th-grade (61.4%) than 9th-grade (15.9%) students; hi gher among 11th-grade (47.9%) and 12th-grade (61.4%) than 10th-grade (25.0%) students; higher among 12th-grade (61.4%) than 11th-grade (47.9%) students; higher among 10th-grade female (24.7%), 11th-grade female (45.1%), and 12th-grade female (60.8%) than 9th-grade female (14.4%) students; higher among 11th-grade female (45.1%) and 12th-grade female (60.8%) than 10th-grade female (24.7%) students; higher among 12th-grade female (60.8%) than 11th-grade female (45.1%) students; higher among 10th-grade male (25.2%), 11th-grade male (50.1%), and 12th-grade male (61.9%) than 9th-grade male (17.4%) students; higher among 11th-grade male (50.1%) and 12th-grade male (61.9%) than 10th-grade male (25.2%) students; and higher among 12th-grade male (61.9%) than 11th-grade male (50.1%) students.

Because of changes in response options starting in 2013, long-term temporal trends are not available for the prevalence of having texted or e-mailed while driving. The prevalence of having texted or e-mailed while driving did not change significantly from 2013 (41.4%) to 2015 (41.5%).

Across 35 states, the prevalence of having texted or e-mailed while driving ranged from 26.1% to 63.2% (median: 39.3%) ( Table 8). Across 18 large urban school districts, the prevalence ranged from 14.1% to 38.7% (median: 32.1%).

Behaviors that Contribute to Violence

Carried a Weapon

Nationwide, 16.2% of students had carried a weapon (e.g., gun, knife, or club) on at least 1 day during the 30 days before the survey ( Table 9). The prevalence of having carried a weapon was higher among male (24.3%) than female (7.5%) students; higher among white male (28.0%), black male (17.6%), and Hispanic male (20.2%) than white female (8.1%), black female (6.2%), and Hispanic female (7.1%) students, respectively; and higher among 9th-grade male (24.6%), 10th-grade male (25.5%), 11th-grade male (23.0%), and 12th-grade male (23.4%) than 9th-grade female (6.6%), 10th-grade female (7.2%), 11th-grade female (8.0%), and 12th-grade female (8.0%) students, respectively. The prevalence of having carried a weapon was higher among white (18.1%) than black (12.4%) and Hispanic (13.7%) students and higher among white male (28.0%) than black male (17.6%) and Hispanic male (20.2%) students.

During 1991–2015, a significant linear decrease occurred overall in the prevalence of having carried a weapon (26.1%–16.2%). A significant quadratic trend also was identified. The prevalence of having carried a weapon decreased during 1991–1997 (26.1%–18.3%) and then did not change significantly during 1997–2015 (18.3%–16.2%). The prevalence of having carried a weapon also did not change significantly from 2013 (17.9%) to 2015 (16.2%).

Across 27 states, the prevalence of having carried a weapon ranged from 8.9% to 29.6% (median: 19.3%) ( Table 10). Across 19 large urban school districts, the prevalence ranged from 7.7% to 21.9% (median: 12.5%).

Carried a Gun

Nationwide, 5.3% of students had carried a gun on at least 1 day during the 30 days before the survey (Table 9). The prevalence of having carried a gun was higher among male (8.7%) than female (1.6%) students; higher among white male (9.6%), black male (9.6%), and Hispanic male (6.5%) than white female (1.4%), black female (1.7%), and Hispanic female (1.9%) students, respectively; and higher among 9th-grade male (7.0%), 10th-grade male (8.8%), 11th-grade male (9.0%), and 12th-grade male (9.7%) than 9th-grade female (1.2%), 10th-grade female (1.6%), 11th-grade female (1.4%), and 12th-grade female (1.7%) students, respectively. The prevalence of having carried a gun was higher among white male (9.6%) than Hispanic male (6.5%) students. The prevalence of having carried a gun was higher among 12th-grade (5.7%) than 9th-grade (4.4%) students and higher among 12th-grade male (9.0%) than 9th-grade male (7.0%) students.

During 1993–2015, a significant linear decrease occurred overall in the prevalence of having carried a gun (7.9%–5.3%). A significant quadratic trend also was identified. The prevalence of having carried a gun decreased during 1993–1997 (7.9%–5.9%) and then did not change significantly during 1997–2015 (5.9%–5.3%). The prevalence of having carried a gun also did not change significantly from 2013 (5.5%) to 2015 (5.3%).

Across 19 states, the prevalence of having carried a gun ranged from 2.7% to 11.5% (median: 6.8%) (Table 10). Across 15 large urban school districts, the prevalence ranged from 2.2% to 5.9% (median: 4.5%).

Carried a Weapon on School Property

Nationwide, 4.1% of students had carried a weapon (e.g., a gun, knife, or club) on school property on at least 1 day during the 30 days before the survey ( Table 11). The prevalence of having carried a weapon on school property was higher among male (5.9%) than female (2.0%) students; higher among white male (5.7%), black male (4.7%), and Hispanic male (6.1%) than white female (1.6%), black female (2.1%), and Hispanic female (2.9%) students, respectively; and higher among 9th-grade male (4.6%), 10th-grade male (6.1%), 11th-grade male (7.4%), and 12th-grade male (5.1%) than 9th-grade female (1.9%), 10th-grade female (2.2%), 11th-grade female (1.9%), and 12th-grade female (2.0%) students, respectively. The prevalence of having carried a weapon on school property was higher among 11th-grade (4.8%) than 9th-grade (3.4%) students and higher among 11th-grade male (7.4%) than 9th-grade male (4.6%) students.

During 1993–2015, a significant linear decrease occurred overall in the prevalence of having carried a weapon on school property (11.8%–4.1%). A significant quadratic trend also was identified. The prevalence of having carried a weapon on school property decreased during 1993–1997 (11.8%–8.5%) and then decreased more rapidly during 1997–2015 (8.5%–4.1%). The prevalence of having carried a weapon on school property also decreased significantly from 2013 (5.2%) to 2015 (4.1%).

Across 33 states, the prevalence of having carried a weapon on school property ranged from 2.0% to 10.7% (median: 5.2%) ( Table 12). Across 17 large urban school districts, the prevalence ranged from 2.4% to 9.8% (median: 3.3%).

Threatened or Injured with a Weapon on School Property

Nationwide, 6.0% of students had been threatened or injured with a weapon (e.g., a gun, knife, or club) on school property one or more times during the 12 months before the survey (Table 11). The prevalence of having been threatened or injured with a weapon on school property was higher among male (7.0%) than female (4.6%) students; higher among black male (8.9%) and Hispanic male (8.4%) than black female (6.5%) and Hispanic female (4.7%) students, respectively; and higher among 11th-grade male (7.3%) and 12th-grade male (5.7%) than 11th-grade female (2.9%) and 12th-grade female (3.2%) students, respectively. The prevalence of having been threatened or injured with a weapon on school property was higher among black (7.9%) and Hispanic (6.6%) than white (4.9%) students and higher among black male (8.9%) and Hispanic male (8.4%) than white male (5.4%) students. The prevalence of having been threatened or injured with a weapon on school property was higher among 9th-grade (7.2%) than 11th-grade (5.5%) students, higher among 9th-grade (7.2%) and 10th-grade (6.2%) than 12th-grade (4.4%) students, higher among 9th-grade female (6.2%) and 10th-grade female (5.5%) than 11th-grade female (2.9%) students, and higher among 9th-grade female (6.2%) and 10th-grade female (5.5%) than 12th-grade female (3.2%) students.

During 1993–2015, a significant linear decrease occurred overall in the prevalence of having been threatened or injured with a weapon on school property (7.3%–6.0%). A significant quadratic trend also was identified. The prevalence of having been threatened or injured with a weapon on school property did not change significantly from 1993–2003 (7.3%–9.2%) and then decreased during 2003–2015 (9.2%–6.0%). The prevalence of having been threatened or injured with a weapon on school property did not change significantly from 2013 (6.9%) to 2015 (6.0%).

Across 30 states, the prevalence of having been threatened or injured with a weapon ranged from 4.1% to 10.6% (median: 6.6%) (Table 12). Across 18 large urban school districts, the prevalence ranged from 4.3% to 13.9% (median: 6.8%).

In a Physical Fight

Nationwide, 22.6% of students had been in a physical fight one or more times during the 12 months before the survey ( Table 13). The prevalence of having been in a physical fight was higher among male (28.4%) than female (16.5%) students; higher among white male (26.6%), black male (38.6%), and Hispanic male (27.3%) than white female (13.5%), black female (25.4%), and Hispanic female (18.6%) students, respectively; and higher among 9th-grade male (32.5%), 10th-grade male (29.4%), 11th-grade male (27.1%), and 12th-grade male (22.9%) than 9th-grade female (22.6%), 10th-grade female (17.6%), 11th-grade female (12.8%), and 12th-grade female (12.0%) students, respectively. The prevalence of having been in a physical fight was higher among black (32.4%) than white (20.1%) and Hispanic (23.0%) students, higher among black female (25.4%) and Hispanic female (18.6%) than white female (13.5%) students, higher among black female (25.4%) than His panic female (18.6%) students, and higher among black male (38.6%) than white male (26.6%) and Hispanic male (27.3%) students. The prevalence of having been in a physical fight was higher among 9th-grade (27.9%) than 10th-grade (23.4%), 11th-grade (20.5%), and 12^th-grade (17.4%) students; higher among 10th-grade (23.4%) than 11th-grade (20.5%) and 12th-grade (17.4%) students; higher among 9th-grade female (22.6%) than 10th-grade female (17.6%), 11th-grade female (12.8%), and 12th-grade female (12.0%) students; higher among 10th-grade female (17.6%) than 11th-grade female (12.8%) and 12th-grade female (12.0%) students; and higher among 9th-grade male (32.5%) and 10th-grade male (29.4%) than 12th-grade male (22.9%) students.

During 1991–2015, a significant linear decrease occurred in the prevalence of having been in a physical fight (42.5%–22.6%). A significant quadratic trend also was identified. The prevalence of having been in a physical fight decreased during 1991–2011 (42.5%–32.8%) and then decreased more gradually during 2011–2015 (32.8%–22.6%). The prevalence of having been in a physical fight did not change significantly from 2013 (24.7%) to 2015 (22.6%).

Across 31 states, the prevalence of having been in a physical fight ranged from 14.9% to 27.3% (median: 20.6%) ( Table 14). Across 19 large urban school districts, the prevalence ranged from 13.9% to 42.5% (median: 22.8%).

Injured in a Physical Fight

During the 12 months before the survey, 2.9% of students nationwide had been in a physical fight one or more times in which they were injured and had to be treated by a doctor or nurse (Table 13). The prevalence of having been injured in a physical fight was higher among male (3.7%) than female (1.8%) students; higher among white male (2.8%) than white female (0.9%) students; and higher among 10th-grade male (3.3%), 11th-grade male (4.3%), and 12th-grade male (3.5%) than 10th-grade female (1.4%), 11th-grade female (1.5%), and 12th-grade female (1.4%) students, respectively. The prevalence of having been injured in a physical fight was higher among black (4.7%) and Hispanic (3.8%) than white (1.9%) students, higher among black female (3.4%) and Hispanic female (3.0%) than white female (0.9%) students, and higher among black male (5.8%) than white male (2.8%) students. The prevalence of having been injured in a physical fight was highe r among 9th-grade female (2.5%) than 12th-grade female (1.4%) students.

During 1991–2015, a significant linear decrease occurred overall in the prevalence of having been injured in a physical fight (4.4%–2.9%). A significant quadratic trend was not identified. The prevalence of having been injured in a physical fight did not change significantly from 2013 (3.1%) to 2015 (2.9%).

Across 29 states, the prevalence of having been injured in a physical fight ranged from 1.9% to 6.5% (median: 2.8%) (Table 14). Across 14 large urban school districts, the prevalence ranged from 2.2% to 9.4% (median: 3.5%).

In a Physical Fight on School Property

Nationwide, 7.8% of students had been in a physical fight on school property one or more times during the 12 months before the survey ( Table 15). The prevalence of having been in a physical fight on school property was higher among male (10.3%) than female (5.0%) students; higher among white male (8.0%), black male (15.4%), and Hispanic male (10.7%) than white female (3.2%), black female (9.4%), and Hispanic female (7.1%) students, respectively; and higher among 9th-grade male (14.7%), 10th-grade male (10.0%), 11th-grade male (8.3%), and 12th-grade male (6.4%) than 9th-grade female (8.2%), 10th-grade female (4.6%), 11th-grade female (4.1%), and 12th-grade female (2.5%) students, respectively. The prevalence of having been in a physical fight on school property was higher among black (12.6%) and Hispanic (8.9%) than white (5.6%) students, higher among black female (9.4%) and Hispanic female (7.1%) than white female (3.2%) students, an d higher among black male (15.4%) than white male (8.0%) students. The prevalence of having been in a physical fight on school property was higher among 9th-grade (11.6%) than 10th-grade (7.3%), 11th-grade (6.5%), and 12th-grade (4.5%) students; higher among 10th-grade (7.3%) and 11th-grade (6.5%) than 12th-grade (4.5%) students; higher among 9th-grade female (8.2%) than 10th-grade female (4.6%), 11th-grade female (4.1%), and 12th-grade female (2.5%) students; higher among 10th-grade female (4.6% that 12th-grade female (2.5%) students; higher among 9th-grade male (14.7%) than 10th-grade male (10.0%), 11th-grade male (8.3%), and 12th-grade male (6.4%) students; and higher among 10th-grade male (10.0%) than 12th-grade male (6.4%) students.

During 1993–2015, a significant linear decrease occurred overall in the prevalence of having been in a physical fight on school property (16.2%–7.8%). A significant quadratic trend also was identified. The prevalence of having been in a physical fight on school property decreased during 1993–2011 (16.2%–12.0%) and then decreased more gradually from 2011–2015 (12.0%–7.8%). The prevalence of having been in a physical fight on school property did not change significantly from 2013 (8.1%) to 2015 (7.8%).

Across 33 states, the prevalence of having been in a physical fight on school property ranged from 4.9% to 12.2% (median: 7.2%) ( Table 16). Across 16 large urban school districts, the prevalence ranged from 5.7% to 17.5% (median: 8.1%).

Did Not Go to School Because of Safety Concerns

Nationwide, 5.6% of students had not gone to school on at least 1 day during the 30 days before the survey because they felt they would be unsafe at school or on their way to or from school (i.e., did not go to school because of safety concerns) (Table 15). The prevalence of having not gone to school because of safety concerns was higher among female (6.0%) than male (5.0%) students; higher among white female (5.4%) than white male (2.9%) students; and higher among 9th-grade female (7.7%) and 10th-grade female (6.3%) than 9th-grade male (4.9%) and 10th-grade male (4.4%) students, respectively. The prevalence of having not gone to school because of safety concerns was higher among black (6.8%) and Hispanic (7.6%) than white (4.2%) students and higher among black male (6.9%) and Hispanic male (7.6%) than white male (2.9%) students. The prevalence of having not gone to school because of safety concerns was higher among 9th-grade (6.4%) than 11th-grade (4.6%) students and higher among 9th-grade female (7.7%) than 11th-grade female (5.3%) and 12th-grade female (4.3%) students.

During 1993–2015, a significant linear increase occurred overall in the prevalence of having not gone to school because of safety concerns (4.4%–5.6%). A significant quadratic trend was not identified. The prevalence of having not gone to school because of safety concerns decreased significantly from 2013 (7.1%) to 2015 (5.6%).

Across 36 states, the prevalence of having not gone to school because of safety concerns ranged from 4.3% to 11.5% (median: 6.2%) (Table 16). Across 18 large urban school districts, the prevalence ranged from 4.5% to 12.8% (median: 9.1%).

Electronically Bullied

Nationwide, 15.5% of students had been electronically bullied, counting being bullied through e-mail, chat rooms, instant messaging, websites, or texting, during the 12 months before the survey ( Table 17). The prevalence of having been electronically bullied was higher among female (21.7%) than male (9.7%) students; higher among white female (26.0%), black female (11.9%), and Hispanic female (16.7%) than white male (10.8%), black male (5.6%), and Hispanic male (8.1%) students, respectively; and higher among 9th-grade female (22.7%), 10th-grade female (23.2%), 11th-grade female (21.4%), and 12th-grade female (19.5%) than 9th-grade male (11.0%), 10th-grade male (9.9%), 11th-grade male (8.4%), and 12th-grade male (9.2%) students, respectively. The prevalence of having been electronically bullied was higher among white (18.4%) and Hispanic (12.4%) than black (8.6%) students, higher among white (18.4%) than Hispanic (12.4%) students, high er among white female (26.0%) and Hispanic female (16.7%) than black female (11.9%) students, higher among white female (26.0%) than Hispanic female (16.7%) students, and higher among white male (10.8%) than black male (5.6%) and Hispanic male (8.1%) students. The prevalence of having been electronically bullied was higher among 10th-grade (16.6%) than 12th-grade (14.3%) students and higher among 10th-grade female (23.2%) than 12th-grade female (19.5%) students.

During 2011–2015, significant linear and quadratic trends were not identified in the prevalence of having been electronically bullied. The prevalence of having been electronically bullied did not change significantly from 2013 (14.8%) to 2015 (15.5%).

Across 36 states, the prevalence of having been electronically bullied ranged from 11.6% to 21.1% (median: 15.4%) ( Table 18). Across 19 large urban school districts, the prevalence ranged from 7.9% to 16.3% (median: 11.2%).

Bullied on School Property

Nationwide, 20.2% of students had been bullied on school property during the 12 months before the survey (Table 17). The prevalence of having been bullied on school property was higher among female (24.8%) than male (15.8%) students; higher among white female (29.1%), black female (15.1%), and Hispanic female (19.3%) than white male (18.1%), black male (11.2%), and Hispanic male (13.7%) students, respectively; and higher among 9th-grade female (29.0%), 10th-grade female (25.5%), 11th-grade female (24.2%), and 12th-grade female (19.8%) than 9th-grade male (18.3%), 10th-grade male (16.1%), 11th-grade male (16.4%), and 12th-grade male (12.1%) students, respectively. The prevalence of having been bullied on school property was higher among white (23.5%) than black (13.2%) and Hispanic (16.5%) students, higher among white female (29.1%) than black female (15.1%) and Hispanic female (19.3%) students, and higher among white male (18.1%) tha n black male (11.2%) and Hispanic male (13.7%) students. The prevalence of having been bullied on school property was higher among 9th-grade (23.4%), 10th-grade (20.8%), and 11th-grade (20.3%) than 12th-grade (15.9%) students; higher among 9th-grade female (29.0%) than 11th-grade female (24.2%) students; higher among 9th-grade female (29.0%), 10th-grade female (25.5%), and 11th-grade female (24.2%) than 12th-grade female (19.8%) students; and higher among 9th-grade male (18.3%), 10th-grade male (16.1%), and 11th-grade male (16.4%) than 12th-grade male (12.1%) students.

During 2009–2015, significant linear and quadratic trends were not identified in the prevalence of having been bullied on school property. The prevalence of having been bullied on school property did not change significantly from 2013 (19.6%) to 2015 (20.2%).

Across 35 states, the prevalence of having been bullied on school property ranged from 15.0% to 26.3% (median: 19.9%) (Table 18). Across 19 large urban school districts, the prevalence ranged from 11.3% to 20.2% (median: 14.6%).

Forced to Have Sexual Intercourse

Nationwide, 6.7% of students had ever been physically forced to have sexual intercourse when they did not want to ( Table 19). The prevalence of having been forced to have sexual intercourse was higher among female (10.3%) than male (3.1%) students; higher among white female (9.9%), black female (10.3%), and Hispanic female (10.1%) than white male (2.0%), black male (4.4%), and Hispanic male (4.0%) students, respectively; and higher among 9th-grade female (9.4%), 10th-grade female (7.9%), 11th-grade female (12.0%), and 12th-grade female (11.9%) than 9th-grade male (2.1%), 10th-grade male (3.9%), 11th-grade male (2.8%), and 12th-grade male (3.5%) students, respectively. The prevalence of having been forced to have sexual intercourse was higher among black male (4.4%) and Hispanic male (4.0%) than white male (2.0%) students. The prevalence of having been forced to have sexual intercourse was higher among 11th-grade (7.6%) and 12th-grade (7.6%) than 9th-grade (5.6%) students, higher among 12th-grade (7.6%) than 10th-grade (5.9%) students, higher among 11th-grade female (12.0%) and 12th-grade female (11.9%) than 10th-grade female (7.9%) students, and higher among 10th-grade male (3.9%) and 12th-grade male (3.5%) than 9th-grade male (2.1%) students.

During 2001–2015, a significant linear decrease occurred overall in the prevalence of having been forced to have sexual intercourse (7.7%–6.7%). A significant quadratic trend was not identified. The prevalence of having been forced to have sexual intercourse did not change significantly from 2013 (7.3%) to 2015 (6.7%).

Across 34 states, the prevalence of having been physically forced to have sexual intercourse ranged from 5.1% to 11.7% (median: 7.9%) ( Table 20). Across 17 large urban school districts, the prevalence ranged from 5.5% to 12.6% (median: 8.2%).

Physical Dating Violence

Among the 68.6% of students nationwide who dated or went out with someone during the 12 months before the survey,^¶¶ 9.6% had been physically hurt on purpose (counting hit, slammed into something, or injured with an object or weapon) by someone they were dating or going out with one or more times during the 12 months before the survey (i.e., physical dating violence) ( Table 21). The prevalence of physical dating violence was higher among female (11.7%) than male (7.4%) students; higher among white female (11.9%) and Hispanic female (11.4%) than white male (5.9%) and Hispanic male (8.0%) students, respectively; and higher among 9th-grade female (11.1%), 11th-grade female (11.6%), and 12th-grade female (12.9%) than 9th-grade male (5.3%), 11th-grade male (7.9%), and 12th-grade male (8.2%) students, respectively. The prevalence of physical dating violence was higher among 11th- grade (10.1%) than 9th-grade (8.1%) students and higher among 11th-grade male (7.9%) and 12th-grade male (8.2%) than 9th-grade male (5.3%) students.

Because of changes in the question and response options starting in 2013, long-term temporal trends are not available for the prevalence of physical dating violence. The prevalence of physical dating violence did not change significantly from 2013 (10.3%) to 2015 (9.6%).

Across 36 states, the prevalence of physical dating violence ranged from 6.7% to 14.6% (median: 9.0%) ( Table 22). Across 19 large urban school districts, the prevalence ranged from 6.4% to 12.7% (median: 10.1%).

Sexual Dating Violence

Among the 69.1% of students nationwide who dated or went out with someone during the 12 months before the survey,^¶¶ 10.6% of students had been forced to do sexual things (counting being kissed, touched, or physically forced to have sexual intercourse) they did not want to do by someone they were dating or going out with one or more times during the 12 months before the survey (i.e., sexual dating violence) (Table 21). The prevalence of sexual dating violence was higher among female (15.6%) than male (5.4%) students; higher among white female (16.6%) and Hispanic female (14.2%) than white male (3.5%) and Hispanic male (7.0%) students, respectively; and higher among 9th-grade female (17.6%), 10th-grade female (15.8%), 11th-grade female (14.9%), and 12th-grade female (13.9%) than 9th-grade male (4.5%), 10th-grade male (7.4%), 11th-grade male (5.1%), and 12th-grade male (4.6%) students, respectively. The prevalence of sexual dating violence was higher among black male (8.0%) and Hispanic male (7.0%) than white male (3.5%) students. The prevalence of sexual dating violence was higher among 10th-grade (11.8%) than 12th-grade (9.2%) students and higher among 10th-grade male (7.4%) than 9th-grade male (4.5%) and 12th-grade male (4.6%) students.

Because of changes in the question and response options starting in 2013, long-term temporal trends are not available for the prevalence of sexual dating violence. The prevalence of sexual dating violence did not change significantly from 2013 (10.4%) to 2015 (10.6%).

Across 30 states, the prevalence of sexual dating violence ranged from 7.5% to 14.7% (median: 10.1%) (Table 22). Across 19 large urban school districts, the prevalence ranged from 6.8% to 14.4% (median: 10.5%).

Felt Sad or Hopeless

During the 12 months before the survey, 29.9% of students nationwide had felt so sad or hopeless almost every day for 2 or more weeks in a row that they stopped doing some usual activities ( Table 23). The prevalence of having felt sad or hopeless was higher among female (39.8%) than male (20.3%) students; higher among white female (37.9%), black female (33.9%), and Hispanic female (46.7%) than white male (19.2%), black male (17.6%), and Hispanic male (24.3%) students, respectively; and higher among 9th-grade female (41.5%), 10th-grade female (40.1%), 11th-grade female (40.9%), and 12th-grade female (36.3%) than 9th-grade male (16.7%), 10th-grade male (19.2%), 11th-grade male (22.1%), and 12th-grade male (23.9%) students, respectively. The prevalence of having felt sad or hopeless was higher among Hispanic (35.3%) than white (28.6%) and black (25.2%) students, higher among Hispanic female (46.7%) than white female (37.9%) and black female (33.9%) students, and higher among Hispanic male (24.3%) than white male (19.2%) and black male (17.6%) students. The prevalence of having felt sad or hopeless was higher among 9th-grade female (41.5%) and 11th-grade female (40.9%) than 12th-grade female (36.3%) students, higher among 11th-grade male (23.9%) than 10th-grade male (19.2%) students.

During 1999–2015, significant linear and quadratic trends were not identified in the prevalence of having felt sad or hopeless. The prevalence of having felt sad or hopeless did not change significantly from 2013 (29.9%) to 2015 (29.9%).

Across 37 states, the prevalence of having felt sad or hopeless ranged from 24.1% to 34.2% (median: 28.9%) ( Table 24). Across 19 large urban school districts, the prevalence ranged from 24.9% to 36.0% (median: 29.8%).

Seriously Considered Attempting Suicide

Nationwide, 17.7% of students had seriously considered attempting suicide during the 12 months before the survey ( Table 25). The prevalence of having seriously considered attempting suicide was higher among female (23.4%) than male (12.2%) students; higher among white female (22.8%), black female (18.7%), and Hispanic female (25.6%) than white male (11.5%), black male (11.0%), and Hispanic male (12.4%) students, respectively; and higher among 9th-grade female (26.5%), 10th-grade female (25.7%), 11th-grade female (22.1%), and 12th-grade female (18.6%) than 9th-grade male (10.7%), 10th-grade male (10.8%), 11th-grade male (13.3%), and 12th-grade male (14.0%) students, respectively. The prevalence of having seriously considered attempting suicide was higher among Hispanic (18.8%) than black (14.5%) students and higher among Hispanic female (25.6%) than black female (18.7%) students. The prevalence of having seriously considered attempting suicide was higher among 9th-grade female (26.5%) and 10th-grade female (25.7%) than 11th-grade female (22.1%) students and 12th-grade female (22.1%) students and higher among 11th-grade male (13.3%) and 12th-grade male (14.0%) than 10th-grade male (10.8%) students.

During 1991–2015, a significant linear decrease occurred overall in the prevalence of having seriously considered attempting suicide (29.0%–17.7%). A significant quadratic trend also was identified. The prevalence of having seriously considered attempting suicide decreased during 1991–2009 (29.0%–13.8%) and then increased during 2009–2015 (13.8%–17.7%). The prevalence of having seriously considered attempting suicide did not change significantly from 2013 (17.0%) to 2015 (17.7%).

Across 36 states, the prevalence of having seriously considered attempting suicide ranged from 13.4% to 20.3% (median: 16.0%) ( Table 26). Across 19 large urban school districts, the prevalence ranged from 10.7% to 19.7% (median: 15.1%).

Made a Suicide Plan

During the 12 months before the survey, 14.6% of students nationwide had made a plan about how they would attempt suicide (Table 25). The prevalence of having made a suicide plan was higher among female (19.4%) than male (9.8%) students; higher among white female (18.4%), black female (17.3%), and Hispanic female (20.7%) than white male (9.3%), black male (10.6%), and Hispanic male (10.9%) students, respectively; and higher among 9th-grade female (22.5%), 10th-grade female (21.6%), 11th-grade female (17.2%), and 12th-grade female (15.7%) than 9th-grade male (8.1%), 10th-grade male (9.2%), 11th-grade male (10.4%), and 12th-grade male (12.0%) students, respectively. The prevalence of having made a suicide plan was higher among 9th-grade female (22.5%) and 10th-grade female (21.6%) than 11th-grade female (17.2%) and 12th-grade female (15.7%) students, higher among 11th-grade male (10.4%) and 12th-grade male (12.0%) than 9^th-grade male (8.1%) students, and higher among 12th-grade male (12.0%) than 10th-grade male (9.2%) students.

During 1991–2015, a significant linear decrease occurred overall in the prevalence of having made a suicide plan (18.6%–14.6%). A significant quadratic trend also was identified. The prevalence of having made a suicide plan decreased during 1991–2009 (18.6%–10.9%) and then increased during 2009–2015 (10.9%–14.6%). The prevalence of having made a suicide plan did not change significantly from 2013 (13.6%) to 2015 (14.6%).

Across 34 states, the prevalence of having made a suicide plan ranged from 11.0% to 18.2% (median: 14.3%) (Table 26). Across 16 large urban school districts, the prevalence ranged from 8.7% to 19.3% (median: 13.8%).

Attempted Suicide

Nationwide, 8.6% of students had attempted suicide one or more times during the 12 months before the survey ( Table 27). The prevalence of having attempted suicide was higher among female (11.6%) than male (5.5%) students; higher among white female (9.8%) and Hispanic female (15.1%) than white male (3.7%) and Hispanic male (7.6%) students, respectively; and higher among 9th-grade female (15.1%), 10th-grade female (13.0%), and 11th-grade female (10.2%) than 9th-grade male (5.1%), 10th-grade male (5.7%), and 11th-grade male (5.8%) students, respectively. The prevalence of having attempted suicide was higher among Hispanic (11.3%) than white (6.8%) students, higher among Hispanic female (15.1%) than white female (9.8%) and black female (10.2%) students, and higher among black male (7.2%) and Hispanic male (7.6%) than white male (3.7%) students. The prevalence of having attempted suicide was higher among 9th-grade (9.9%) than 11th-grade ( 8.0%) students; higher among 9th-grade (9.9%) and 10th-grade (9.4%) than 12th-grade (6.2%) students; higher among 9th-grade female (15.1%) than 11th-grade female (10.2%) students; and higher among 9th-grade female (15.1%), 10th-grade female (13.0%), and 11th-grade female (10.2%) than 12th-grade female (7.2%) students.

During 1991–2015, a significant linear decrease occurred overall in the prevalence of having attempted suicide (7.3%–8.6%).*** A significant quadratic trend was not identified. The prevalence having attempted suicide did not change significantly from 2013 (8.0%) to 2015 (8.6%).

Across 35 states, the prevalence of having attempted suicide ranged from 5.9% to 12.7% (median: 9.6%) ( Table 28). Across 19 large urban school districts, the prevalence ranged from 6.4% to 20.7% (median: 9.9%).

Suicide Attempt Treated by a Doctor or Nurse

During the 12 months before the survey, 2.8% 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 (Table 27). The prevalence of having made a suicide attempt that resulted in an injury, poisoning, or overdose that had to be treated by a doctor or nurse was higher among female (3.7%) than male (1.9%) students; higher among white female (3.4%) and Hispanic female (4.5%) than white male (0.9%) and Hispanic male (2.9%) students, respectively; and higher among 9th-grade female (4.7%) than 9th-grade male (1.9%) students. The prevalence of having made a suicide attempt that resulted in an injury, poisoning, or overdose that had to be treated by a doctor or nurse was higher among Hispanic (3.7%) than white (2.1%) students and higher among black male (4.0%) and Hispanic male (2.9%) than white male (0.9%) students. The prevalence of having made a suicide attempt that resulted in an injury, poisoning, or overdose that had to be treated by a doctor or nurse was higher among 9th-grade (3.2%) and 10th-grade (3.1%) than 12th-grade (1.9%) students and higher among 9th-grade female (4.7%) and 10th-grade female (3.9%) than 12th-grade female (2.3%) students.

During 1991–2015, significant linear and quadratic trends were not identified in the prevalence of having 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 resulted in an injury, poisoning, or overdose that had to be treated by a doctor or nurse did not change significantly from 2013 (2.7%) to 2015 (2.8%).

Across 33 states, the prevalence of having made a suicide attempt that resulted in an injury, poisoning, or overdose that had to be treated by a doctor or nurse ranged from 1.9% to 9.3% (median: 3.2%) (Table 28). Across 17 large urban school districts, the prevalence ranged from 1.9% to 7.4% (median: 3.5%).

Tobacco Use

Ever Tried Cigarette Smoking

Nationwide, 32.3% of students had ever tried cigarette smoking (even one or two puffs) (i.e., ever tried cigarette smoking) ( Table 29). The prevalence of having ever tried cigarette smoking was higher among Hispanic male (37.8%) than Hispanic female (32.7%) students and higher among 11th-grade male (40.5%) than 11th-grade female (34.4%) students. The prevalence of having ever tried cigarette smoking was higher among Hispanic male (37.8%) than white male (33.2%) and black male (30.6%) students. The prevalence of having ever tried cigarette smoking was higher among 11th-grade (37.5%) and 12th-grade (38.3%) than 9th-grade (25.1%) students and 10th-grade (29.1%) students, higher among 11th-grade female (34.4%) and 12th-grade female (36.3%) than 9th-grade female (24.5%) and 10th-grade female (28.2%) students, and higher among 11th-grade male (40.5%) and 12th-grade male (40.4%) than 9th-grade male (25.8%) and 10th-grade male (30.0%) students.

During 1991–2015, a significant linear decrease occurred overall in the prevalence of having ever tried cigarette smoking (70.1%–32.3%). A significant quadratic trend also was identified. The prevalence of having ever tried cigarette smoking did not change significantly during 1991–1999 (70.1%–70.4%) and then decreased during 1999–2015 (70.4%–32.3%). The prevalence of having ever tried cigarette smoking also decreased significantly from 2013 (41.1%) to 2015 (32.3%).

Across 31 states, the prevalence of having ever tried cigarette smoking ranged from 22.4% to 47.3% (median: 34.5%) ( Table 30). Across 15 large urban school districts, the prevalence ranged from 21.4% to 34.4% (median: 26.4%).

Smoked a Whole Cigarette Before Age 13 Years

Nationwide, 6.6% of students had smoked a whole cigarette for the first time before age 13 years (Table 29). The prevalence of having smoked a whole cigarette before age 13 years was higher among male (8.0%) than female (5.0%) students; higher among black male (10.1%) and Hispanic male (9.2%) than black female (3.8%) and Hispanic female (4.9%) students, respectively; and higher among 9th-grade male (8.2%), 10th-grade male (9.1%), 11th-grade male (6.8%), and 12th-grade male (7.3%) than 9th-grade female (6.1%), 10th-grade female (6.0%), 11th-grade female (4.5%), and 12th-grade female (3.0%) students, respectively. The prevalence of having smoked a whole cigarette before age 13 years was higher among black male (10.1%) and Hispanic male (9.2%) than white male (6.6%) students. The prevalence of having smoked a whole cigarette before age 13 years was higher among 10th-grade (7.6%) than 11th-grade (5.6%) and 12th-grade (5.2%) students and higher among 9th-grade female (6.1%), 10th-grade female (6.0%), and 11th-grade female (4.5%) than 12th-grade female (3.0%) students.

During 1991–2015, a significant linear decrease occurred overall in the prevalence of having smoked a whole cigarette before age 13 years (23.8%–6.6%). A significant quadratic trend also was identified. The prevalence of having smoked a whole cigarette before age 13 years did not change significantly during 1991–1999 (23.8%–24.7%) and then decreased during 1999–2015 (24.7%–6.6%). The prevalence of having smoked a whole cigarette before age 13 years also decreased significantly from 2013 (9.3%) to 2015 (6.6%).

Across 35 states, the prevalence of having smoked a whole cigarette before age 13 years ranged from 4.3% to 13.1% (median: 7.8%) (Table 30). Across 16 large urban school districts, the prevalence ranged from 3.8% to 13.7% (median: 5.8%).

Current Cigarette Use

Nationwide, 10.8% of students had smoked cigarettes on at least 1 day during the 30 days before the survey (i.e., current cigarette use) ( Table 31). The prevalence of current cigarette use was higher among male (11.8%) than female (9.7%) students; higher among black male (9.1%) and Hispanic male (11.3%) than black female (3.7%) and Hispanic female (7.1%) students, respectively; and higher among 11th-grade male (15.8%) than 11th-grade female (10.1%) students. The prevalence of current cigarette use was higher among white (12.4%) and Hispanic (9.2%) than black (6.5%) students, higher among white (12.4%) than Hispanic (9.2%) students, higher among white female (12.2%) and Hispanic female (7.1%) than black female (3.7%) students, and higher among white female (12.2%) and Hispanic female (7.1%) students. The prevalence of current cigarette use was higher among 11th-grade (13.1%) and 12th-grade (14.1%) than 9th-grade (7.6%) and 10th-grade (8.8%) students, higher among 11th-grade female (10.1%) than 9th-grade female (6.7%) students; higher among 12th-grade female (13.3%) than 9th-grade female (6.7%), 10th-grade female (9.1%), and 11th grade female (10.1%) students; and higher among 11th-grade male (15.8%) and 12th-grade male (15.0%) than 9th-grade male (8.3%) and 10th-grade male (8.5%) students.

During 1991–2015, a significant linear decrease occurred overall in the prevalence of current cigarette use (27.5%–10.8%). A significant quadratic trend also was identified. The prevalence of current cigarette use increased during 1991–1997 (27.5%–36.4%) and then decreased during 1997–2015 (36.4%–10.8%). The prevalence of current cigarette use also decreased significantly from 2013 (15.7%) to 2015 (10.8%).

Across 37 states, the prevalence of current cigarette use ranged from 4.8% to 18.8% (median: 10.8%) ( Table 32). Across 18 large urban school districts, the prevalence ranged from 4.2% to 9.0% (median: 5.8%).

Current Frequent Cigarette Use

Nationwide, 3.4% of students had smoked cigarettes 20 or more days during the 30 days before the survey (i.e., current frequent cigarette use) (Table 31). The prevalence of current frequent cigarette use was higher among white (4.0%) than black (1.8%) and Hispanic (2.1%) students, higher among white female (4.4%) and Hispanic female (2.1%) than black female (0.8%) students, higher among white female (4.4%) than Hispanic female (2.1%) students, and higher among white male (3.6%) than Hispanic male (2.2%) students. The prevalence of current frequent cigarette use was higher among 12th-grade (5.1%) than 9th-grade (2.2%), 10th-grade (2.9%), and 11th-grade (3.2%) students; higher among 12th-grade female (4.9%) than 9th-grade female (2.5%) and 10th-grade female (2.7%) students; higher among 11th-grade male (3.5%) and 12th-grade male (5.4%) than 9th-grade male (1.9%) students; and higher among 12th-grade male (5.4%) than 10th-grade male (3. 1%) students.

During 1991–2015, a significant linear decrease occurred overall in the prevalence of current frequent cigarette use (12.7%–3.4%). A significant quadratic trend also was identified. The prevalence of current frequent cigarette use increased during 1991–1999 (12.7%–16.8%) and then decreased during 1999–2015 (16.8%–3.4%). The prevalence of current frequent cigarette use also decreased significantly from 2013 (5.6%) to 2015 (3.4%).

Across 37 states, the prevalence of current frequent cigarette use ranged from 1.5% to 7.4% (median: 3.6%) (Table 32). Across 18 large urban school districts, the prevalence ranged from 0.6% to 2.0% (median: 1.3%).

Smoked More Than 10 Cigarettes per Day

Among the 10.8% of students nationwide who currently smoked cigarettes, 7.9% of students had smoked more than 10 cigarettes per day on the days they smoked during the 30 days before the survey ( Table 33). The prevalence of having smoked more than 10 cigarettes per day was higher among 10th-grade (10.4%) and 12th-grade (9.1%) than 11th-grade (3.4%) students, higher among 10th-grade male (14.7%) than 9th-grade male (5.1%) students, and higher among 10th-grade male (14.7%) and 12th-grade male (12.5%) than 11th-grade male (3.6%) students.

During 1991–2015, a significant linear decrease occurred overall in the prevalence of having smoked more than 10 cigarettes per day (18.0%–7.9%). A significant quadratic trend was not identified. The prevalence of having smoked more than 10 cigarettes per day did not change significantly from 2013 (8.6%) to 2015 (7.9%).

Across 30 states, the prevalence of having smoked more than 10 cigarettes per day ranged from 2.0% to 14.6% (median: 8.3%) ( Table 34). Across 12 large urban school districts, the prevalence ranged from 0.9% to 12.8% (median: 8.2%).

Currently Smoked Cigarettes Daily

Nationwide, 2.3% of students had smoked cigarettes on all 30 days during the 30 days before the survey (i.e., currently smoked cigarettes daily) (Table 33). The prevalence of having currently smoked cigarettes daily was higher among black male (2.4%) than black female (0.4%) students and higher among 10th-grade male (2.7%) than 10th-grade female (1.4%) students. The prevalence of having currently smoked cigarettes daily was higher among white (2.8%) than black (1.4%) and Hispanic (1.6%) students, higher among white female (3.1%) and Hispanic female (1.4%) than black female (0.4%) students, and higher among white female (3.1%) than Hispanic female (1.4%) students. The prevalence of having currently smoked cigarettes daily was higher among 12th-grade (3.4%) than 9th-grade (1.7%), 10th-grade (2.1%), and 11th-grade (1.9%) students; higher among 12th-grade female (3.5%) than 10th-grade female (1.4%) students; and higher among 12th-grade male (3.2%) than 9th-grade male (1.6%) and 11th-grade male (1.8%) students.

During 1991–2015, a significant linear decrease occurred overall in the prevalence of having currently smoked cigarettes daily (9.8%–2.3%). A significant quadratic trend also was identified. The prevalence of having currently smoked cigarettes daily increased during 1991–1999 (9.8%–12.8%) and then decreased during 1999–2015 (12.8%–2.3%). The prevalence of having currently smoked cigarettes daily also decreased significantly from 2013 (4.0%) to 2015 (2.3%).

Across 37 states, the prevalence of having currently smoked cigarettes daily ranged from 1.0% to 5.4% (median: 2.6%) (Table 34). Across 18 large urban school districts, the prevalence ranged from 0.3% to 1.6% (median: 0.9%).

Bought Cigarettes in a Store or Gas Station

Among the 8.5% of students who currently smoked cigarettes and were aged <18 years, 12.6% had usually obtained their own cigarettes by buying them in a store (e.g., convenience store, supermarket, or discount store) or gas station during the 30 days before the survey ( Table 35). The prevalence of usually obtaining their own cigarettes by buying them in a store or gas station was higher among male (16.5%) than female (7.7%) students; higher among white male (12.8%) and Hispanic male (21.9%) than white female (6.6%) and Hispanic female (9.8%) students, respectively; and higher among 11th-grade male (27.1%) than 11th-grade female (8.8%) students. The prevalence of usually obtaining their own cigarettes by buying them in a store or gas station was higher among Hispanic (17.5%) than white (9.7%) students and higher among Hispanic male (21.9%) than white male (12.8%) students. The prevalence of usually obtaining their own cigarettes by buying them in a store or gas station was higher among 11th-grade (20.2%) and 12th-grade (16.5%) than 9th-grade (6.3%) students and 10th-grade (6.1%) students and higher among 11th-grade male (27.1%) and 12th-grade male (22.8%) than 9th-grade male (6.2%) and 10th-grade male (6.7%) students.

During 2001–2015, a significant linear decrease occurred overall in the prevalence of usually obtaining their own cigarettes by buying them in a store or gas station (19.0%–12.6%). A significant quadratic trend was not identified. The prevalence of usually obtaining their own cigarettes by buying them in a store or gas station also decreased significantly from 2013 (18.1%) to 2015 (12.6%).

Across 28 states, the prevalence of usually obtaining their own cigarettes by buying them in a store or gas station ranged from 4.4% to 20.6% (median: 11.6%) ( Table 36). Across 5 large urban school districts, the prevalence ranged from 14.9% to 64.5% (median: 22.5%).

Bought Cigarettes on the Internet

Among the 8.5% of students who currently smoked cigarettes and were aged <18 years, 1.0% had usually obtained their own cigarettes by buying them on the Internet during the 30 days before the survey (Table 35). Because the response option “I got them on the Internet” was included for the first time in 2015 in the question on usual source of cigarettes, long-term temporal trends and 2-year temporal changes are not available.

Across 28 states, the prevalence of usually obtaining their own cigarettes by buying them on the Internet ranged from 0.0% to 6.0% (median: 1.1%) (Table 36). Across 5 large urban school districts, the prevalence ranged from 1.7% to 5.9% (median: 2.4%).

Tried to Quit Smoking Cigarettes

Among the 10.8% of students nationwide who currently smoked cigarettes, 45.4% had tried to quit smoking cigarettes during the 12 months before the survey ( Table 37). The prevalence of having tried to quit smoking cigarettes was higher among female (52.8%) than male (39.7%) students; higher among white female (51.0%) than white male (37.9%) students; and higher among 11th-grade female (52.2%) and 12th-grade female (54.1%) than 11th-grade male (29.9%) and 12th-grade male (42.0%) students, respectively. The prevalence of having tried to quit smoking cigarettes was higher among 9th-grade (47.8%), 10th-grade (51.6%), and 12th-grade (47.7%) than 11th-grade (37.9%) students and higher among 9th-grade male (48.2%) and 12th-grade male (42.0%) than 11th-grade male (29.9%) students.

During 2001–2015, a significant linear decrease occurred overall in the prevalence of having tried to quit smoking cigarettes (57.4%–45.4%). A significant quadratic trend was not identified. The prevalence of having tried to quit smoking cigarettes did not change significantly from 2013 (48.0%) to 2015 (45.4%).

Across 29 states, the prevalence of having tried to quit smoking cigarettes ranged from 35.2% to 59.5% (median: 49.2%) ( Table 38). Across 9 large urban school districts, the prevalence ranged from 35.7% to 81.8% (median: 46.9%).

Current Smokeless Tobacco Use

Nationwide, 7.3% of students had used smokeless tobacco (e.g., chewing tobacco, snuff, or dip) on at least 1 day during the 30 days before the survey (i.e., current smokeless tobacco use) ( Table 39). The prevalence of current smokeless tobacco use was higher among male (11.9%) than female (2.3%) students; higher among white male (15.9%), black male (5.6%), and Hispanic male (6.4%) than white female (2.5%), black female (1.1%), and Hispanic female (2.5%) students, respectively; and higher among 9th-grade male (8.8%), 10th-grade male (10.6%), 11th-grade male (15.0%), and 12th-grade male (13.1%) than 9th-grade female (2.4%), 10th-grade female (2.0%), 11th-grade female (2.9%), and 12th-grade female (1.7%) students, respectively. The prevalence of current smokeless tobacco use was higher among white (9.3%) than black (3.7%) and Hispanic (4.5%) students, higher among white female (2.5%) and Hispanic female (2.5%) than black female (1.1%) s tudents, and higher among white male (15.9%) than black male (5.6%) and Hispanic male (6.4%) students. The prevalence of current smokeless tobacco use was higher among 11th-grade (9.3%) than 9th-grade (5.9%) and 10th-grade (6.3%) students, higher among 11th-grade male (15.0%) and 12th-grade male (13.1%) than 9th-grade male (8.8%) students, and higher among 11th-grade male (15.0%) than 10th-grade male (10.6%) students.

During 1995–2015, a significant linear trend was not identified in the prevalence of current smokeless tobacco use. A significant quadratic trend was identified. The prevalence of current smokeless tobacco use decreased during 1995–1999 (11.4%–7.8%) and then did not change significantly during 1999–2015 (7.8%–7.3%). The prevalence of current smokeless tobacco use also did not change significantly from 2013 (8.8%) to 2015 (7.3%).

Across 34 states, the prevalence of current smokeless tobacco use ranged from 3.0% to 13.4% (median: 8.6%) ( Table 40). Across 15 large urban school districts, the prevalence ranged from 2.4% to 7.8% (median: 3.7%).

Current Cigar Use

Nationwide, 10.3% of students had smoked cigars, cigarillos, or little cigars on at least 1 day during the 30 days before the survey (i.e., current cigar use) (Table 39). The prevalence of current cigar use was higher among male (14.0%) than female (6.3%) students; higher among white male (14.8%), black male (12.9%), and Hispanic male (12.4%) than white female (6.0%), black female (8.5%), and Hispanic female (6.5%) students, respectively; and higher among 9th-grade male (8.5%), 10th-grade male (12.5%), 11th-grade male (15.1%), and 12th-grade male (20.4%) than 9th-grade female (4.1%), 10th-grade female (6.6%), 11th-grade female (6.3%), and 12th-grade female (8.1%) students, respectively. The prevalence of current cigar use was higher among 10th-grade (9.6%), 11th-grade (11.0%), and 12th-grade (14.3%) than 9th-grade (6.6%) students; higher among 12th-grade (14.3%) than 10th-grade (9.6%) students; higher among 10th-grade female (6.6%), 11th-grade female (6.3%), and 12th-grade female (8.1%) than 9th-grade female (4.1%) students; higher among 10th-grade male (12.5%), 11th-grade male (15.1%), and 12th-grade male (20.4%) than 9th-grade male (8.5%) students; and higher among 12th-grade male (20.4%) than 10th-grade male (12.5%) students.

During 1997–2015, a significant linear decrease occurred overall in the prevalence of current cigar use (22.0%–10.3%). A significant quadratic trend was not identified. The prevalence of current cigar use decreased significantly from 2013 (12.6%) to 2015 (10.3%).

Across 33 states, the prevalence of current cigar use ranged from 6.8% to 16.5% (median: 10.4%) (Table 40). Across 16 large urban school districts, the prevalence ranged from 4.4% to 14.9% (median: 9.1%).

Ever Used Electronic Vapor Products

Nationwide, 44.9% of students had ever used electronic vapor products (including e-cigarettes, e-cigars, e-pipes, vape pipes, vaping pens, e-hookahs, and hookah pens) (i.e., ever used electronic vapor products) ( Table 41). The prevalence of having ever used electronic vapor products was higher among 10th-grade male (45.3%) than 10th-grade female (41.2%) students. The prevalence of having ever used electronic vapor products was higher among Hispanic (51.9%) than white (43.2%) and black (42.4%) students, higher among Hispanic female (51.2%) than white female (42.3%) and black female (37.7%) students, and higher among Hispanic male (52.6%) than white male (44.0%) students. The prevalence of having ever used electronic vapor products was higher among 10th-grade (43.3%), 11th-grade (49.5%), and 12th-grade (50.9%) than 9th-grade (37.2%) students; higher among 11th-grade (49.5%) and 12th-grade (50.9%) than 10th-grade (43.3%) students; highe r among 11th-grade female (47.8%) and 12th-grade female (49.0%) than 9th-grade female (37.4%) and 10th-grade female (41.2%) students; higher among 10th-grade male (45.3%), 11th-grade male (51.1%), and 12th-grade male (52.6%) than 9th-grade male (37.0%) students; and higher among 11th-grade male (51.1%) than 10th-grade male (45.3%) students. Because the question measuring the prevalence of having ever used electronic vapor products was used for the first time in the 2015 national YRBS, long-term temporal trends and 2-year temporal changes are not available.

Across 31 states, the prevalence of having ever used electronic vapor products ranged from 30.4% to 54.4% (median: 42.9%) ( Table 42). Across 16 large urban school districts, the prevalence ranged from 32.2% to 49.9% (median: 39.9%).

Current Electronic Vapor Products Use

Nationwide, 24.1% of students had used electronic vapor products (including e-cigarettes, e-cigars, e-pipes, vape pipes, vaping pens, e-hookahs, and hookah pens) on at least 1 day during the 30 days before the survey (i.e., current electronic vapor product use) (Table 41). The prevalence of current electronic vapor product use was higher among male (25.6%) than female (22.6%) students, higher among black male (21.2%) than black female (14.5%) students, and higher among 12th-grade male (31.9%) than 12th-grade female (24.6%) students. The prevalence of current electronic vapor product use was higher among white (25.2%) and Hispanic (26.3%) than black (18.0%) students, higher among white female (24.2%) and Hispanic female (25.0%) than black female (14.5%) students, and higher among Hispanic male (27.4%) than black male (21.2%) students. The prevalence of current electronic vapor product use was higher among 11th-grade (25.9%) than 9th-g rade (19.7%) students; higher among 12th-grade (28.2%) than 9th-grade (19.7%), 10th-grade (23.2%), and 11th-grade (25.9%) students; higher among 11th-grade female (24.1%) and 12th-grade female (24.6%) than 9th-grade female (19.8%) students; higher among 10th-grade male (24.2%), 11th-grade male (27.4%), and 12th-grade male (31.9%) than 9th-grade male (19.6%) students; and higher among 12th-grade male (31.9%) than 10th-grade male (24.2%) and 11th-grade male (27.4%) students. Because the question measuring the prevalence of current electronic vapor product use was used for the first time in the 2015 national YRBS, long-term temporal trends and 2-year temporal changes are not available.

Across 35 states, the prevalence of current electronic vapor product use ranged from 15.3% to 31.2% (median: 23.5%) (Table 42). Across 19 large urban school districts, the prevalence ranged from 13.0% to 27.4% (median: 17.6%).

Current Cigarette or Cigar Use

Nationwide, 16.0% of students reported current cigarette or cigar use ( Table 43). The prevalence of current cigarette or cigar use was higher among male (19.0%) than female (12.7%) students; higher among white male (20.4%), black male (16.8%), and Hispanic male (16.5%) than white female (14.7%), black female (10.1%), and Hispanic female (9.7%) students, respectively; and higher among 9th-grade male (12.3%), 11th-grade male (22.9%), and 12th-grade male (25.9%) than 9th-grade female (8.8%), 11th-grade female (13.0%), and 12th-grade female (17.2%) students, respectively. The prevalence of current cigarette or cigar use was higher among white (17.5%) than black (13.9%) and Hispanic (13.1%) students and higher among white female (14.7%) than black female (10.1%) and Hispanic female (9.7%) students. The prevalence of current cigarette or cigar use was higher among 11th-grade (18.3%) and 12th-grade (21.6%) than 9th-grade (10.7%) and 10th-gr ade (13.9%) students; higher among 11th-grade female (13.0%) than 9th-grade female (8.8%) students; higher among 12th-grade female (17.2%) than 9th-grade female (8.8%), 10th-grade female (12.2%), and 11th-grade female (13.0%) students; and higher among 11th-grade male (22.9%) and 12th-grade male (25.9%) than 9th-grade male (12.3%) and 10th-grade male (15.6%) students.

During 1997–2015, a significant linear decrease occurred overall in the prevalence of current cigarette or cigar use (42.6%–16.0%). A significant quadratic trend was not identified. The prevalence of current cigarette or cigar use decreased significantly from 2013 (21.0%) to 2015 (16.0%).

Across 33 states, the prevalence of current cigarette or cigar use ranged from 10.7% to 24.8% (median: 15.7%) ( Table 44). Across 15 large urban school districts, the prevalence ranged from 6.8% to 18.1% (median: 12.0%).

Current Cigarette, Cigar, or Smokeless Tobacco Use

Nationwide, 18.5% of students reported current cigarette, cigar, or smokeless tobacco use (Table 43). The prevalence of current cigarette, cigar, or smokeless tobacco use was higher among male (23.3%) than female (13.4%) students; higher among white male (26.7%), black male (18.6%), and Hispanic male (18.1%) than white female (15.6%), black female (10.3%), and Hispanic female (10.3%) students, respectively; and higher among 9th-grade male (15.8%), 10th-grade male (19.6%), 11th-grade male (28.8%), and 12th-grade male (29.9%) than 9th-grade female (9.3%), 10th-grade female (12.6%), 11th-grade female (14.2%), and 12th-grade female (17.9%) students, respectively. The prevalence of current cigarette, cigar, or smokeless tobacco use was higher among white (21.2%) than black (14.9%) and Hispanic (14.2%) students, higher among white female (15.6%) than black female (10.3%) and Hispanic female (10.3%) students, and higher among white male (26 .7%) than black male (18.6%) and Hispanic male (18.1%) students. The prevalence of current cigarette, cigar, or smokeless tobacco use was higher among 11th-grade (21.9%) and 12th-grade (23.9%) than 9th-grade (12.8%) and 10th-grade (16.1%) students; higher among 11th-grade female (14.2%) than 9th-grade female (9.3%) students; higher among 12th-grade female (17.9%) than 9th-grade female (9.3%), 10th-grade female (12.6%), and 11th-grade female (14.2%) students; and higher among 11th-grade male (28.8%) and 12th-grade male (29.9%) than 9th-grade male (15.8%) and 10th-grade male (19.6%) students.

During 1997–2015, a significant linear decrease occurred in the prevalence of current cigarette, cigar, or smokeless tobacco use (44.5%–18.5%). A significant quadratic trend was not identified. The prevalence of current cigarette, cigar, or smokeless tobacco use decreased significantly from 2013 (24.0%) to 2015 (18.5%).

Across 33 states, the prevalence of current cigarette, cigar, or smokeless tobacco use ranged from 11.9% to 29.2% (median: 19.7%) (Table 44). Across 15 large urban school districts, the prevalence ranged from 7.5% to 20.4% (median: 12.8%).

Current Cigarette, Cigar, Smokeless Tobacco, or Electronic Vapor Product Use

Nationwide, 31.4% of students reported current cigarette, cigar, smokeless tobacco, or electronic vapor product use ( Table 45). The prevalence of current cigarette, cigar, smokeless tobacco, or electronic vapor product use was higher among male (34.9%) than female (27.7%) students; higher among white male (36.6%), black male (30.6%), and Hispanic male (34.2%) than white female (29.4%), black female (21.2%), and Hispanic female (29.4%) students, respectively; and higher among 9th-grade male (26.9%), 10th-grade male (31.7%), 11th-grade male (39.4%), and 12th-grade male (43.0%) than 9th-grade female (23.0%), 10th-grade female (26.3%), 11th-grade female (30.0%), and 12th-grade female (32.2%) students, respectively. The prevalence of current cigarette, cigar, smokeless tobacco, or electronic vapor product use was higher among white (32.9%) and Hispanic (31.8%) than black (26.3%) students, higher among white female (29.4%) and Hispanic female (29.4%) than black female (21.2%) students, and higher among white male (36.6%) than black male (30.6%) students. The prevalence of current cigarette, cigar, smokeless tobacco, or electronic vapor product use was higher among 11th-grade (34.9%) and 12th-grade (37.5%) than 9th-grade (25.1%) and 10th-grade (28.9%) students, higher among 11th-grade female (30.0%) and 12th-grade female (32.2%) than 9th-grade female (23.0%) students, higher among 12th-grade female (32.2%) than 10th-grade female (26.3%) students, and higher among 11th-grade male (39.4%) and 12th-grade male (43.0%) than 9th-grade male (26.9%) and 10th-grade male (31.7%) students. Because the question measuring the prevalence of current electronic vapor product use was used for the first time in the 2015 national YRBS, long-term temporal trends and 2-year temporal changes are not available for current cigarette, cigar, smokeless tobacco, or electronic vapor product use.

Across 33 states, the prevalence of current cigarette, cigar, smokeless tobacco, or electronic vapor product use ranged from 22.7% to 40.8% (median: 30.9%) ( Table 46). Across 15 large urban school districts, the prevalence ranged from 19.9% to 34.3% (median: 25.5%).

Alcohol and Other Drug Use

Ever Drank Alcohol

Nationwide, 63.2% of students had had at least one drink of alcohol on at least 1 day during their life (i.e., ever drank alcohol) ( Table 47). The prevalence of having ever drunk alcohol was higher among female (65.3%) than male (61.4%) students; higher among black female (57.9%) and Hispanic female (68.6%) than black male (51.0%) and Hispanic male (63.4%) students, respectively; and higher among 9th-grade female (53.0%) than 9th-grade male (48.9%) students. The prevalence of having ever drunk alcohol was higher among white (65.3%) and Hispanic (65.9%) than black (54.4%) students, higher among white female (66.7%) and Hispanic female (68.6%) than black female (57.9%) students, and higher among white male (64.0%) and Hispanic male (63.4%) than black male (51.0%) students. The prevalence of having ever drunk alcohol was higher among 10th-grade (60.8%), 11th-grade (70.3%), and 12th-grade (73.3%) than 9th-grade (50.8%) students; higher a mong 11th-grade (70.3%) and 12th-grade (73.3%) than 10th-grade (60.8%) students; higher among 11th-grade female (72.1%) and 12th-grade female (75.2%) than 9th-grade female (53.0%) and 10th-grade female (62.7%) students; higher among 10th-grade male (58.8%), 11th-grade male (68.7%), and 12th-grade male (71.5%) than 9th-grade male (48.9%) students; and higher among 11th-grade male (68.7%) and 12th-grade male (71.5%) than 10th-grade male (58.8%) students.

During 1991–2015, a significant linear decrease occurred overall in the prevalence having ever drunk alcohol (81.6%–63.2%). A significant quadratic trend also was identified. The prevalence of having ever drunk alcohol decreased during 1991–2007 (81.6%–75.0%) and then decreased more rapidly during 2007–2015 (75.0%–63.2%). The prevalence of having ever drunk alcohol did not change significantly from 2013 (66.2%) to 2015 (63.2%).

Across 26 states, the prevalence of having ever drunk alcohol ranged from 50.7% to 69.9% (median: 59.8%) ( Table 48). Across 17 large urban school districts, the prevalence ranged from 43.5% to 62.8% (median: 56.1%).

Drank Alcohol Before Age 13 Years

Nationwide, 17.2% of students had drunk alcohol (other than a few sips) for the first time before age 13 years (Table 47). The prevalence of having drunk alcohol for the first time before age 13 years was higher among male (19.7%) than female (14.6%) students; higher among white male (17.3%) and Hispanic male (23.6%) than white female (11.7%) and Hispanic female (19.0%) students, respectively; and higher among 10th-grade male (21.3%), 11th-grade male (17.5%), and 12th-grade male (17.0%) than 10th-grade female (15.8%), 11th-grade female (12.9%), and 12th-grade female (9.9%) students, respectively. The prevalence of having drunk alcohol for the first time before age 13 years was higher among black (18.0%) and Hispanic (21.3%) than white (14.5%) students, higher among Hispanic (21.3%) than black (18.0%) students, higher among black female (16.9%) and Hispanic female (19.0%) than white female (11.7%) students, and higher among Hispanic m ale (23.6%) than white male (17.3%) and black male (18.7%) students. The prevalence of having drunk alcohol for the first time before age 13 years was higher among 9th-grade (20.3%) and 10th-grade (18.6%) than 11th-grade (15.2%) and 12th-grade (13.5%) students, higher among 9th-grade female (18.8%) than 11th-grade female (12.9%) and 12th-grade female (9.9%) students, higher among 10th-grade female (15.8%) than 12th-grade female (9.9%) students, and higher among 9th-grade male (21.5%) than 12th-grade male (17.0%) students.

During 1991–2015, a significant linear decrease occurred overall in the prevalence of having drunk alcohol for the first time before age 13 years (32.7%–17.2%). A significant quadratic trend also was identified. The prevalence of having drunk alcohol for the first time before age 13 years did not change significantly during 1991–1999 (32.7%–32.2%) and then decreased during 1999–2015 (32.2%–17.2%). The prevalence of having drunk alcohol for the first time before age 13 years did not change significantly from 2013 (18.6%) to 2015 (17.2%).

Across 36 states, the prevalence of having drunk alcohol for the first time before age 13 years ranged from 10.6% to 24.5% (median: 15.7%) (Table 48). Across 19 large urban school districts, the prevalence ranged from 14.8% to 23.6% (median: 18.1%).

Current Alcohol Use

Nationwide, 32.8% of students had had at least one drink of alcohol on at least 1 day during the 30 days before the survey (i.e., current alcohol use) ( Table 49). The prevalence of current alcohol use was higher among white (35.2%) and Hispanic (34.4%) than black (23.8%) students, higher among white female (35.3%) and Hispanic female (35.6%) than black female (25.9%) students, and higher among white male (35.2%) and Hispanic male (33.4%) than black male (22.1%) students. The prevalence of current alcohol use was higher among 11th-grade (38.0%) and 12th-grade (42.4%) than 9th-grade (23.4%) and 10th-grade (29.0%) students, higher among 12th-grade (42.4%) than 11th-grade (38.0%) students, higher among 11th-grade female (38.3%) and 12th-grade female (43.2%) than 9th-grade female (24.9%) and 10th-grade female (28.8%) students; higher among 12th-grade female (43.2%) than 11th-grade female (38.3%) students, and higher among 11th-grade male (37.7%) and 12th-grade male (41.6%) than 9th-grade male (22.1%) students and 10th-grade male (29.3%) students.

During 1991–2015, a significant linear decrease occurred overall in the prevalence of current alcohol use (50.8%–32.8%). A significant quadratic trend also was identified. The prevalence of current alcohol use decreased during 1991–2007 (50.8%–44.7%) and then decreased more rapidly during 2007–2015 (44.7%–32.8%). The prevalence of current alcohol use did not change significantly from 2013 (34.9%) to 2015 (32.8%).

Across 36 states, the prevalence of current alcohol use ranged from 22.0% to 34.8% (median: 29.8%) ( Table 50). Across 19 large urban school districts, the prevalence ranged from 18.4% to 38.2% (median: 24.8%).

Someone Gave Alcohol to Them

Among the 32.8% of students nationwide who currently drank alcohol, 44.1% had usually obtained the alcohol they drank by someone giving it to them during the 30 days before the survey (Table 49). The prevalence of usually obtaining the alcohol they drank by someone giving it to them was higher among female (48.5%) than male (39.9%) students; higher among white female (50.7%) and Hispanic female (45.9%) than white male (41.6%) and Hispanic male (36.5%) students, respectively; and higher among 9th-grade female (50.4%), 10th-grade female (50.0%), and 11th-grade female (49.7%) than 9th-grade male (39.4%), 10th-grade male (34.5%), and 11th-grade male (39.3%) students, respectively. The prevalence of usually obtaining the alcohol they drank by someone giving it to them was higher among white (46.1%) than Hispanic (41.3%) students.

During 2007–2015, significant linear and quadratic trends were not identified in the prevalence of usually obtaining the alcohol they drank by someone giving it to them. The prevalence of usually obtaining the alcohol they drank by someone giving it to them did not change significantly from 2013 (41.8%) to 2015 (44.1%).

Across 32 states, the prevalence of usually obtaining the alcohol they drank by someone giving it to them ranged from 32.2% to 45.3% (median: 39.8%) (Table 44). Across 14 large urban school districts, the prevalence ranged from 26.9% to 44.8% (median: 37.9%).

Consumed Five or More Drinks in a Row

Nationwide, 17.7% of students had had five or more drinks of alcohol in a row (i.e., within a couple of hours) on at least 1 day during the 30 days before the survey ( Table 51). The prevalence of having five or more drinks of alcohol in a row was higher among white (19.7%) and Hispanic (17.7%) than black (11.4%) students, higher among white female (18.6%) and Hispanic female (17.9%) than black female (9.9%) students, and higher among white male (21.0%) and Hispanic male (17.5%) than black male (12.8%) students. The prevalence of having five or more drinks of alcohol in a row was higher among 10th-grade (15.1%), 11th-grade (22.1%), and 12th-grade (24.6%) than 9th-grade (10.4%) students; higher among 11th-grade (22.1%) and 12th-grade (24.6%) than 10th-grade (15.1%) students; higher among 10th-grade female (14.1%), 11th-grade female (19.6%), and 12th-grade female (23.8%) than 9th-grade female (10.5%) students; higher among 11th-grade female (19.6%) and 12th-grade female (23.8%) than 10th-grade female (14.1%) students; higher among 12th-grade female (23.8%) than 11th-grade female (19.6%) students, higher among 10th-grade male (16.2%), 11th-grade male (24.4%), and 12th-grade male (25.6%) than 9th-grade male (10.2%) students; and higher among 11th-grade male (24.4%) and 12th-grade male (25.6%) than 10th-grade male (16.2%) students.

During 1991–2015, a significant linear decrease occurred overall in the prevalence of having five or more drinks of alcohol in a row (31.3%–17.7%). A significant quadratic trend also was identified. The prevalence of having five or more drinks of alcohol in a row increased during 1991–1999 (31.3%–31.5%) and then decreased during 1999–2015 (31.5%–17.7%). The prevalence of having five or more drinks of alcohol in a row also decreased significantly from 2013 (20.8%) to 2015 (17.7%).

Across 36 states, the prevalence of having five or more drinks of alcohol in a row ranged from 11.0% to 20.7% (median: 15.5%) ( Table 52). Across 19 large urban school districts, the prevalence ranged from 8.0% to 16.5% (median: 10.9%).

Largest Number of Drinks in a Row Was 10 or More

Nationwide, 4.3% of students reported that the largest number of drinks that they had had in a row (i.e., within a couple of hours) during the 30 days before the survey was 10 or more (Table 51). The prevalence of reporting 10 or more as the largest number of drinks in a row was higher among male (6.1%) than female (2.5%) students; higher among white male (6.6%), black male (3.2%), and Hispanic male (6.5%) than white female (2.4%), black female (1.0%), and Hispanic female (3.6%) students, respectively; and higher among 10th-grade male (6.3%), 11th-grade male (7.3%), and 12th-grade male (8.8%) than 10th-grade female (2.2%), 11th-grade female (2.5%), and 12th-grade female (3.0%) students, respectively. The prevalence of reporting 10 or more as the largest number of drinks in a row was higher among white (4.5%) and Hispanic (5.1%) than black (2.1%) students, higher among white female (2.4%) and Hispanic female (3.6%) than black female ( 1.0%) students, and higher among white male (6.6%) and Hispanic male (6.5%) than black male (3.2%) students. The prevalence of reporting 10 or more as the largest number of drinks in a row was higher among 10th-grade (4.2%), 11th-grade (5.0%), and 12th-grade (5.9%) than 9th-grade (2.4%) students and higher among 10th-grade male (6.3%), 11th-grade male (7.3%), and 12th-grade male (8.8%) than 9th-grade male (2.4%) students.

Because the question measuring the reporting of 10 or more as the largest number of drinks in a row was used for the first time in the 2013 national YRBS, long-term temporal trends are not available. The prevalence of reporting 10 or more as the largest number of drinks in a row decreased significantly from 2013 (6.1%) to 2015 (4.3%).

Across 20 states, the prevalence of reporting 10 or more as the largest number of drinks in a row ranged from 2.1% to 7.4% (median: 3.5%) (Table 52). Across 13 large urban school districts, the prevalence ranged from 0.7% to 3.4% (median: 2.2%).

Ever Used Marijuana

Nationwide, 38.6% of students had used marijuana one or more times during their life (i.e., ever used marijuana) ( Table 53). The prevalence of having ever used marijuana was higher among black male (49.7%) than black female (40.5%) students. The prevalence of having ever used marijuana was higher among black (45.5%) and Hispanic (45.6%) than white (35.2%) students, higher among black female (40.5%) and Hispanic female (45.3%) than white female (34.3%) students, and higher among black male (49.7%) and Hispanic male (46.0%) than white male (36.2%) students. The prevalence of having ever used marijuana was higher among 10th-grade (35.5%), 11th-grade (45.2%), and 12th-grade (49.8%) than 9th-grade (25.9%) students; higher among 11th-grade (45.2%) and 12th-grade (49.8%) than 10th-grade (35.5%) students; higher among 12th-grade (49.8%) than 11th-grade (45.2%) students; higher among 10th-grade female (33.8%), 11th-grade female (43.6%), and 1 2th-grade female (48.8%) than 9th-grade female (25.3%) students; higher among 11th-grade female (43.6%) and 12th-grade female (48.8%) than 10th-grade female (33.8%) students; higher among 12th-grade female (48.8%) than 11th-grade female (43.6%) students; higher among 10th-grade male (37.1%), 11th-grade male (46.9%), and 12th-grade male (50.9%) than 9th-grade male (26.5%) students; and higher among 11th-grade male (46.9%) and 12th-grade male (50.9%) than 10th-grade male (37.1%) students.

During 1991–2015, a significant linear trend was not identified in the prevalence of having ever used marijuana (31.3%–38.6%). A significant quadratic trend was identified. The prevalence of having ever used marijuana increased during 1991–1997 (31.3%–47.1%) and then decreased during 1997–2015 (47.1%–38.6%). The prevalence of having ever used marijuana did not change significantly from 2013 (40.7%) to 2015 (38.6%).

Across 29 states, the prevalence of having ever used marijuana ranged from 25.0% to 42.9% (median: 34.7%) ( Table 54). Across 15 large urban school districts, the prevalence ranged from 28.7% to 45.8% (median: 40.1%).

Tried Marijuana Before Age 13 Years

Nationwide, 7.5% of students had tried marijuana for the first time before age 13 years (Table 53). The prevalence of having tried marijuana before age 13 years was higher among male (9.2%) than female (5.6%) students; higher among white male (6.7%), black male (13.0%), and Hispanic male (13.6%) than white female (4.2%), black female (7.4%), and Hispanic female (8.2%) students, respectively; and higher among 11th-grade male (8.9%) and 12th-grade male (8.5%) than 11th-grade female (4.5%) and 12th-grade female (3.7%) students, respectively. The prevalence of having tried marijuana before age 13 years was higher among black (10.6%) and Hispanic (10.9%) than white (5.4%) students, higher among black female (7.4%) and Hispanic female (8.2%) than white female (4.2%) students, and higher among black male (13.0%) and Hispanic male (13.6%) than white male (6.7%) students. The prevalence of having tried marijuana before age 13 years was higher among 9th-grade (8.5%) and 10th-grade (8.3%) than 12th-grade (6.1%) students and higher among 9th-grade female (6.8%) and 10th-grade female (7.2%) than 11th-grade female (4.5%) and 12th-grade female (3.7%) students.

During 1991–2015, a significant linear decrease occurred overall in the prevalence of having tried marijuana before age 13 years (7.4%–7.5%).^*** A significant quadratic trend also was identified. The prevalence of having tried marijuana before age 13 years increased during 1991–1999 (7.4%–11.3%) and then decreased during 1999–2015 (11.3%–7.5%). The prevalence of having tried marijuana before age 13 years did not change significantly from 2013 (8.6%) to 2015 (7.5%).

Across 35 states, the prevalence of having tried marijuana before age 13 years ranged from 5.3% to 16.5% (median: 7.2%) (Table 54). Across 18 large urban school districts, the prevalence ranged from 5.7% to 15.7% (median: 8.9%).

Current Marijuana Use

Nationwide, 21.7% of students had used marijuana one or more times during the 30 days before the survey (i.e., current marijuana use) ( Table 55). The prevalence of current marijuana use was higher among male (23.2%) than female (20.1%) students, higher among black male (31.3%) than black female (22.1%) students, and higher among 10th-grade male (22.6%) than 10th-grade female (17.5%) students. The prevalence of current marijuana use was higher among black (27.1%) and Hispanic (24.5%) than white (19.9%) students and higher among black male (31.3%) than white male (21.2%) and Hispanic male (25.5%) students. The prevalence of current marijuana use was higher among 10th-grade (20.0%), 11th-grade (24.8%), and 12th-grade (27.6%) than 9th-grade (15.2%) students; higher among 11th-grade (24.8%) and 12th-grade (27.6%) than 10th-grade (20.0%) students; higher among 11th-grade female (24.3%) and 12th-grade female (24.6%) than 9th-grade female (1 4.7%) and 10th-grade female (17.5%) students; higher among 10th-grade male (22.6%), 11th-grade male (25.5%), and 12th-grade male (30.5%) than 9th-grade male (15.5%) students; and higher among 12th-grade male (30.5%) than 10th-grade male (22.6%) students.

During 1991–2015, a significant linear trend was not identified in the prevalence of current marijuana use (14.7%–21.7%). A significant quadratic trend was identified. The prevalence of current marijuana use increased during 1991–1995 (14.7%–25.3%) and then decreased during 1995–2015 (25.3%–21.7%). The prevalence of current marijuana use did not change significantly from 2013 (23.4%) to 2015 (21.7%).

Across 36 states, the prevalence of current marijuana use ranged from 12.4% to 25.3% (median: 19.1%) ( Table 56). Across 19 large urban school districts, the prevalence ranged from 15.9% to 28.7% (median: 22.2%).

Usually Used Marijuana by Smoking It

Among the 21.7% of students who currently used marijuana, 90.0% usually used marijuana by smoking it in a joint, bong, pipe, or blunt during the 30 days before the survey (Table 55). The prevalence of usually using marijuana by smoking it was higher among female (92.5%) than male (89.0%) students and higher among 12th-grade female (96.7%) than 12th-grade male (87.4%) students. The prevalence of usually using marijuana by smoking it was higher among 12th-grade female (96.7%) than 10th-grade female (91.4%) students. Because the question measuring the prevalence of usually using marijuana by smoking it in a joint, bong, pipe, or blunt was used for the first time in the 2015 national YRBS, long-term temporal trends and 2-year temporal changes are not available.

Also, this question was not included in the standard questionnaire used in the state and large urban school district surveys in 2015. Consequently, the range and median prevalence estimates across states and large urban school districts for the prevalence of usually using marijuana by smoking it are not available.

Ever Used Synthetic Marijuana

Nationwide, 9.2% of students had used synthetic marijuana (also called “K2,” “Spice,” “fake weed,” “King Kong,” “Yucatan Fire,” “Skunk,” or “Moon Rocks”) one or more times during their life (i.e., ever used synthetic marijuana) ( Table 57). The prevalence of having ever used synthetic marijuana was higher among male (10.3%) than female (7.9%) students; higher among white male (9.9%) and Hispanic male (12.9%) than white female (7.6%) and Hispanic female (10.3%) students, respectively; and higher among 11th-grade male (11.1%) and 12th-grade male (14.2%) than 11th-grade female (8.8%) and 12th-grade female (7.6%) students, respectively. The prevalence of having ever used synthetic marijuana was higher among Hispanic (11.7%) than white (8.8%) and black (7.8%) students, higher among Hispanic female (10.3%) than black female (5.9%) students, and higher among Hispanic male (12.9%) than white male (9.9%) and black male (8.9%) students. The prevalence of having ever used synthetic marijuana was higher among 11th-grade (10.0%) and 12th-grade (11.0%) than 9th-grade (7.1%) students; higher among 10th-grade male (9.7%), 11th-grade male (11.1%), and 12th-grade male (14.2%) than 9th-grade male (6.7%) students; and higher among 12th-grade male (14.2%) than 10th-grade male (9.7%) students. Because the question measuring the prevalence of having ever used synthetic marijuana was used for the first time in the 2015 national YRBS, long-term temporal trends and 2-year temporal changes are not available.

Across 27 states, the prevalence of having ever used synthetic marijuana ranged from 5.9% to 14.6% (median: 9.2%) ( Table 58). Across 17 large urban school districts, the prevalence ranged from 4.9% to 13.3% (median: 8.6%).

Ever Used Hallucinogenic Drugs

Nationwide, 6.4% of students had used hallucinogenic drugs (e.g., LSD, acid, PCP, angel dust, mescaline, or mushrooms) one or more times during their life (i.e., ever used hallucinogenic drugs) (Table 57). The prevalence of having ever used hallucinogenic drugs was higher among male (8.0%) than female (4.6%) students; higher among white male (8.1%) and black male (6.7%) than white female (4.7%) and black female (1.9%) students, respectively; and higher among 9th-grade male (5.9%) and 12th-grade male (12.0%) than 9th-grade female (3.1%) and 12th-grade female (3.9%) students, respectively. The prevalence of having ever used hallucinogenic drugs was higher among Hispanic (6.8%) than black (4.7%) students and higher among white female (4.7%) and Hispanic female (6.1%) than black female (1.9%) students. The prevalence of having ever used hallucinogenic drugs was higher among 11th-grade (6.7%) and 12th-grade (8.0%) than 9th-grade (4.7%) students; higher among 10th-grade female (5.3%) and 11th-grade female (5.9%) than 9th-grade female (3.1%) students; and higher among 12th-grade male (12.0%) than 9th-grade male (5.9%), 10th-grade male (7.0%), and 11th-grade male (7.0%) students.

During 2001–2015, a significant linear decrease occurred overall in the prevalence of having ever used hallucinogenic drugs (13.3%–6.4%). A significant quadratic trend also was identified. The prevalence of having ever used hallucinogenic drugs decreased during 2001–2005 (13.3%–8.5%) and then decreased more gradually during 2005–2015 (8.5%–6.4%). The prevalence of having ever used hallucinogenic drugs did not change significantly from 2013 (7.1%) to 2015 (6.4%).

This question was not included in the standard questionnaire used in the state and large urban school district surveys in 2015. As a result, the range and median prevalence estimates across states and large urban school districts for the prevalence of having ever used hallucinogenic drugs are not available.

Ever Used Cocaine

Nationwide, 5.2% of students had used any form of cocaine (e.g., powder, crack,^††† or freebase^§§§) one or more times during their life (i.e., ever used cocaine) ( Table 59). The prevalence of having ever used cocaine was higher among male (6.3%) than female (3.8%) students; higher among white male (5.0%), black male (5.3%), and Hispanic male (9.4%) than white female (3.3%), black female (1.8%), and Hispanic female (6.6%) students, respectively; and higher among 10th-grade male (6.4%), 11th-grade male (6.2%), and 12th-grade male (9.7%) than 10th-grade female (3.8%), 11th-grade female (3.3%), and 12th-grade female (4.5%) students, respectively. The prevalence of having ever used cocaine was higher among Hispanic (8.0%) than white (4.1%) and black (3.8%) students, higher among Hispanic female (6.6%) than white female (3.3%) and black female (1.8%) students, and higher among Hispanic male (9.4%) than white male (5.0%) and black male (5.3%) students. The prevalence of having ever used cocaine was higher among 10th-grade (5.1%), 11th-grade (5.0%), and 12th-grade (7.2%) than 9th-grade (3.4%) students; higher among 12th-grade (7.2%) than 10th-grade (5.1%) and 11th-grade (5.0%) students; higher among 10th-grade male (6.4%), 11th-grade male (6.2%), and 12th-grade male (9.7%) than 9th-grade male (3.3%) students; and higher among 12th-grade male (9.7%) than 10th-grade male (6.4%) and 11th-grade male (6.2%) students.

During 1991–2015, a significant linear decrease occurred in the prevalence of having ever used cocaine (5.9%–5.2%). A significant quadratic trend also was identified. The prevalence of having ever used cocaine increased during 1991–1999 (5.9%–9.5%) and then decreased during 1999–2015 (9.5%–5.2%). The prevalence of having ever used cocaine did not change significantly from 2013 (5.5%) to 2015 (5.2%).

Across 32 states, the prevalence of having ever used cocaine ranged from 3.4% to 9.2% (median: 4.8%) ( Table 60). Across 16 large urban school districts, the prevalence ranged from 4.4% to 9.6% (median: 5.3%).

Ever Used Ecstasy

Nationwide, 5.0% of students had used ecstasy (also called “MDMA”) one or more times during their life (i.e., ever used ecstasy) (Table 59). The prevalence of having ever used ecstasy was higher among male (6.0%) than female (3.9%) students; higher among black male (5.9%) and Hispanic male (7.8%) than black female (2.5%) and Hispanic female (4.1%) students, respectively; and higher among 10th-grade male (6.0%) and 12th-grade male (8.0%) than 10th-grade female (3.7%) and 12th-grade female (4.0%) students, respectively. The prevalence of having ever used ecstasy was higher among Hispanic (6.1%) than white (4.3%) and black (4.3%) students and higher among Hispanic male (7.8%) than white male (4.7%) students. The prevalence of having ever used ecstasy was higher among 10th-grade (4.9%), 11th-grade (5.7%), and 12th-grade (6.1%) than 9th-grade (3.2%) students; higher among 11th-grade female (4.8%) than 9th-grade female (2.8%) students; and higher among 10th-grade male (6.0%), 11th-grade male (6.2%), and 12th-grade male (8.0%) than 9th-grade male (3.6%) students.

During 2001–2015, a significant linear decrease occurred overall in the prevalence of having ever used ecstasy (11.1%–5.0%). A significant quadratic trend also was identified. The prevalence of having ever used ecstasy decreased during 2001–2005 (11.1%–6.3%) and then did not change significantly during 2005–2015 (6.3%–5.0%). The prevalence of having ever used ecstasy decreased significantly from 2013 (6.6%) to 2015 (5.0%).

Across 27 states, the prevalence of having ever used ecstasy ranged from 3.4% to 8.0% (median: 5.1%) (Table 60). Across 14 large urban school districts, the prevalence ranged from 4.2% to 9.1% (median: 5.6%).

Ever Used Heroin

Nationwide, 2.1% of students had used heroin (also called “smack,” “junk,” or “China White”) one or more times during their life (i.e., ever used heroin) ( Table 61). The prevalence of having ever used heroin was higher among male (2.7%) than female (1.2%) students; higher among black male (3.8%) and Hispanic male (3.2%) than black female (1.5%) and Hispanic female (1.9%) students, respectively; and higher among 10th-grade male (3.3%), 11th-grade male (2.3%), and 12th-grade male (2.8%) than 10th-grade female (1.5%), 11th-grade female (0.9%), and 12th-grade female (1.0%) students, respectively. The prevalence of having ever used heroin was higher among Hispanic (2.6%) than white (1.3%) students, higher among Hispanic female (1.9%) than white female (0.8%) students, and higher among Hispanic male (3.2%) than white male (1.7%) students. The prevalence of having ever used heroin was higher among 1 0th-grade male (3.3%) than 9th-grade male (2.0%) students.

During 1999–2015, a significant linear decrease occurred overall in the prevalence of having ever used heroin (2.4%–2.1%). A significant quadratic trend was not identified. The prevalence of having ever used heroin did not change significantly from 2013 (2.2%) to 2015 (2.1%).

Across 32 states, the prevalence of having ever used heroin ranged from 0.9% to 5.9% (median: 2.5%) ( Table 62). Across 17 large urban school districts, the prevalence ranged from 1.5% to 8.3% (median: 3.3%).

Ever Used Methamphetamines

Nationwide, 3.0% of students had used methamphetamines (also called “speed,” “crystal,” “crank,” or “ice”) one or more times during their life (i.e., ever used methamphetamines) (Table 61). The prevalence of having ever used methamphetamines was higher among male (3.6%) than female (2.3%) students, higher among black male (3.9%) than black female (1.4%) students, and higher among 12th-grade male (5.6%) than 12th-grade female (1.8%) students. The prevalence of having ever used methamphetamines was higher among Hispanic (4.4%) than white (2.1%) students, higher among Hispanic female (4.0%) than white female (1.7%) and black female (1.4%) students, and higher among Hispanic male (4.7%) than white male (2.5%) students. The prevalence of having ever used methamphetamines was higher among 10th-grade (3.3%) and 12th-grade (3.8%) than 9th-grade (2.0%) students, higher among 10th-grade m ale (4.2%) and 12th-grade male (5.6%) than 9th-grade male (1.9%) students, and higher among 12th-grade male (5.6%) than 11th-grade male (2.8%) students.

During 1999–2015, a significant linear decrease occurred overall in the prevalence of having ever used methamphetamines (9.1%–3.0%). A significant quadratic trend was not identified. The prevalence of having ever used methamphetamines did not change significantly from 2013 (3.2%) to 2015 (3.0%).

Across 29 states, the prevalence of having ever used methamphetamines ranged from 1.7% to 6.0% (median: 3.2%) (Table 62). Across 16 large urban school districts, the prevalence ranged from 2.4% to 7.9% (median: 3.7%).

Ever Took Steroids Without a Doctor’s Prescription

Nationwide, 3.5% of students had taken steroid pills or shots without a doctor’s prescription one or more times during their life (i.e., ever took steroids without a doctor’s prescription) ( Table 63). The prevalence of having ever taken steroids without a doctor’s prescription was higher among male (4.0%) than female (2.7%) students, higher among white male (3.6%) than white female (1.8%) students, and higher among 12th-grade male (4.8%) higher than 12th-grade female (1.6%) students. The prevalence of having ever taken steroids without a doctor’s prescription was higher among Hispanic (4.1%) than white (2.7%) students and higher among Hispanic female (3.9%) than white female (1.8%) students. The prevalence of having ever taken steroids without a doctor’s prescription was higher among 9th-grade female (3.4%) and 10th-grade female (3.4%) than 12th-grade female (2.0%) students and higher among 10th-gra de male (4.4%) and 12th-grade male (4.8%) than 11th-grade male (2.8%) students.

During 1991–2015, a significant linear trend was not identified in the prevalence of having ever taken steroids without a doctor’s prescription. A significant quadratic trend was identified. The prevalence of having ever taken steroids without a doctor’s prescription increased during 1991–2001 (2.7%–5.0%) and then decreased during 2001–2015 (5.0%–3.5%). The prevalence of having ever taken steroids without a doctor’s prescription did not change significantly from 2013 (3.2%) to 2015 (3.5%).

Across 24 states, the prevalence of having ever taken steroids without a doctor’s prescription ranged from 1.4% to 6.3% (median: 3.8%) ( Table 64). Across 12 large urban school districts, the prevalence ranged from 2.5% to 8.7% (median: 3.5%).

Ever Took Prescription Drugs Without a Doctor’s Prescription

Nationwide, 16.8% of students had taken prescription drugs (e.g., Oxycontin, Percocet, Vicodin, codeine, Adderall, Ritalin, or Xanax) without a doctor’s prescription one or more times during their life (i.e., ever took prescription drugs without a doctor’s prescription) (Table 63). The prevalence of having ever taken prescription drugs without a doctor’s prescription was higher among male (17.8%) than female (15.6%) students, higher among black male (18.1%) than black female (10.7%) students, and higher among 11th-grade male (21.5%) higher than 11th-grade female (16.0%) students. The prevalence of having ever taken prescription drugs without a doctor’s prescription was higher among Hispanic (17.5%) than black (14.8%) students and higher among white female (15.9%) and Hispanic female (16.5%) than black female (10.7%) students. The prevalence of having ever taken prescription drugs without a doctor’s prescription was higher among 11th-grade (18.9%) and 12th-grade (20.3%) than 9th-grade (13.0%) and 10th-grade (15.3%) students, higher among 11th-grade female (16.0%) and 12th-grade female (18.8%) than 9th-grade female (12.5%) students, and higher among 11th-grade male (21.5%) and 12th-grade male (21.7%) than 9th-grade male (13.3%) and 10th-grade male (15.1%) students.

During 2011–2015, a significant linear decrease occurred in the prevalence of having ever taken prescription drugs without a doctor’s prescription (20.2%–16.8%). A significant quadratic trend was not identified. The prevalence of having ever taken prescription drugs without a doctor’s prescription did not change significantly from 2013 (17.8%) to 2015 (16.8%).

Across 32 states, the prevalence of having ever taken prescription drugs without a doctor’s prescription ranged from 10.8% to 19.2% (median: 14.4%) (Table 64). Across 17 large urban school districts, the prevalence ranged from 7.9% to 16.1% (median: 13.3%).

Ever Used Inhalants

Nationwide, 7.0% of students had sniffed glue, breathed the contents of aerosol spray cans, or inhaled any paints or sprays to get high one or more times during their life (i.e., ever used inhalants) ( Table 65). The prevalence of having ever used inhalants was higher among Hispanic female (8.3%) than white female (5.9%) students. The prevalence of having ever used inhalants was higher among 9th-grade (8.3%) than 11th-grade (5.9%) and 12th-grade (6.0%) students and higher among 9th-grade female (8.5%) and 10th-grade female (7.8%) than 11th-grade female (4.6%) and 12th-grade female (4.9%) students.

During 1995–2015, a significant linear decrease occurred overall in the prevalence of having ever used inhalants (20.3%–7.0%). A significant quadratic trend was not identified. The prevalence of having ever used inhalants without a doctor’s prescription decreased significantly from 2013 (8.9%) to 2015 (7.0%).

Across 29 states, the prevalence of having ever used inhalants ranged from 3.2% to 11.6% (median: 7.7%) ( Table 66). Across 16 large urban school districts, the prevalence ranged from 4.7% to 12.7% (median: 7.7%).

Ever Injected Any Illegal Drug

Nationwide, 1.8% of students had used a needle to inject any illegal drug into their body one or more times during their life (i.e., ever injected any illegal drug) ( Table 67). The prevalence of having ever injected any illegal drug was higher among male (2.3%) than female (1.0%) students; higher among white male (1.7%) and Hispanic male (2.8%) than white female (0.7%) and Hispanic female (1.6%) students, respectively; and higher among 10th-grade male (2.6%) and 12th-grade male (3.4%) than 10th-grade female (0.7%) and 12th-grade female (0.8%) students, respectively. The prevalence of having ever injected any illegal drug was higher among black (2.5%) and Hispanic (2.2%) than white (1.2%) students and higher among Hispanic female (1.6%) than white female (0.7%) students. The prevalence of having ever injected any illegal drug was higher among 9th-grade female (1.5%) than 10th-grade female (0.7%) students.

During 1995–2015, a significant linear trend was not identified in the prevalence of having ever injected any illegal drug. A significant quadratic trend was identified. The prevalence of having ever injected any illegal drug did not change during 1995–2011 (2.1%–2.3%) and then decreased during 2011–2015 (2.3%–1.8%). The prevalence of having ever injected any illegal drug did not change significantly from 2013 (1.7%) to 2015 (1.8%).

Across 25 states, the prevalence of having ever injected any illegal drug ranged from 1.0% to 5.4% (median: 2.4%) ( Table 68). Across 13 large urban school districts, the prevalence ranged from 1.6% to 6.6% (median: 2.5%).

Offered, Sold, or Given an Illegal Drug on School Property

Nationwide, 21.7% of students had been offered, sold, or given an illegal drug by someone on school property during the 12 months before the survey (Table 67). The prevalence of having been offered, sold, or given an illegal drug on school property was higher among male (24.2%) than female (19.1%) students; higher among white male (23.2%) than white female (16.5%) students; and higher among 10th-grade male (24.6%), 11th-grade male (24.9%), and 12th-grade male (24.4%) than 10th-grade female (19.3%), 11th-grade female (20.4%), and 12th-grade female (16.3%) students, respectively. The prevalence of having been offered, sold, or given an illegal drug on school property was higher among Hispanic (27.2%) than white (19.8%) and black (20.6%) students, higher among Hispanic female (25.5%) than white female (16.5%) students, and higher among Hispanic male (28.9%) than white male (23.2%) and black male (22.0%) students. The prevalence of havin g been offered, sold, or given an illegal drug on school property was higher among 9th-grade female (20.0%) and 11th-grade female (20.4%) than 12th-grade female (20.4%) students.

During 1993–2015, a significant linear decrease occurred overall in the prevalence of having been offered, sold, or given an illegal drug on school property (24.0%–21.7%). A significant quadratic trend also was identified. The prevalence of having been offered, sold, or given an illegal drug on school property increased during 1993–1997 (24.0%–31.7%) and then decreased during 1997–2015 (31.7%–21.7%). The prevalence of having been offered, sold, or given an illegal drug on school property did not change significantly from 2013 (22.1%) to 2015 (21.7%).

Across 32 states, the prevalence of having been offered, sold, or given an illegal drug on school property ranged from 14.7% to 29.8% (median: 22.3%) (Table 68). Across 16 large urban school districts, the prevalence ranged from 20.5% to 34.6% (median: 26.8%).

Sexual Behaviors Related to Unintended Pregnancy and Sexually Transmitted Infections, Including HIV Infection

Ever Had Sexual Intercourse

Nationwide, 41.2% of students had ever had sexual intercourse ( Table 69). The prevalence of having ever had sexual intercourse was higher among male (43.2%) than female (39.2%) students; higher among black male (58.8%) and Hispanic male (45.1%) than black female (37.4%) and Hispanic female (39.8%) students, respectively; and higher among 9th-grade male (27.3%) than 9th-grade female (20.7%) students. The prevalence of having ever had sexual intercourse was higher among black (48.5%) than white (39.9%) students and higher among black male (58.8%) than white male (39.5%) and Hispanic male (45.1%) students. The prevalence of having ever had sexual intercourse was higher among 10th-grade (35.7%), 11th-grade (49.6%), and 12th-grade (58.1%) than 9th-grade (24.1%) students; higher among 11th-grade (49.6%) and 12th-grade (58.1%) than 10th-grade (35.7%) students; higher among 12th-grade (58.1%) than 11th-grade (49.6%) students; higher among 10 th-grade female (33.5%), 11th-grade female (48.2%), and 12th-grade female (57.2%) than 9th-grade female (20.7%) students; higher among 11th-grade female (48.2%) and 12th-grade female (57.2%) than 10th-grade female (33.5%) students; higher among 12th-grade female (57.2%) than 11th-grade female (48.2%) students; higher among 10th-grade male (37.9%), 11th-grade male (51.2%), and 12th-grade male (59.0%) than 9th-grade male (27.3%) students; higher among 11th-grade male (51.2%) and 12th-grade male (59.0%) than 10th-grade male (37.9%) students; and higher among 12th-grade male (59.0%) than 11th-grade male (51.2%) students.

During 1991–2015, a significant linear decrease occurred overall in the prevalence of having ever had sexual intercourse (54.1%–41.2%). A significant quadratic trend was not identified. The prevalence of having ever had sexual intercourse decreased significantly from 2013 (46.8%) to 2015 (41.2%).

Across 33 states, the prevalence of having ever had sexual intercourse ranged from 30.4% to 48.0% (median: 39.0%) ( Table 70). Across 19 large urban school districts, the prevalence ranged from 25.9% to 52.4% (median: 39.5%).

Had First Sexual Intercourse Before Age 13 Years

Nationwide, 3.9% of students had had sexual intercourse for the first time before age 13 years (Table 69). The prevalence of having had sexual intercourse before age 13 years was higher among male (5.6%) than female (2.2%) students; higher among white male (3.5%), black male (12.1%), and Hispanic male (6.8%) than white female (1.6%), black female (4.3%), and Hispanic female (3.1%) students, respectively; and higher among 9th-grade male (4.6%), 10th-grade male (6.8%), 11th-grade male (4.8%), and 12th-grade male (5.5%) than 9th-grade female (2.5%), 10th-grade female (2.7%), 11th-grade female (1.6%), and 12th-grade female (1.7%) students, respectively. The prevalence of having had sexual intercourse before age 13 years was higher among black (8.3%) and Hispanic (5.0%) than white (2.5%) students, higher among black (8.3%) than Hispanic (5.0%) students, higher among black female (4.3%) and Hispanic female (3.1%) than white female (1.6%) students, higher among black male (12.1%) and Hispanic male (6.8%) than white male (3.5%) students, and higher among black male (12.1%) than Hispanic male (6.8%) students. The prevalence of having had sexual intercourse before age 13 years was higher among 10th-grade (4.7%) than 11th-grade (3.2%) students and higher among 10th-grade male (6.8%) than 9th-grade male (4.6%) and 11th-grade male (4.8%) students.

During 1991–2015, a significant linear decrease occurred overall in the prevalence of having had sexual intercourse before age 13 years (10.2%–3.9%). A significant quadratic trend was not identified. The prevalence of having had sexual intercourse before age 13 years decreased significantly from 2013 (5.6%) to 2015 (3.9%).

Across 35 states, the prevalence of having had sexual intercourse before age 13 years ranged from 2.6% to 8.3% (median: 3.5%) (Table 70). Across 19 large urban school districts, the prevalence ranged from 2.7% to 12.2% (median: 5.7%).

Had Sexual Intercourse with Four or More Persons During Their Life

Nationwide, 11.5% of students had had sexual intercourse with four or more persons during their life ( Table 71). The prevalence of having had sexual intercourse with four or more persons was higher among male (14.1%) than female (8.8%) students; higher among black male (28.2%) and Hispanic male (15.3%) than black female (9.2%) and Hispanic female (6.7%) students, respectively; and higher among 9th-grade male (6.7%), 10th-grade male (12.1%), 11th-grade male (16.0%), and 12th-grade male (22.4%) than 9th-grade female (3.0%), 10th-grade female (6.0%), 11th-grade female (10.7%), and 12th-grade female (16.1%) students, respectively. The prevalence of having had sexual intercourse with four or more persons was higher among black (19.0%) than white (9.9%) and Hispanic (11.0%) students, higher among black male (28.2%) and Hispanic male (15.3%) than white male (10.6%) students, and higher among black male (28.2%) than Hispanic male (15.3%) stu dents. The prevalence of having had sexual intercourse with four or more persons was higher among 10th-grade (9.0%), 11th-grade (13.4%), and 12th-grade (19.2%) than 9th-grade (4.9%) students; higher among 11th-grade (13.4%) and 12th-grade (19.2%) than 10th-grade (9.0%) students; higher among 12th-grade (19.2%) than 11th-grade (13.4%) students, higher among 10th-grade female (6.0%), 11th-grade female (10.7%), and 12th-grade female (16.1%) than 9th-grade female (3.0%) students; higher among 11th-grade female (10.7%) and 12th-grade female (16.1%) than 10th-grade female (6.0%) students; higher among 12th-grade female (16.1%) than 11th-grade female (10.7%) students, and higher among 10th-grade male (12.1%), 11th-grade male (16.0%), and 12th-grade male (22.4%) than 9th-grade male (6.7%) students; higher among 11th-grade male (16.0%) and 12th-grade male (22.4%) than 10th-grade male (12.1%) students; and higher among 12th-grade male (22.4%) than 11th-grade male (16.0%) students.

During 1991–2015, a significant linear decrease occurred overall in the prevalence of having had sexual intercourse with four or more persons (18.7%–11.5%). A significant quadratic trend was not identified. The prevalence of having had sexual intercourse with four or more persons decreased significantly from 2013 (15.0%) to 2015 (11.5%).

Across 31 states, the prevalence of having had sexual intercourse with four or more persons ranged from 6.2% to 16.0% (median: 10.0%) ( Table 72). Across 18 large urban school districts, the prevalence ranged from 5.7% to 19.4% (median: 11.2%).

Currently Sexually Active

Nationwide, 30.1% of students had had sexual intercourse with at least one person during the 3 months before the survey (i.e., currently sexually active) (Table 71). The prevalence of being currently sexually active was higher among black male (40.0%) than black female (25.7%) students and higher among 9th-grade male (17.3%) than 9th-grade female (14.0%) students. The prevalence of being currently sexually active was higher among white female (31.4%) than black female (25.7%) students and higher among black male (40.0%) than white male (29.1%) and Hispanic male (30.5%) students. The prevalence of being currently sexually active was higher among 10th-grade (25.5%), 11th-grade (35.5%), and 12th-grade (46.0%) than 9th-grade (15.7%) students; higher among 11th-grade (35.5%) and 12th-grade (46.0%) than 10th-grade (25.5%) students; higher among 12th-grade (46.0%) than 11th-grade (35.5%) students; higher among 10th-grade female (24.7%), 11t h-grade female (36.7%), and 12th-grade female (46.5%) than 9th-grade female (14.0%) students; higher among 11th-grade female (36.7%) and 12th-grade female (46.5%) than 10th-grade female (24.7%) students; higher among 12th-grade female (46.5%) than 11th-grade female (36.7%) students; higher among 10th-grade male (26.4%), 11th-grade male (34.5%), and 12th-grade male (45.4%) than 9th-grade male (17.3%) students; higher among 11th-grade male (34.5%) and 12th-grade male (45.4%) than 10th-grade male (26.4%) students; and higher among 12th-grade male (45.4%) than 11th-grade male (34.5%) students.

During 1991–2015, a significant linear decrease occurred overall in the prevalence of being currently sexually active (37.5%–30.1%). A significant quadratic trend was not identified. The prevalence of being currently sexually active decreased significantly from 2013 (34.0%) to 2015 (30.1%).

Across 35 states, the prevalence of being currently sexually active ranged from 22.3% to 35.5% (median: 28.5%) (Table 72). Across 19 large urban school districts, the prevalence ranged from 18.7% to 37.2% (median: 26.3%).

Condom Use

Among the 30.1% of currently sexually active students nationwide, 56.9% reported that either they or their partner had used a condom during last sexual intercourse ( Table 73). The prevalence of having used a condom during last sexual intercourse was higher among male (61.5%) than female (52.0%) students; higher among black male (73.6%) and Hispanic male (62.5%) than black female (46.7%) and Hispanic female (48.3%) students, respectively; and higher among 10th-grade male (65.6%), 11th-grade male (62.5%), and 12th-grade male (57.4%) than 10th-grade female (54.0%), 11th-grade female (52.9%), and 12th-grade female (48.8%) students, respectively. The prevalence of having used a condom during last sexual intercourse was higher among black (63.4%) than Hispanic (55.6%) students, higher among white female (55.9%) than black female (46.7%) students, and higher among black male (73.6%) than white male (58.1%) and Hispanic male (62.5%) students . The prevalence of having used a condom during last sexual intercourse was higher among 9th-grade (60.5%) and 10th-grade (59.9%) than 12th-grade (52.9%) students and higher among 9th-grade female (56.7%) than 12th-grade female (48.8%) students.

During 1991–2015, a significant linear increase occurred overall in the prevalence of having used a condom during last sexual intercourse (46.2%–56.9%). A significant quadratic trend also was identified. The prevalence of having used a condom during last sexual intercourse increased during 1991–2003 (46.2%–63.0%) and then decreased during 2003–2015 (63.0%–56.9%). The prevalence of having used a condom during last sexual intercourse did not change significantly from 2013 (59.1%) to 2015 (56.9%).

Across 35 states, the prevalence of having used a condom during last sexual intercourse ranged from 48.4% to 63.3% (median: 57.9%) ( Table 74). Across 19 large urban school districts, the prevalence ranged from 55.4% to 68.9% (median: 60.6%).

Birth Control Pill Use

Among the 30.1% of currently sexually active students nationwide, 18.2% reported that either they or their partner had used birth control pills to prevent pregnancy before last sexual intercourse (Table 73). The prevalence of having used birth control pills before last sexual intercourse was higher among female (21.3%) than male (15.2%) students; higher among Hispanic female (15.4%) than Hispanic male (8.1%) students; and higher among 10th-grade female (20.2%) and 12th-grade female (23.2%) than 10th-grade male (11.6%) and 12th-grade male (16.9%) students, respectively. The prevalence of having used birth control pills before last sexual intercourse was higher among white (23.5%) than black (9.0%) and Hispanic (11.8%) students, higher among white female (25.4%) than black female (9.0%) and Hispanic female (15.4%) students, and higher among white male (21.4%) than black male (9.0%) and Hispanic male (8.1%) students. The prevalence of h aving used birth control pills before last sexual intercourse was higher among 10th-grade (15.9%), 11th-grade (21.5%), and 12th-grade (20.1%) than 9th-grade (10.9%) students; higher among 11th-grade (21.5%) than 10th-grade (15.9%) students; higher among 10th-grade female (20.2%), 11th-grade female (23.9%), and 12th-grade female (23.2%) than 9th-grade female (11.2%) students; higher among 11th-grade male (19.1%) and 12th-grade male (16.9%) than 9th-grade male (10.8%) students; and higher among 11th-grade male (19.1%) than 10th-grade male (11.6%) students.

During 1991–2015, a significant linear trend was not identified in the prevalence of having used birth control pills before last sexual intercourse. A significant quadratic trend was identified. The prevalence of having used birth control pills before last sexual intercourse decreased during 1991–1995 (20.8%–17.4%) and then increased during 1995–2015 (17.4%–18.2%). The prevalence of having used birth control pills before last sexual intercourse did not change significantly from 2013 (19.0%) to 2015 (18.2%).

Across 33 states, the prevalence of having used birth control pills before last sexual intercourse ranged from 13.1% to 34.6% (median: 20.7%) (Table 74). Across 18 large urban school districts, the prevalence ranged from 6.8% to 18.6% (median: 12.0%).

IUD or Implant Use

Among the 30.1% of currently sexually active students nationwide, 3.3% reported that either they or their partner had used an IUD (such as Mirena or ParaGard) or implant (such as Implanon or Nexplanon) to prevent pregnancy before last sexual intercourse ( Table 75). The prevalence of having used an IUD or implant before last sexual intercourse was higher among female (4.5%) than male (2.2%) students.

Because the response option measuring the prevalence of having used an IUD or implant before last sexual intercourse was used for the first time in the 2013 national YRBS, long-term temporal trends are not available. The prevalence of having used an IUD or implant before last sexual intercourse increased from 2013 (1.6%) to 2015 (3.3%).

Across 33 states, the prevalence of having used an IUD or implant before last sexual intercourse ranged from 1.3% to 9.7% (median: 3.4%) ( Table 76). Across 18 large urban school districts, the prevalence ranged from 0.5% to 16.9% (median: 2.1%).

Shot, Patch, or Birth Control Ring Use

Among the 30.1% of currently sexually active students nationwide, 5.3% reported that either they or their partner had used a shot (such as Depo-Provera), patch (such as OrthoEvra), or birth control ring (such as NuvaRing) to prevent pregnancy before last sexual intercourse (Table 75). The prevalence of having used a shot, patch, or birth control ring before last sexual intercourse was higher among female (7.9%) than male (2.7%) students; higher among white female (8.9%) and black female (7.8%) than white male (2.7%) and black male (3.1%) students, respectively; and higher among 9th-grade female (5.8%), 10th-grade female (9.3%), 11th-grade female (7.3%), and 12th-grade female (8.3%) than 9th-grade male (1.4%), 10th-grade male (2.4%), 11th-grade male (3.5%), and 12th-grade male (3.0%) students, respectively. The prevalence of having used a shot, patch, or birth control ring before last sexual intercourse was higher among white (6.0%) than Hispanic (3.1%) students and higher among white female (8.9%) and black female (7.8%) than Hispanic female (3.7%) students.

Because the response option measuring the prevalence of having used a shot, patch, or birth control ring before last sexual intercourse was used for the first time in the 2013 national YRBS, long-term temporal trends are not available. The prevalence of having used a shot, patch, or birth control ring before last sexual intercourse did not change significantly from 2013 (4.7%) to 2015 (5.3%).

Across 33 states, the prevalence of having used a shot, patch, or birth control ring before last sexual intercourse ranged from 1.6% to 9.5% (median: 5.6%) (Table 76). Across 18 large urban school districts, the prevalence ranged from 1.1% to 10.5% (median: 4.4%).

Birth Control Pill; IUD or Implant; or Shot, Patch, or Birth Control Ring Use

Among the 30.1% of currently sexually active students nationwide, 26.8% reported that either they or their partner had used birth control pills; an IUD (such as Mirena or ParaGard) or implant (such as Implanon or Nexplanon); or a shot (such as Depo-Provera), patch (such as OrthoEvra), or birth control ring (such as NuvaRing) to prevent pregnancy before last sexual intercourse ( Table 77). The prevalence of having used birth control pills; an IUD or implant; or a shot, patch, or birth control ring before last sexual intercourse was higher among female (33.7%) than male (20.2%) students; higher among white female (39.2%) and Hispanic female (23.2%) than white male (27.0%) and Hispanic male (12.3%) students, respectively; and higher among 9th-grade female (20.8%), 10th-grade female (33.6%), 11th-grade female (36.2%), and 12th-grade female (36.2%) than 9th-grade male (13.1%), 10th-grade male (15.5%), 11th-grade male (25.5%), and 12th-grad e male (22.7%) students, respectively. The prevalence of having used birth control pills; an IUD or implant; or a shot, patch, or birth control ring before last sexual intercourse was higher among white (33.3%) than black (15.9%) and Hispanic (17.8%) students, higher among white female (39.2%) than black female (20.5%) and Hispanic female (23.2%) students, and higher among white male (27.0%) than black male (13.1%) and Hispanic male (12.3%) students. The prevalence of having used birth control pills; an IUD or implant; or a shot, patch, or birth control ring before last sexual intercourse was higher among 10th-grade (24.4%), 11th-grade (30.9%), and 12th-grade (29.6%) than 9th-grade (16.4%) students; higher among 11th-grade (30.9%) than 10th-grade (24.4%) students; higher among 10th-grade female (33.6%), 11th-grade female (36.2%), and 12th-grade female (36.2%) than 9th-grade female (20.8%) students; and higher among 11th-grade male (25.5%) and 12th-grade male (22.7%) than 9th -grade male (13.1%) and 10th-grade male (15.5%) students.

During 2011–2015, a significant linear increase occurred overall in the prevalence of having used birth control pills; an IUD or implant; or a shot, patch, or birth control ring before last sexual intercourse (23.3%–26.8%). A significant quadratic trend was not identified. The prevalence of having used birth control pills; an IUD or implant; or a shot, patch, or birth control ring before last sexual intercourse did not change significantly from 2013 (25.3%) to 2015 (26.8%).

Across 33 states, the prevalence of having used birth control pills; an IUD or implant; or a shot, patch, or birth control ring before last sexual intercourse ranged from 17.5% to 47.3% (median: 30.1%) ( Table 78). Across 18 large urban school districts, the prevalence ranged from 10.4% to 37.6% (median: 18.3%).

Condom Use and Birth Control Pill; IUD or Implant; or Shot, Patch, or Birth Control Ring Use

Among the 30.1% of currently sexually active students nationwide, 8.8% reported that either they or their partner had used both a condom during last sexual intercourse and birth control pills; an IUD (such as Mirena or ParaGard) or implant (such as Implanon or Nexplanon); or a shot (such as Depo-Provera), patch (such as OrthoEvra), or birth control ring (such as NuvaRing) to prevent pregnancy before last sexual intercourse (Table 77). The prevalence of having used both a condom during last sexual intercourse and birth control pills; an IUD or implant; or a shot, patch, or birth control ring before last sexual intercourse was higher among female (11.8%) than male (5.9%) students; higher among white female (15.9%) than white male (7.7%) students; and higher among 10th-grade female (12.4%) and 12th-grade female (9.9%) than 10th-grade male (4.3%) and 12th-grade male (5.5%) students, respectively. The prevalence of having used both a cond om during last sexual intercourse and birth control pills; an IUD or implant; or a shot, patch, or birth control ring before last sexual intercourse was higher among white (12.0%) than black (4.7%) and Hispanic (4.7%) students, higher among white female (15.9%) than black female (5.7%) and Hispanic female (4.8%) students, and higher among white male (7.7%) than black male (4.1%) students. The prevalence of having used both a condom during last sexual intercourse and birth control pills; an IUD or implant; or a shot, patch, or birth control ring before last sexual intercourse was higher among 11th-grade (12.2%) than 9th-grade (5.8%) and 12th-grade (7.7%) students and higher among 11th-grade male (9.4%) than 9th-grade male (3.2%) students.

Because the response options measuring the prevalence of using both a condom during last sexual intercourse and birth control pills; an IUD or implant; or a shot, patch, or birth control ring before last sexual intercourse were used for the first time in the 2013 national YRBS, long-term temporal trends are not available. The prevalence of having used both a condom during last sexual intercourse and birth control pills; an IUD or implant; or a shot, patch, or birth control ring before last sexual intercourse did not change significantly from 2013 (8.8%) to 2015 (8.8%).

Across 33 states, the prevalence of having used both a condom during last sexual intercourse and birth control pills; an IUD or implant; or a shot, patch, or birth control ring before last sexual intercourse ranged from 5.8% to 18.8% (median: 11.1%) (Table 78). Across 18 large urban school districts, the prevalence ranged from 2.8% to 10.2% (median: 6.5%).

Did Not Use Any Method to Prevent Pregnancy

Among the 30.1% of currently sexually active students nationwide, 13.8% reported that neither they nor their partner had used any method to prevent pregnancy during last sexual intercourse ( Table 79). The prevalence of not having used any method to prevent pregnancy was higher among black female (25.6%) than black male (9.9%) students and higher among 9th-grade female (22.0%) than 9th-grade male (12.1%) students. The prevalence of not having used any method to prevent pregnancy was higher among Hispanic (20.0%) than white (10.4%) students, higher among black female (25.6%) and Hispanic female (22.7%) than white female (10.2%) students, and higher among Hispanic male (17.2%) than white male (10.3%) and black male (9.9%) students. The prevalence of not having used any method to prevent pregnancy was higher among 9th-grade (16.5%) and 12th-grade (15.5%) than 11th-grade (11.1%) students and higher among 9th-grade female (22.0%) than 10th -grade female (12.9%) and 11th-grade female (12.3%) students.

During 1991–2015, a significant linear decrease occurred overall in the prevalence of not having used any method to prevent pregnancy (16.5%–13.8%). A significant quadratic trend also was identified. The prevalence of not having used any method to prevent pregnancy decreased during 1991–2007 (16.5%–12.2%) and then did not change significantly during 2007–2015 (12.2%–13.8%). The prevalence of not having used any method to prevent pregnancy also did not change significantly from 2013 (13.7%) to 2015 (13.8%).

Across 33 states, the prevalence of not having used any method to prevent pregnancy ranged from 7.2% to 20.0% (median: 12.8%) ( Table 80). Across 18 large urban school districts, the prevalence ranged from 10.5% to 22.0% (median: 17.1%).

Drank Alcohol or Used Drugs Before Last Sexual Intercourse

Among the 30.1% of currently sexually active students nationwide, 20.6% had drunk alcohol or used drugs before last sexual intercourse (Table 79). The prevalence of having drunk alcohol or used drugs before last sexual intercourse was higher among male (24.6%) than female (16.4%) students; higher among white male (24.4%) and Hispanic male (27.7%) than white female (14.7%) and Hispanic female (17.7%) students, respectively; and higher among 9th-grade male (27.2%) and 12th-grade male (25.6%) than 9th-grade female (16.8%) and 12th-grade female (16.1%) students, respectively.

During 1991–2015, a significant linear trend in the prevalence of having drunk alcohol or used drugs before last sexual intercourse was not identified. A significant quadratic trend was identified. The prevalence of having drunk alcohol or used drugs before last sexual intercourse increased during 1991–1999 (21.6%–24.8%) and then decreased during 1999–2015 (24.8%–20.6%). The prevalence of having drunk alcohol or used drugs before last sexual intercourse did not change significantly from 2013 (22.4%) to 2015 (20.6%).

Across 34 states, the prevalence of having drunk alcohol or used drugs before last sexual intercourse ranged from 13.5% to 24.6% (median: 18.9%) (Table 80). Across 19 large urban school districts, the prevalence ranged from 13.2% to 24.8% (median: 19.8%).

Tested for HIV

Nationwide, 10.2% of students had ever been tested for HIV, not counting tests done when donating blood ( Table 81). The prevalence of having ever been tested for HIV was higher among 12th-grade female (16.8%) than 12th-grade male (10.9%) students. The prevalence of having ever been tested for HIV was higher among black (16.6%) and Hispanic (11.1%) than white (8.0%) students, higher among black female (16.2%) and Hispanic female (12.3%) than white female (9.1%) students, and higher among black male (17.1%) and Hispanic male (10.1%) than white male (7.0%) students. The prevalence of having ever been tested for HIV was higher among 12th-grade (13.8%) than 9th-grade (7.8%), 10th-grade (9.8%), and 11th-grade (9.6%) students and higher among 12th-grade female (16.8%) than 9th-grade female (7.7%), 10th-grade female (9.8%), and 11th-grade female (10.3%) students.

During 2005–2015, a significant linear decrease occurred overall in the prevalence of having ever been tested for HIV (11.9%–10.2%). A significant quadratic trend also was identified. The prevalence of having ever been tested for HIV did not change significantly during 2005–2011 (11.9%–12.9%) and then decreased during 2011–2015 (12.9%–10.2%). The prevalence of having ever been tested for HIV also decreased significantly from 2013 (12.9%) to 2015 (10.2%).

Across 27 states, the prevalence of having ever been tested for HIV ranged from 7.4% to 18.0% (median: 11.4%) ( Table 82). Across 19 large urban school districts, the prevalence ranged from 7.0% to 37.4% (median: 18.9%).

Dietary Behaviors

Did Not Eat Fruit or Drink 100% Fruit Juices

Nationwide, 5.2% of students had not eaten fruit or drunk 100% fruit juices during the 7 days before the survey ( Table 83). The prevalence of not having eaten fruit or drunk 100% fruit juices was higher among male (5.9%) than female (4.3%) students, higher among black male (8.6%) than black female (5.2%) students, and higher among 10th-grade male (6.7%) than 10th-grade female (3.4%) students. The prevalence of not having eaten fruit or drunk 100% fruit juices was higher among 9th-grade (6.0%) than 11th-grade (4.4%) students and higher among 9th-grade male (6.7%) than 11th-grade male (4.7%) students.

During 1999–2015, a significant linear decrease occurred overall in the prevalence of not having eaten fruit or drunk 100% fruit juices (5.4%–5.2%). A significant quadratic trend was not identified. The prevalence of not having eaten fruit or drunk 100% fruit juices did not change significantly from 2013 (5.0%) to 2015 (5.2%).

Across 36 states, the prevalence of not having eaten fruit or drunk 100% fruit juices ranged from 3.2% to 11.7% (median: 7.0%) ( Table 84). Across 18 large urban school districts, the prevalence ranged from 3.8% to 11.4% (median: 7.1%).

Ate Fruit or Drank 100% Fruit Juices One or More Times per Day

Nationwide, 63.3% of students had eaten fruit or drunk 100% fruit juices one or more times per day during the 7 days before the survey (Table 83). The prevalence of having eaten fruit or drunk 100% fruit juices one or more times per day was higher among black male (67.0%) and Hispanic male (67.3%) than black female (56.5%) and Hispanic female (60.7%) students, respectively. The prevalence of having eaten fruit or drunk 100% fruit juices one or more times per day was higher among white female (64.1%) than black female (56.5%) students and higher among Hispanic male (67.3%) than white male (62.1%) students.

During 1999–2015, significant linear and quadratic trends were not identified in the prevalence of having eaten fruit or drunk 100% fruit juices one or more times per day. The prevalence of having eaten fruit or drunk 100% fruit juices one or more times per day did not change significantly from 2013 (62.6%) to 2015 (63.3%).

Across 36 states, the prevalence of having eaten fruit or drunk 100% fruit juices one or more times per day ranged from 49.0% to 67.7% (median: 58.7%) (Table 84). Across 18 large urban school districts, the prevalence ranged from 52.4% to 66.7% (median: 57.6%).

Ate Fruit or Drank 100% Fruit Juices Two or More Times per Day

Nationwide, 31.5% of students had eaten fruit or drunk 100% fruit juices two or more times per day during the 7 days before the survey ( Table 85). The prevalence of having eaten fruit or drunk 100% fruit juices two or more times per day was higher among male (33.1%) than female (30.0%) students; higher among black male (38.2%) and Hispanic male (36.7%) than black female (27.8%) and Hispanic female (29.9%) students, respectively; and higher among 9th-grade male (35.0%) than 9th-grade female (30.0%) students. The prevalence of having eaten fruit or drunk 100% fruit juices two or more times per day was higher among Hispanic (33.4%) than white (29.8%) students and higher among black male (38.2%) and Hispanic male (36.7%) than white male (29.9%) students.

During 1999–2015, significant linear and quadratic trends were not identified in the prevalence of having eaten fruit or drunk 100% fruit juices two or more times per day. The prevalence of having eaten fruit or drunk 100% fruit juices two or more times per day did not change significantly from 2013 (33.2%) to 2015 (31.5%).

Across 36 states, the prevalence of having eaten fruit or drunk 100% fruit juices two or more times per day ranged from 21.0% to 34.3% (median: 27.7%) ( Table 86). Across 18 large urban school districts, the prevalence ranged from 24.0% to 37.6% (median: 32.2%).

Ate Fruit or Drank 100% Fruit Juices Three or More Times per Day

Nationwide, 20.0% of students had eaten fruit or drunk 100% fruit juices three or more times per day during the 7 days before the survey (Table 85). The prevalence of having eaten fruit or drunk 100% fruit juices three or more times per day was higher among male (22.1%) than female (18.0%) students; higher among black male (29.1%) and Hispanic male (26.6%) than black female (20.5%) and Hispanic female (20.5%) students, respectively; and higher among 9th-grade male (24.3%) than 9th-grade female (16.9%) students. The prevalence of having eaten fruit or drunk 100% fruit juices three or more times per day was higher among black (25.1%) and Hispanic (23.6%) than white (17.0%) students, higher among black female (20.5%) and Hispanic female (20.5%) than white female (16.0%) students, and higher among black male (29.1%) and Hispanic male (26.6%) than white male (18.0%) students.

During 1999–2015, a significant linear decrease occurred in the prevalence of having eaten fruit or drunk 100% fruit juices three or more times per day (24.9%–20.0%). A significant quadratic trend was not identified. The prevalence of having eaten fruit or drunk 100% fruit juices three or more times per day decreased significantly from 2013 (21.9%) to 2015 (20.0%).

Across 36 states, the prevalence of having eaten fruit or drunk 100% fruit juices three or more times per day ranged from 13.1% to 22.5% (median: 17.0%) (Table 86). Across 18 large urban school districts, the prevalence ranged from 17.3% to 24.6% (median: 21.4%).

Did Not Eat Vegetables

Nationwide, 6.7% of students had not eaten vegetables^¶¶¶ during the 7 days before the survey ( Table 87). The prevalence of not having eaten vegetables was higher among male (7.7%) than female (5.6%) students; higher among white male (6.0%) and black male (13.0%) than white female (3.7%) and black female (8.8%) students, respectively; and higher among 11th-grade male (8.0%) than 11th-grade female (4.5%) students. The prevalence of not having eaten vegetables was higher among black (10.9%) and Hispanic (8.5%) than white (4.9%) students, higher among black (10.9%) than Hispanic (8.5%) students, higher among black female (8.8%) and Hispanic female (7.7%) than white female (3.7%) students, higher among black male (13.0%) and Hispanic male (9.2%) than white male (6.0%) students, and higher among black male (13.0%) than Hispanic male (9.2%) students.

During 1999–2015, a significant linear increase occurred overall in the prevalence of not having eaten vegetables (4.2%–6.7%). A significant quadratic trend was not identified. The prevalence of not having eaten vegetables did not change significantly from 2013 (6.6%) to 2015 (6.7%).

Across 32 states, the prevalence of not having eaten vegetables ranged from 3.3% to 11.3% (median: 7.0%) ( Table 88). Across 16 large urban school districts, the prevalence ranged from 5.6% to 11.7% (median: 10.7%).

Ate Vegetables One or More Times per Day

Nationwide, 61.0% of students had eaten vegetables one or more times per day during the 7 days before the survey (Table 87). The prevalence of having eaten vegetables one or more times per day was higher among black male (56.5%) than black female (48.0%) students. The prevalence of having eaten vegetables one or more times per day was higher among white (64.2%) and Hispanic (56.5%) than black (52.5%) students, higher among white (64.2%) than Hispanic (56.5%) students, higher among white female (64.5%) and Hispanic female (55.3%) than black female (48.0%) students, higher among white female (64.5%) than Hispanic female (55.3%) students, and higher among white male (64.0%) than black male (56.5%) and Hispanic male (57.7%) students. The prevalence of having eaten vegetables one or more times per day was higher among 11th-grade (62.5%) and 12th-grade (63.5%) than 9th-grade (58.6%) students, higher among 12th-grade (63.5%) than 10th-grade (59.9%) students, and higher among 12th-grade female (63.1%) than 9th-grade female (57.3%) and 10th-grade female (58.6%) students.

During 1999–2015, significant linear and quadratic trends were not identified in the prevalence of having eaten vegetables one or more times per day. The prevalence of having eaten vegetables one or more times per day did not change significantly from 2013 (61.5%) to 2015 (61.0%).

Across 32 states, the prevalence of having eaten vegetables one or more times per day ranged from 46.7% to 72.3% (median: 59.1%) (Table 88). Across 16 large urban school districts, the prevalence ranged from 48.7% to 61.1% (median: 54.3%).

Ate Vegetables Two or More Times per Day

Nationwide, 28.0% of students had eaten vegetables two or more times per day during the 7 days before the survey ( Table 89). The prevalence of having eaten vegetables two or more times per day was higher among male (29.6%) than female (26.5%) students and higher among black male (25.7%) and Hispanic male (30.3%) than black female (17.9%) and Hispanic female (23.8%) students, respectively. The prevalence of having eaten vegetables two or more times per day was higher among white (28.6%) and Hispanic (27.2%) than black (22.0%) students, higher among white female (29.1%) and Hispanic female (23.8%) than black female (17.9%) students, and higher among white female (29.1%) than Hispanic female (23.8%) students. The prevalence of having eaten vegetables two or more times per day was higher among 12th-grade female (29.8%) than 9th-grade female (24.2%) students.

During 1999–2015, significant linear and quadratic trends were not identified in the prevalence of having eaten vegetables two or more times per day. The prevalence of having eaten vegetables two or more times per day did not change significantly from 2013 (28.4%) to 2015 (28.0%).

Across 32 states, the prevalence of having eaten vegetables two or more times per day ranged from 18.5% to 36.3% (median: 25.2%) ( Table 90). Across 16 large urban school districts, the prevalence ranged from 19.0% to 27.4% (median: 23.2%).

Ate Vegetables Three or More Times per Day

Nationwide, 14.8% of students had eaten vegetables three or more times per day during the 7 days before the survey (Table 89). The prevalence of having eaten vegetables three or more times per day was higher among male (16.6%) than female (12.9%) students; higher among Hispanic male (18.8%) than Hispanic female (12.7%) students; and higher among 9th-grade male (17.1%) and 10th-grade male (15.9%) than 9th-grade female (11.6%) and 10th-grade female (11.2%), respectively. The prevalence of having eaten vegetables three or more times per day was higher among Hispanic (15.8%) than white (13.5%) students and higher among Hispanic male (18.8%) than white male (13.9%) students. The prevalence of having eaten vegetables three or more times per day was higher among 12th-grade (16.0%) than 10th-grade (13.5%) students and higher among 11th-grade female (13.9%) than 10th-grade female (11.2%) students.

During 1999–2015, a significant linear increase occurred in the prevalence of having eaten vegetables three or more times per day (14.0%–14.8%). A significant quadratic trend was not identified. The prevalence of having eaten vegetables three or more times per day did not change significantly from 2013 (15.7%) to 2015 (14.8%).

Across 32 states, the prevalence of having eaten vegetables three or more times per day ranged from 9.1% to 18.1% (median: 12.6%) (Table 90). Across 16 large urban school districts, the prevalence ranged from 9.5% to 16.8% (median: 12.6%).

Did Not Drink Milk

Nationwide, 21.5% of students had not drunk milk during the 7 days before the survey ( Table 91). The prevalence of not having drunk milk was higher among female (28.4%) than male (15.1%) students; higher among white female (24.4%), black female (44.6%), and Hispanic female (26.3%) than white male (12.1%), black male (25.8%), and Hispanic male (13.0%) students, respectively; and higher among 9th-grade female (27.0%), 10th-grade female (26.9%), 11th-grade female (31.7%), and 12th-grade female (28.2%) than 9th-grade male (15.6%), 10th-grade male (14.1%), 11th-grade male (14.2%), and 12th-grade male (16.6%) students, respectively. The prevalence of not having drunk milk was higher among black (34.7%) than white (18.3%) and Hispanic (19.6%) students, higher among black female (44.6%) than white female (24.4%) and Hispanic female (26.3%) students, and higher among black male (25.8%) than white male (12.1%) and Hispanic male (13.0%) student s. The prevalence of not having drunk milk was higher among 11th-grade female (31.7%) than 9th-grade female (27.0%) students.

During 1999–2015, a significant linear increase occurred overall in the prevalence of not having drunk milk (17.0%–21.5%). A significant quadratic trend also was identified. The prevalence of not having drunk milk did not change significantly during 1999–2011 (17.0%–17.3%) and then increased during 2011–2015 (17.3%–21.5%). The prevalence of not having drunk milk did not change significantly from 2013 (19.4%) to 2015 (21.5%).

Across 28 states, the prevalence of not having drunk milk ranged from 13.9% to 31.7% (median: 22.6%) ( Table 92). Across 15 large urban school districts, the prevalence ranged from 20.7% to 36.9% (median: 27.5%).

Drank One or More Glasses of Milk per Day

Nationwide, 37.5% of students had drunk one or more glasses of milk per day during the 7 days before the survey (Table 91). The prevalence of having drunk one or more glasses of milk per day was higher among male (46.2%) than female (28.2%) students; higher among white male (50.6%), black male (31.8%), and Hispanic male (45.1%) than white female (32.0%), black female (17.7%), and Hispanic female (27.2%) students, respectively; and higher among 9th-grade male (47.0%), 10th-grade male (49.2%), 11th-grade male (44.7%), and 12th-grade male (43.8%) than 9th-grade female (29.3%), 10th-grade female (30.1%), 11th-grade female (26.3%), and 12th-grade female (26.5%) students, respectively. The prevalence of having drunk one or more glasses of milk per day was higher among white (41.2%) and Hispanic (36.2%) than black (25.1%) students, higher among white (41.2%) than Hispanic (36.2%) students, higher among white female (32.0%) and Hispanic fema le (27.2%) than black female (17.7%) students, higher among white female (32.0%) than Hispanic female (27.2%) students, and higher among white male (50.6%) and Hispanic male (45.1%) than black male (31.8%) students.

During 1999–2015, a significant linear decrease occurred overall in the prevalence of having drunk one or more glasses of milk per day (47.1%–37.5%). A significant quadratic trend was not identified. The prevalence of having drunk one or more glasses of milk per day did not change significantly from 2013 (40.3%) to 2015 (37.5%).

Across 28 states, the prevalence of having drunk one or more glasses of milk per day ranged from 23.0% to 51.6% (median: 34.0%) (Table 92). Across 15 large urban school districts, the prevalence ranged from 16.2% to 34.1% (median: 26.1%).

Drank Two or More Glasses of Milk per Day

Nationwide, 22.4% of students had drunk two or more glasses of milk per day during the 7 days before the survey ( Table 93). The prevalence of having drunk two or more glasses of milk per day was higher among male (29.6%) than female (14.6%) students; higher among white male (32.9%), black male (21.0%), and Hispanic male (28.3%) than white female (17.8%), black female (5.8%), and Hispanic female (12.8%) students, respectively; and higher among 9th-grade male (32.5%), 10th-grade male (30.8%), 11th-grade male (29.2%), and 12th-grade male (25.4%) than 9th-grade female (16.7%), 10th-grade female (14.8%), 11th-grade female (13.7%), and 12th-grade female (12.5%) students, respectively. The prevalence of having drunk two or more glasses of milk per day was higher among white (25.3%) and Hispanic (20.6%) than black (13.8%) students, higher among white (25.3%) than Hispanic (20.6%) students, higher among white female (17.8%) and Hispanic female (12.8%) than black female (5.8%) students, higher among white female (17.8%) than Hispanic female (12.8%) students, and higher among white male (32.9%) and Hispanic male (28.3%) than black male (21.0%) students. The prevalence of having drunk two or more glasses of milk per day was higher among 9th-grade (25.1%) than 11th-grade (21.9%) and 12th-grade (19.0%) students, higher among 9th-grade female (16.7%) than 12th-grade female (12.5%) students, and higher among 9th-grade male (32.5%) than 12th-grade male (25.4%) students.

During 1999–2015, a significant linear decrease occurred overall in the prevalence of having drunk two or more glasses of milk per day (33.6%–22.4%). A significant quadratic trend was not identified. The prevalence of having drunk two or more glasses of milk per day did not change significantly from 2013 (25.9%) to 2015 (22.4%).

Across 28 states, the prevalence of having drunk two or more glasses of milk per day ranged from 12.6% to 35.8% (median: 20.0%) ( Table 94). Across 15 large urban school districts, the prevalence ranged from 8.2% to 20.2% (median: 14.6%).

Drank Three or More Glasses of Milk per Day

Nationwide, 10.2% of students had drunk three or more glasses of milk per day during the 7 days before the survey (Table 93). The prevalence of having drunk three or more glasses of milk per day was higher among male (14.8%) than female (5.4%) students; higher among white male (16.1%), black male (10.3%), and Hispanic male (15.0%) than white female (6.4%), black female (3.0%), and Hispanic female (4.9%) students, respectively; and higher among 9th-grade male (15.7%), 10th-grade male (17.0%), 11th-grade male (13.8%), and 12th-grade male (12.1%) than 9th-grade female (6.9%), 10th-grade female (5.1%), 11th-grade female (4.6%), and 12th-grade female (4.6%) students, respectively. The prevalence of having drunk three or more glasses of milk per day was higher among white (11.2%) and Hispanic (10.0%) than black (6.9%) students, higher among white female (6.4%) than black female (3.0%) students, and higher among white male (16.1%) and Hispanic male (15.0%) than black male (10.3%) students. The prevalence of having drunk three or more glasses of milk per day was higher among 9th-grade (11.5%) and 10th-grade (11.0%) than 12th-grade (8.4%) students and higher among 9th-grade male (15.7%) and 10th-grade male (17.0%) than 12th-grade male (13.8%) students.

During 1999–2015, a significant linear decrease occurred overall in the prevalence of having drunk three or more glasses of milk per day (18.0%–10.2%). A significant quadratic trend was not identified. The prevalence of having drunk three or more glasses of milk per day decreased significantly from 2013 (12.5%) to 2015 (10.2%).

Across 28 states, the prevalence of having drunk three or more glasses of milk per day ranged from 5.8% to 17.9% (median: 9.0%) (Table 94). Across 15 large urban school districts, the prevalence ranged from 4.1% to 9.9% (median: 7.1%).

Did Not Drink Soda or Pop

Nationwide, 26.2% of students had not drunk soda or pop (not including diet soda or diet pop) during the 7 days before the survey ( Table 95). The prevalence of not having drunk soda or pop was higher among female (31.0%) than male (21.4%) students; higher among white female (33.3%) and Hispanic female (26.3%) than white male (21.6%) and Hispanic male (19.0%) students, respectively; and higher among 9th-grade female (30.3%), 10th-grade female (28.7%), 11th-grade female (33.3%), and 12th-grade female (31.9%) than 9th-grade male (21.6%), 10th-grade male (20.5%), 11th-grade male (19.8%), and 12th-grade male (23.6%) students, respectively. The prevalence of not having drunk soda or pop was higher among white (27.5%) than black (22.8%) and Hispanic (22.6%) students and higher among white female (33.3%) than black female (22.6%) and Hispanic female (26.3%) students. The prevalence of not having drunk soda or pop was higher among 12th-grade (27.7%) than 10th-grade (24.6%) students, higher among 11th-grade female (33.3%) than 10th-grade female (28.7%) students, and higher among 12th-grade male (23.6%) than 10th-grade male (20.5%) students.

During 2007–2015, a significant linear increase occurred overall in the prevalence of not having drunk soda or pop (18.6%–26.2%). A significant quadratic trend was not identified. The prevalence of not having drunk soda or pop increased significantly from 2013 (22.3%) to 2015 (26.2%).

Across 36 states, the prevalence of not having drunk soda or pop ranged from 18.7% to 37.0% (median: 26.0%) ( Table 96). Across 18 large urban school districts, the prevalence ranged from 18.9% to 39.0% (median: 27.6%).

Drank Soda or Pop One or More Times per Day

Nationwide, 20.4% of students had drunk a can, bottle, or glass of soda or pop (not counting diet soda or diet pop) one or more times per day during the 7 days before the survey (Table 95). The prevalence of having drunk soda or pop one or more times per day was higher among male (24.3%) than female (16.4%) students; higher among white male (24.5%) and Hispanic male (25.1%) than white female (15.0%) and Hispanic female (18.1%) students, respectively; and higher among 9th-grade male (22.4%), 10th-grade male (25.4%), 11th-grade male (25.6%), and 12th-grade male (24.2%) than 9th-grade female (16.1%), 10th-grade female (16.2%), 11th-grade female (15.1%), and 12th-grade female (17.9%) students, respectively. The prevalence of having drunk soda or pop one or more times per day was higher among black female (21.6%) than white female (15.0%) students.

During 2007–2015, a significant linear decrease occurred overall in the prevalence of having drunk soda or pop one or more times per day (33.8%–20.4%). A significant quadratic trend was not identified. The prevalence of having drunk soda or pop one or more times per day decreased significantly from 2013 (27.0%) to 2015 (20.4%).

Across 36 states, the prevalence of having drunk soda or pop one or more times per day ranged from 11.9% to 32.4% (median: 19.0%) (Table 96). Across 18 large urban school districts, the prevalence ranged from 9.6% to 27.5% (median: 18.9%).

Drank Soda or Pop Two or More Times per Day

Nationwide, 13.0% of students had drunk a can, bottle, or glass of soda or pop (not counting diet soda or diet pop) two or more times per day during the 7 days before the survey ( Table 97). The prevalence of having drunk soda or pop two or more times per day was higher among male (15.6%) than female (10.4%) students; higher among white male (15.1%) and Hispanic male (17.4%) than white female (9.1%) and Hispanic female (11.4%) students, respectively; and higher among 9th-grade male (14.6%), 10th-grade male (15.8%), 11th-grade male (16.1%), and 12th-grade male (16.0%) than 9th-grade female (10.0%), 10th-grade female (10.2%), 11th-grade female (10.5%), and 12th-grade female (10.5%) students, respectively. The prevalence of having drunk soda or pop two or more times per day was higher among black female (15.0%) than white female (9.1%) students.

During 2007–2015, a significant linear decrease occurred overall in the prevalence of having drunk soda or pop two or more times per day (24.4%–13.0%). A significant quadratic trend was not identified. The prevalence of having drunk soda or pop two or more times per day decreased significantly from 2013 (19.4%) to 2015 (13.0%).

Across 36 states, the prevalence of having drunk soda or pop two or more times per day ranged from 7.3% to 23.3% (median: 11.8%) ( Table 98). Across 18 large urban school districts, the prevalence ranged from 6.0% to 19.2% (median: 12.0%).

Drank Soda or Pop Three or More Times per Day

Nationwide, 7.1% of students had drunk a can, bottle, or glass of soda or pop (not counting diet soda or diet pop) three or more times per day during the 7 days before the survey (Table 97). The prevalence of having drunk soda or pop three or more times per day was higher among male (8.3%) than female (5.9%) students; higher among white male (7.2%) and Hispanic male (9.4%) than white female (4.7%) and Hispanic female (6.7%) students, respectively; and higher among 10th-grade male (9.1%) and 12th-grade male (8.4%) than 10th-grade female (6.0%) and 12th-grade female (5.5%) students, respectively. The prevalence of having drunk soda or pop three or more times per day was higher among black (9.5%) and Hispanic (8.1%) than white (5.9%) students and higher among black female (9.9%) than white female (4.7%) students.

During 2007–2015, a significant linear decrease occurred overall in the prevalence of having drunk soda or pop three or more times per day (14.4%–7.1%). A significant quadratic trend was not identified. The prevalence of having drunk soda or pop three or more times per day decreased significantly from 2013 (11.2%) to 2015 (7.1%).

Across 36 states, the prevalence of having drunk soda or pop three or more times per day ranged from 4.0% to 13.5% (median: 6.6%) (Table 98). Across 18 large urban school districts, the prevalence ranged from 2.6% to13.5% (median: 7.6%).

Did Not Drink Sports Drinks

Nationwide, 42.4% of students had not drunk a can, bottle, or glass of a sports drink (not counting low-calorie sports drinks) during the 7 days before the survey ( Table 99). The prevalence of not having drunk a sports drink was higher among female (52.7%) than male (32.3%) students; higher among white female (55.8%), black female (45.7%), and Hispanic female (45.2%) than white male (33.5%), black male (25.9%), and Hispanic male (27.6%) students, respectively; and higher among 9th-grade female (49.7%), 10th-grade female (51.4%), 11th-grade female (53.4%), and 12th-grade female (57.1%) than 9th-grade male (31.3%), 10th-grade male (31.2%), 11th-grade male (29.8%), and 12th-grade male (36.9%) students, respectively. The prevalence of not having drunk a sports drink was higher among white (44.6%) than black (36.0%) and Hispanic (36.2%) students, higher among white female (55.8%) than black female (45.7%) and Hispanic female (45.2%) students, and higher among white male (33.5%) than black male (25.9%) and Hispanic male (27.6%) students. The prevalence of not having drunk a sports drink was higher among 12th-grade (46.8%) than 9th-grade (40.0%) and 10th-grade (41.6%) students and higher among 12th-grade female (57.1%) than 9th-grade female (49.7%) and 10th-grade female (51.4%) students. Because the question measuring the prevalence of not having drunk a sports drink was used for the first time in the 2015 national YRBS, long-term temporal trends and 2-year temporal changes are not available.

This question was not included in the standard questionnaire used in the state and large urban school district surveys in 2015. As a result, the range and median prevalence estimates across states and large urban school districts for the prevalence of not having drunk a sports drink are not available.

Drank Sports Drinks One or More Times per Day

Nationwide, 13.8% of students had drunk a can, bottle, or glass of a sports drink (not counting low- calorie sports drinks) one or more times per day during the 7 days before the survey (Table 99). The prevalence of having drunk a sports drink one or more times per day was higher among male (18.7%) than female (8.8%) students; higher among white male (18.1%), black male (25.2%), and Hispanic male (19.0%) than white female (6.7%), black female (14.3%), and Hispanic female (12.2%) students, respectively; and higher among 9th-grade male (18.5%), 10th-grade male (20.5%), 11th-grade male (21.1%), and 12th-grade male (14.5%) than 9th-grade female (9.9%), 10th-grade female (9.6%), 11th-grade female (9.0%), and 12th-grade female (6.5%) students, respectively. The prevalence of having drunk a sports drink one or more times per day was higher among black (19.7%) and Hispanic (15.7%) than white (12.4%) students, higher among black female (14.3% ) and Hispanic female (12.2%) than white female (6.7%) students, and higher among black male (25.2%) than white male (18.1%) students. The prevalence of having drunk a sports drink one or more times per day was higher among 9th-grade (14.4%), 10th-grade (14.9%), and 11th-grade (15.3%) than 12th-grade (10.6%) students, higher among 9th-grade female (9.9%) and 10th-grade female (9.6%) than 12th-grade female (6.5%) students, and higher among 10th-grade male (20.5%) and 11th-grade male (21.1%) than 12th-grade male (14.5%) students. Because the question measuring the prevalence of having drunk a sports drink one or more times per day was used for the first time in the 2015 national YRBS, long-term temporal trends and 2-year temporal changes are not available.

This question was not included in the standard questionnaire used in the state and large urban school district surveys in 2015. As a result, the range and median prevalence estimates across states and large urban school districts for the prevalence of having drunk a sports drink one or more times per day are not available.

Drank Sports Drinks Two or More Times per Day

Nationwide, 8.3% of students had drunk a can, bottle, or glass of a sports drink (not counting low- calorie sports drinks) two or more times per day during the 7 days before the survey ( Table 100). The prevalence of having drunk a sports drink two or more times per day was higher among male (11.2%) than female (5.4%) students; higher among white male (9.0%), black male (21.4%), and Hispanic male (13.0%) than white female (3.5%), black female (10.1%), and Hispanic female (7.9%) students, respectively; and higher among 9th-grade male (10.6%), 10th-grade male (12.8%), 11th-grade male (12.4%), and 12th-grade male (9.0%) than 9th-grade female (5.4%), 10th-grade female (5.8%), 11th-grade female (5.9%), and 12th-grade female (4.1%) students, respectively. The prevalence of having drunk a sports drink two or more times per day was higher among black (15.8%) and Hispanic (10.5%) than white (6.3%) students, higher among black (15.8%) than Hispanic (10.5%) students, higher among black female (10.1%) and Hispanic female (7.9%) than white female (3.5%) students, higher among black male (21.4%) and Hispanic male (13.0%) than white male (9.0%) students, and higher among black male (21.4%) than Hispanic male (13.0%) students. The prevalence of having drunk a sports drink two or more times per day was higher among 10th-grade (9.2%) and 11th-grade (9.3%) than 12th-grade (6.6%) students and higher among 10th-grade male (12.8%) and 11th-grade male (12.4%) than 12th-grade male (9.0%) students. Because the question measuring the prevalence of having drunk a sports drink two or more times per day was used for the first time in the 2015 national YRBS, long-term temporal trends and 2-year temporal changes are not available.

This question was not included in the standard questionnaire used in the state and large urban school district surveys in 2015. As a result, the range and median prevalence estimates across states and large urban school districts for the prevalence of having drunk a sports drink two or more times per day are not available.

Drank Sports Drinks Three or More Times per Day

Nationwide, 4.8% of students had drunk a can, bottle, or glass of a sports drink (not counting low-calorie sports drinks) three or more times per day during the 7 days before the survey (Table 100). The prevalence of having drunk a sports drink three or more times per day was higher among male (6.3%) than female (3.1%) students; higher among white male (4.3%), black male (13.1%), and Hispanic male (8.7%) than white female (1.9%), black female (5.1%), and Hispanic female (5.4%) students, respectively; and higher among 10th-grade male (8.3%), 11th-grade male (6.6%), and 12th-grade male (5.5%) than 10th-grade female (3.4%), 11th-grade female (3.6%), and 12th-grade female (2.1%) students, respectively. The prevalence of having drunk a sports drink three or more times per day was higher among black (9.2%) and Hispanic (7.1%) than white (3.1%) students, higher among black female (5.1%) and Hispanic female (5.4%) than white female (1.9%) s tudents, and higher among black male (13.1%) and Hispanic male (8.7%) than white male (4.3%) students. The prevalence of having drunk a sports drink three or more times per day was higher among 10th-grade (5.8%) than 9th-grade (4.2%) and 12th-grade (3.8%) students, higher among 11th-grade (5.2%) than 12th-grade (3.8%) students, and higher among 10th-grade male (8.3%) than 9th-grade male (5.0%) and 12th-grade male (5.5%) students. Because the question measuring the prevalence of having drunk a sports drink three or more times per day was used for the first time in the 2015 national YRBS, long-term temporal trends and 2-year temporal changes are not available.

This question was not included in the standard questionnaire used in the state and large urban school district surveys in 2015. As a result, the range and median prevalence estimates across states and large urban school districts for the prevalence of having drunk a sports drink three or more times per day are not available.

Did Not Drink Water

Nationwide, 3.5% of students had not drunk water during the 7 days before the survey ( Table 101). The prevalence of not having drunk water was higher among black (8.7%) than white (2.7%) and Hispanic (3.3%) students, higher among black female (9.0%) than white female (2.5%) and Hispanic female (2.8%) students, and higher among black male (7.8%) than white male (2.9%) and Hispanic male (3.8%) students. The prevalence of not having drunk water was higher among 10th-grade female (4.4%) than 11th-grade female (2.0%) students. Because the question measuring the prevalence of not having drunk water was used for the first time in the 2015 national YRBS, long-term temporal trends and 2-year temporal changes are not available.

This question was not included in the standard questionnaire used in the state and large urban school district surveys in 2015. As a result, the range and median prevalence estimates across states and large urban school districts for the prevalence of not having drunk water are not available.

Drank One or More Glasses of Water per Day

Nationwide, 73.6% of students had drunk one or more glasses of water per day during the 7 days before the survey (Table 101). The prevalence of having drunk one or more glasses of water per day was higher among white (76.6%) and Hispanic (71.6%) than black (60.2%) students, higher among white (76.6%) than Hispanic (71.6%) students, higher among white female (77.2%) and Hispanic female (70.6%) than black female (58.4%) students, higher among white female (77.2%) than Hispanic female (70.6%) students, and higher among white male (76.4%) and Hispanic male (72.5%) than black male (62.0%) students. The prevalence of having drunk one or more glasses of water per day was higher among 11th-grade (75.0%) and 12th-grade (75.3%) than 9th-grade (71.2%) students and higher among 11th-grade female (76.0%) than 9th-grade female (70.9%) students. Because the question measuring the prevalence of having drunk one or more glasses of water per day was used for the first time in the 2015 national YRBS, long-term temporal trends and 2-year temporal changes are not available.

This question was not included in the standard questionnaire used in the state and large urban school district surveys in 2015. As a result, the range and median prevalence estimates across states and large urban school districts for the prevalence of having drunk one or more glasses of water per day are not available.

Drank Two or More Glasses of Water per Day

Nationwide, 64.3% of students had drunk two or more glasses of water per day during the 7 days before the survey ( Table 102). The prevalence of having drunk two or more glasses of water per day was higher among 10th-grade male (67.5%) than 10th-grade female (60.6%) students. The prevalence of having drunk two or more glasses of water per day was higher among white (66.3%) and Hispanic (63.7%) than black (50.8%) students, higher among white female (65.7%) and Hispanic female (62.7%) than black female (47.4%) students, and higher among white male (67.2%) and Hispanic male (64.7%) than black male (54.1%) students. The prevalence of having drunk two or more glasses of water per day was higher among 11th-grade (65.8%) and 12th-grade (66.6%) than 9th-grade (61.3%) students, higher among 12th-grade (66.6%) than 10th-grade (63.9%) students, higher among 11th-grade female (66.1%) than 9th-grade female (61.3%) and 10th-grade female (60.6%) st udents, and higher among 10th-grade male (67.5%) and 12th-grade male (67.6%) than 9th-grade male (61.7%) students. Because the question measuring the prevalence of having drunk two or more glasses of water per day was used for the first time in the 2015 national YRBS, long-term temporal trends and 2-year temporal changes are not available.

This question was not included in the standard questionnaire used in the state and large urban school district surveys in 2015. As a result, the range and median prevalence estimates across states and large urban school districts for the prevalence of having drunk two or more glasses of water per day are not available.

Drank Three or More Glasses of Water per Day

Nationwide, 49.5% of students had drunk three or more glasses of water per day during the 7 days before the survey (Table 102). The prevalence of having drunk three or more glasses of water per day was higher among male (51.0%) than female (48.1%) students and higher among Hispanic male (52.5%) than Hispanic female (47.9%) students. The prevalence of having drunk three or more glasses of water per day was higher among white (49.9%) and Hispanic (50.3%) than black (39.1%) students, higher among white female (49.7%) and Hispanic female (47.9%) than black female (35.7%) students, and higher among Hispanic male (52.5%) than black male (42.2%) students. The prevalence of having drunk three or more glasses of water per day was higher among 11th-grade female (51.4%) than 10th-grade female (46.1%) students. Because the question measuring the prevalence of having drunk three or more glasses of water per day was used for the first time in the 2015 national YRBS, long-term temporal trends and 2-year temporal changes are not available.

This question was not included in the standard questionnaire used in the state and large urban school district surveys in 2015. As a result, the range and median prevalence estimates across states and large urban school districts for the prevalence of having drunk three or more glasses of water per day are not available.

Did Not Eat Breakfast

Nationwide, 13.8% of students had not eaten breakfast during the 7 days before the survey ( Table 103). The prevalence of having not eaten breakfast was higher among 9th-grade female (14.8%) than 9th-grade male (10.9%) students. The prevalence of having not eaten breakfast was higher among black (18.0%) and Hispanic (14.7%) than white (12.0%) students, higher among black female (19.3%) than white female (12.5%) students, and higher among black male (16.8%) than white male (11.3%) students. The prevalence of having not eaten breakfast was higher among 11th-grade male (14.2%) and 12th-grade male (14.8%) than 9th-grade male (10.9%) students.

During 2011–2015, significant linear and quadratic trends were not identified. The prevalence of having not eaten breakfast did not change significantly from 2013 (13.7%) to 2015 (13.8%).

Across 33 states, the prevalence of having not eaten breakfast ranged from 10.3% to 20.1% (median: 14.6%) ( Table 104). Across 18 large urban school districts, the prevalence ranged from 11.6% to 23.8% (median: 16.4%).

Ate Breakfast on All 7 Days

Nationwide, 36.3% of students had eaten breakfast on all 7 days before the survey (Table 103). The prevalence of having eaten breakfast on all 7 days was higher among male (40.5%) than female (32.1%) students; higher among white male (43.3%), black male (30.8%), and Hispanic male (39.5%) than white female (34.8%), black female (24.7%), and Hispanic female (30.1%) students, respectively; and higher among 9th-grade male (46.6%), 10th-grade male (42.3%), and 11th-grade male (37.1%) than 9th-grade female (31.9%), 10th-grade female (31.1%), and 11th-grade female (32.4%) students, respectively. The prevalence of having eaten breakfast on all 7 days was higher among white (39.0%) and Hispanic (34.8%) than black (27.9%) students, higher among white female (34.8%) than black female (24.7%) students, and higher among white male (43.3%) and Hispanic male (39.5%) than black male (30.8%) students. The prevalence of having eaten breakfast on all 7 days was higher among 9th-grade (39.6%) than 11th-grade (34.6%) and 12th-grade (33.8%) students; higher among 9th-grade male (46.6%) than 10th-grade male (42.3%), 11th-grade male (37.1%), and 12th-grade male (34.7%) students, and higher among 10th-grade male (42.3%) than 11th-grade male (37.1%) and 12th-grade male (34.7%) students.

During 2011–2015, significant linear and quadratic trends were not identified. The prevalence of having eaten breakfast on all 7 days did not change significantly from 2013 (38.1%) to 2015 (36.3%).

Across 33 states, the prevalence of having eaten breakfast on all 7 days ranged from 26.6% to 42.1% (median: 34.8%) (Table 104). Across 18 large urban school districts, the prevalence ranged from 16.4% to 44.6% (median: 31.0%).

Physical Activity

Did Not Participate in at Least 60 Minutes of Physical Activity on at Least 1 Day

Nationwide, 14.3% of students had not participated in at least 60 minutes of any kind of physical activity that increased their heart rate and made them breathe hard some of the time on at least 1 day during the 7 days before the survey (i.e., did not participate in at least 60 minutes of physical activity on at least 1 day) ( Table 105). The prevalence of not having participated in at least 60 minutes of physical activity on at least 1 day was higher among female (17.5%) than male (11.1%) students; higher among white female (14.3%), black female (25.2%), and Hispanic female (19.2%) than white male (8.8%), black male (16.2%), and Hispanic male (11.9%) students, respectively; and higher among 9th-grade female (14.7%), 10th-grade female (15.8%), 11th-grade female (18.2%), and 12th-grade female (21.4%) than 9th-grade male (9.5%), 10th-grade male (10.4%), 11th-grade male (12.4%), and 12th-grade male (12.4%) students, respectively. The prevalence of not having participated in at least 60 minutes of physical activity on at least 1 day was higher among black (20.4%) and Hispanic (15.6%) than white (11.6%) students, higher among black (20.4%) than Hispanic (15.6%) students, higher among black female (25.2%) and Hispanic female (19.2%) than white female (14.3%) students, higher among black female (25.2%) than Hispanic female (19.2%) students, and higher among black male (16.2%) than white male (8.8%) students. The prevalence of not having participated in at least 60 minutes of physical activity on at least 1 day was higher among 11th-grade (15.5%) and 12th-grade (16.9%) than 9th-grade (12.0%) students, higher among 12th-grade (16.9%) than 10th-grade (13.1%) students, higher among 11th-grade female (18.2%) and 12th-grade female (21.4%) than 9th-grade female (14.7%) students; higher among 12th-grade female (21.4%) than 10th-grade female (15.8%) students, and higher among 11th-grade male (12.4%) than 9th-grade male (9.5%) students.

During 2011–2015, significant linear and quadratic trends were not identified in the prevalence of not having participated in at least 60 minutes of physical activity on at least 1 day. The prevalence of not having participated in at least 60 minutes of physical activity on at least 1 day did not change significantly from 2013 (15.2%) to 2015 (14.3%).

Across 37 states, the prevalence of not having participated in at least 60 minutes of physical activity on at least 1 day ranged from 10.7% to 22.9% (median: 15.9%) ( Table 106). Across 18 large urban school districts, the prevalence ranged from 13.2% to 30.1% (median: 21.6%).

Physically Active at Least 60 Minutes per Day on 5 or More Days

Nationwide, 48.6% of students had been physically active doing any kind of physical activity that increased their heart rate and made them breathe hard some of the time for a total of at least 60 minutes per day on 5 or more days during the 7 days before the survey (i.e., physically active at least 60 minutes per day on 5 or more days) (Table 105). The prevalence of having been physically active at least 60 minutes per day on 5 or more days was higher among male (57.8%) than female (39.1%) students; higher among white male (62.0%), black male (52.2%), and Hispanic male (53.5%) than white female (43.5%), black female (33.4%), and Hispanic female (33.1%) students, respectively; and higher among 9th-grade male (62.3%), 10th-grade male (58.7%), 11th-grade male (56.3%), and 12th-grade male (53.3%) than 9th-grade female (43.9%), 10th-grade female (41.9%), 11th-grade female (36.6%), and 12th-grade female (33.4%) students, respectively. The prevalence of having been physically active at least 60 minutes per day on 5 or more days was higher among white (52.7%) than black (43.5%) and Hispanic (43.4%) students, higher among white female (43.5%) than black female (33.4%) and Hispanic female (33.1%) students, and higher among white male (62.0%) than black male (52.2%) and Hispanic male (53.5%) students. The prevalence of having been physically active at least 60 minutes per day on 5 or more days was higher among 9th-grade (53.7%) than 11th-grade (46.5%) and 12th-grade (43.5%) students, higher among 10th-grade (50.2%) than 12th-grade (43.5%) students, higher among 9th-grade female (43.9%) than 11th-grade female (36.6%) and 12th-grade female (33.4%) students, higher among 10th-grade female (41.9%) than 12th-grade female (33.4%) students, and higher among 9th-grade male (62.3%) than 11th-grade male (56.3%) and 12th-grade male (53.3%) students.

During 2011–2015, significant linear and quadratic trends were not identified in the prevalence of having been physically active at least 60 minutes per day on 5 or more days. The prevalence of having been physically active at least 60 minutes per day on 5 or more days did not change significantly from 2013 (47.3%) to 2015 (48.6%).

Across 37 states, the prevalence of having been physically active at least 60 minutes per day on 5 or more days ranged from 34.2% to 54.0% (median: 45.3%) (Table 106). Across 18 large urban school districts, the prevalence ranged from 28.1% to 51.1% (median: 36.1%).

Physically Active at Least 60 Minutes per Day on All 7 Days

Nationwide, 27.1% of students had been physically active doing any kind of physical activity that increased their heart rate and made them breathe hard some of the time for a total of at least 60 minutes per day on each of the 7 days before the survey (i.e., physically active at least 60 minutes per day on all 7 days) ( Table 107). The prevalence of having been physically active at least 60 minutes per day on all 7 days was higher among male (36.0%) than female (17.7%) students; higher among white male (38.5%), black male (30.8%), and Hispanic male (34.2%) than white female (19.5%), black female (16.6%), and Hispanic female (14.7%) students, respectively; and higher among 9th-grade male (40.1%), 10th-grade male (36.7%), 11th-grade male (34.3%), and 12th-grade male (32.6%) than 9th-grade female (20.9%), 10th-grade female (19.0%), 11th-grade female (16.0%), and 12th-grade female (14.3%) students, respectively. The prevalence of having been physically active at least 60 minutes per day on all 7 days was higher among white (29.0%) than black (24.2%) and Hispanic (24.6%) students, higher among white female (19.5%) than Hispanic female (14.7%) students, and higher among white male (38.5%) than black male (30.8%) students. The prevalence of having been physically active at least 60 minutes per day on all 7 days was higher among 9th-grade (31.0%) than 10th-grade (27.8%), 11th-grade (25.3%), and 12th-grade (23.5%) students; higher among 10th-grade (27.8%) than 12th-grade (25.3%) students; higher among 9th-grade female (20.9%) than 11th-grade female (16.0%) and 12th-grade female (14.3%) students; higher among 10th-grade female (19.0%) than 12th-grade female (14.3%) students; and higher among 9th-grade male (40.1%) than 11th-grade male (34.3%) and 12th-grade male (32.6%) students.

During 2011–2015, significant linear and quadratic trends were not identified in the prevalence of having been physically active at least 60 minutes per day on all 7 days. The prevalence of having been physically active at least 60 minutes per day on all 7 days did not change significantly from 2013 (27.1%) to 2015 (27.1%).

Across 37 states, the prevalence of having been physically active at least 60 minutes per day on all 7 days ranged from 19.5% to 32.2% (median: 25.3%) ( Table 108). Across 18 large urban school districts, the prevalence ranged from 15.8% to 27.0% (median: 19.7%).

Participated in Muscle Strengthening Activities

Nationwide, 53.4% of students had participated in muscle strengthening exercises (e.g., push-ups, sit-ups, or weight lifting) on 3 or more days during the 7 days before the survey (Table 107). The prevalence of having participated in muscle strengthening exercises on 3 or more days was higher among male (63.7%) than female (42.7%) students; higher among white male (63.0%), black male (69.8%), and Hispanic male (64.4%) than white female (46.1%), black female (34.5%), and Hispanic female (39.9%) students, respectively; and higher among 9th-grade male (64.9%), 10th-grade male (67.3%), 11th-grade male (62.5%), and 12th-grade male (59.9%) than 9th-grade female (48.2%), 10th-grade female (43.0%), 11th-grade female (39.3%), and 12th-grade female (39.9%) students, respectively. The prevalence of having participated in muscle strengthening exercises on 3 or more days was higher among white female (46.1%) than black female (34.5%) and Hispanic female (39.9%) students and higher among black male (69.8%) than white male (63.0%) students. The prevalence of having participated in muscle strengthening exercises on 3 or more days was higher among 9th-grade (56.9%) and 10th-grade (54.9%) than 11th-grade (51.1%) and 12th-grade (50.0%) students; higher among 9th-grade female (48.2%) than 10th-grade female (43.0%), 11th-grade female (39.3%), and 12th-grade female (39.9%) students; and higher among 10th-grade male (67.3%) than 11th-grade male (62.5%) and 12th-grade male (59.9%) students.

During 1991–2015, a significant linear increase occurred overall in the prevalence of having participated in muscle strengthening exercises on 3 or more days (47.8%–53.4%). A significant quadratic trend was not identified. The prevalence of having participated in muscle strengthening exercises on 3 or more days did not change significantly from 2013 (51.7%) to 2015 (53.4%).

This question was not included in the standard questionnaire used in the state and large urban school district surveys in 2015. Consequently, the range and median prevalence estimates across states and large urban school districts for the prevalence of having participated in muscle strengthening exercises on 3 or more days are not available.

Used Computers 3 or More Hours per Day

Nationwide, 41.7% of students played video or computer games or used a computer for something that was not school work for 3 or more hours per day on an average school day (i.e., used computers 3 or more hours per day) ( Table 109). The prevalence of having used computers 3 or more hours per day was higher among 9th-grade female (48.7%) than 9th-grade male (42.5%) students. The prevalence of having used computers 3 or more hours per day was higher among black (44.6%) and Hispanic (46.2%) than white (38.6%) students, higher among black female (48.4%) and Hispanic female (47.4%) than white female (38.3%) students, and higher among Hispanic male (45.1%) than white male (38.9%) students. The prevalence of having used computers 3 or more hours per day was higher among 9th-grade (45.4%) than 11th-grade (37.2%) and 12th-grade (40.5%) students; higher among 10th-grade (43.4%) than 11th-grade (37.2%) students; higher among 9th-grade female (4 8.7%) than 10th-grade female (43.3%), 11th-grade female (38.1%), and 12th-grade female (40.4%) students; higher among 10th-grade female (43.3%) than 11th-grade female (38.1%) students; and higher among 9th-grade male (42.5%), 10th-grade male (43.4%), and 12th-grade male (40.8%) than 11th-grade male (36.1%) students.

During 2003–2015, a significant linear increase occurred overall in the prevalence of having used computers 3 or more hours per day (22.1%–41.7%). A significant quadratic trend also was identified. The prevalence of having used computers 3 or more hours per day increased during 2003–2009 (22.1%–24.9%) and then increased more rapidly during 2009–2015 (24.9%–41.7%). The prevalence of having used computers 3 or more hours per day did not change significantly from 2013 (41.3%) to 2015 (41.7%).

Across 36 states, the prevalence of having used computers 3 or more hours per day ranged from 30.1% to 45.6% (median: 38.7%) ( Table 110). Across 18 large urban school districts, the prevalence ranged from 33.8% to 47.7% (median: 41.7%).

Watched Television 3 or More Hours per Day

Nationwide, 24.7% of students watched television 3 or more hours per day on an average school day (Table 109). The prevalence of having watched television 3 or more hours per day was higher among black (39.2%) and Hispanic (28.2%) than white (20.0%) students, higher among black (39.2%) than Hispanic (28.2%) students, higher among black female (41.5%) and Hispanic female (29.2%) than white female (18.8%) students, higher among black female (41.5%) than Hispanic female (29.2%) students, higher among black male (37.0%) and Hispanic male (27.4%) than white male (21.4%) students, and higher among black male (37.0%) than Hispanic male (27.4%) students.

During 1999–2015, a significant linear decrease occurred overall in the prevalence of having watched television 3 or more hours per day (42.8%–24.7%). A significant quadratic trend was not identified. The prevalence of having watched television 3 or more hours per day decreased significantly from 2013 (32.5%) to 2015 (24.7%).

Across 35 states, the prevalence of having watched television 3 or more hours per day ranged from 18.9% to 33.4% (median: 23.1%) (Table 110). Across 18 large urban school districts, the prevalence ranged from 19.7% to 35.9% (median: 29.3%).

Attended Physical Education Classes

Nationwide, 51.6% of students went to physical education (PE) classes on 1 or more days in an average week when they were in school (i.e., attended PE classes) ( Table 111). The prevalence of having attended PE classes was higher among male (55.3%) than female (47.8%) students; higher among black male (65.4%) and Hispanic male (60.5%) than black female (52.2%) and Hispanic female (50.1%) students, respectively; and higher among 10th-grade male (61.3%) and 12th-grade male (42.9%) than 10th-grade female (53.9%) and 12th-grade female (29.1%) students, respectively. The prevalence of having attended PE classes was higher among black (59.2%) than white (48.4%) students and higher among black male (65.4%) and Hispanic male (60.5%) than white male (51.0%) students. The prevalence of having attended PE classes was higher among 9th-grade (71.4%) than 10th-grade (57.5%), 11th-grade (38.5%), and 12th-grade (36.1%) students; higher among 10th-gr ade (57.5%) than 11th-grade (38.5%) and 12th-grade (36.1%) students; higher among 9th-grade female (70.4%) than 10th-grade female (53.9%), 11th-grade female (34.6%), and 12th-grade female (29.1%) students; higher among 10th-grade female (53.9%) than 11th-grade female (34.6%) and 12th-grade female (29.1%) students; higher among 11th-grade female (34.6%) than 12th-grade female (29.1%) students; higher among 9th-grade male (72.2%) than 10th-grade male (61.3%), 11th-grade male (42.2%), and 12th-grade male (42.9%) students; and higher among 10th-grade male (61.3%) than 11th-grade male (42.2%) and 12th-grade male (42.9%) students.

During 1991–2015, linear and quadratic trends were not identified in the prevalence of having attended PE classes. The prevalence of having attended PE classes also did not change significantly from 2013 (48.0%) to 2015 (51.6%).

Across 35 states, the prevalence of having attended PE classes ranged from 29.9% to 87.8% (median: 44.3%) ( Table 112). Across 14 large urban school districts, the prevalence ranged from 33.4% to 84.0% (median: 45.3%).

Attended Physical Education Classes Daily

Nationwide, 29.8% of students went to physical education (PE) classes on all 5 days in an average week when they were in school (i.e., attended PE classes daily) (Table 111). The prevalence of having attended PE classes daily was higher among male (33.8%) than female (25.5%) students; higher among white male (29.6%), black male (38.9%), and Hispanic male (42.4%) than white female (21.1%), black female (32.2%), and Hispanic female (33.0%) students, respectively; and higher among 10th-grade male (36.1%), 11th-grade male (25.2%), and 12th-grade male (27.9%) than 10th-grade female (27.0%), 11th-grade female (18.1%), and 12th-grade female (16.0%) students, respectively. The prevalence of having attended PE classes daily was higher among black (35.8%) and Hispanic (37.7%) than white (25.4%) students, higher among black female (32.2%) and Hispanic female (33.0%) than white female (21.1%) students, and higher among black male (38.9%) and Hispanic male (42.4%) than white male (29.6%) students. The prevalence of having attended PE classes daily was higher among 9th-grade (42.2%) than 10th-grade (31.5%), 11th-grade (21.8%), and 12th-grade (21.9%) students; higher among 10th-grade (31.5%) than 11th-grade (21.8%) and 12th-grade (21.9%) students; higher among 9th-grade female (39.5%) than 10th-grade female (27.0%), 11th-grade female (18.1%), and 12th-grade female (16.0%) students; higher among 10th-grade female (27.0%) than 11th-grade female (18.1%) and 12th-grade female (16.0%) students, higher among 9th-grade male (44.6%) than 10th-grade male (36.1%), 11th-grade male (25.2%), and 12th-grade male (27.9%) students; and higher among 10th-grade male (36.1%) than 11th-grade male (25.2%) and 12th-grade (27.9%) male students.

During 1991–2015, a significant linear trend was not identified in the prevalence of having attended PE classes daily. A significant quadratic trend was identified. The prevalence of having attended PE classes daily decreased during 1991–1995 (41.6%–25.4%) and then did not change during 1995–2015 (25.4%–29.8%). The prevalence of having attended PE classes daily also did not change significantly from 2013 (29.4%) to 2015 (29.8%).

Across 35 states, the prevalence of having attended PE classes daily ranged from 5.8% to 60.7% (median: 23.0%) (Table 112). Across 14 large urban school districts, the prevalence ranged from 8.6% to 42.7% (median: 22.9%).

Played on at Least One Sports Team

Nationwide, 57.6% of students had played on at least one sports team (run by their school or community groups) during the 12 months before the survey ( Table 113) ( Table 114). The prevalence of having played on at least one sports team was higher among male (62.2%) than female (53.0%) students; higher among black male (66.5%) and Hispanic male (56.3%) than black female (47.7%) and Hispanic female (40.7%) students, respectively; and higher among 9th-grade male (68.1%), 10th-grade male (63.5%), and 11th-grade male (62.3%) than 9th-grade female (57.6%), 10th-grade female (55.1%), and 11th-grade female (51.7%) students, respectively. The prevalence of having played on at least one sports team was higher among white (62.4%) and black (57.6%) than Hispanic (48.5%) students, higher among white female (60.7%) than black female (47.7%) and Hispanic female (40.7%) students, and higher among white male ( 64.4%) and black male (66.5%) than Hispanic male (56.3%) students. The prevalence of having played on at least one sports team was higher among 9th-grade (63.0%) than 11th-grade (57.0%) and 12th-grade (50.8%) students, higher among 10th-grade (59.2%) and 11th-grade (57.0%) than 12th-grade (50.8%) students, higher among 9th-grade female (57.6%) than 11th-grade female (51.7%) and 12th-grade female (46.9%) students, higher among 10th-grade female (55.1%) than 12th-grade female (46.9%) students, higher among 9th-grade male (68.1%) than 11th-grade male (62.3%) and 12th-grade male (54.6%) students, and higher among 10th-grade male (63.5%) than 12th-grade male (54.6%) students.

During 1999–2015, significant linear and quadratic trends were not identified in the prevalence of having played on at least one sports team. The prevalence of having played on at least one sports team also did not change significantly from 2013 (54.0%) to 2015 (57.6%).

Across 25 states, the prevalence of having played on at least one sports team ranged from 48.6% to 64.3% (median: 54.8%) (Table 112). Across 15 large urban school districts, the prevalence ranged from 44.7% to 55.6% (median: 48.9%).

Obesity, Overweight, and Weight Control

Obesity

Nationwide, 13.9% of students had obesity ( Table 115). The prevalence of obesity was higher among male (16.8%) than female (10.8%) students; higher among white male (15.6%) and Hispanic male (19.4%) than white female (9.1%) and Hispanic female (13.3%) students, respectively; and higher among 9th-grade male (15.4%), 10th-grade male (18.2%), 11th-grade male (18.4%), and 12th-grade male (15.0%) than 9th-grade female (10.3%), 10th-grade female (12.1%), 11th-grade female (10.2%), and 12th-grade female (10.5%) students, respectively. The prevalence of obesity was higher among black (16.8%) and Hispanic (16.4%) than white (12.4%) students, higher among black female (15.2%) and Hispanic female (13.3%) than white female (9.1%) students, and higher among Hispanic male (19.4%) than white male (15.6%) students. The prevalence of obesity was higher among 10th-grade (15.2%) than 12th-grade (12.7%) students and higher among 11th-grade male (18.4%) than 9th-grade male (15.4%) and 12th-grade male (15.0%) students.

During 1999–2015, a significant linear increase occurred in the prevalence of obesity (10.6%–13.9%). A significant quadratic trend was not identified. The prevalence of obesity did not change significantly from 2013 (13.7%) to 2015 (13.9%).

Across 37 states, the prevalence of obesity ranged from 10.3% to 18.9% (median: 13.3%) ( Table 116). Across 19 large urban school districts, the prevalence ranged from 9.9% to 22.5% (median: 13.3%).

Overweight

Nationwide, 16.0% of students were overweight (Table 115). The prevalence of overweight was higher among black female (21.2%) than black male (13.6%) students. The prevalence of overweight was higher among Hispanic (18.4%) than white (15.2%) students and higher among black female (21.2%) and Hispanic female (20.0%) than white female (14.6%) students.

During 1999–2015, a significant linear increase occurred in the prevalence of overweight (14.1%–16.0%). A significant quadratic trend was not identified. The prevalence of overweight did not change significantly from 2013 (16.6%) to 2015 (16.0%).

Across 37 states, the prevalence of overweight ranged from 13.3% to 18.2% (median: 15.3%) (Table 116). Across 19 large urban school districts, the prevalence ranged from 13.2% to 21.6% (median: 16.8%).

Described Themselves as Overweight

Nationwide, 31.5% of students described themselves as slightly or very overweight ( Table 117). The prevalence of students describing themselves as overweight was higher among female (38.2%) than male (25.3%) students; higher among white female (35.7%), black female (34.9%), and Hispanic female (45.3%) than white male (24.9%), black male (20.0%), and Hispanic male (28.0%) students, respectively; and higher among 9th-grade female (35.8%), 10th-grade female (38.9%), 11th-grade female (38.5%), and 12th-grade female (39.6%) than 9th-grade male (25.5%), 10th-grade male (25.2%), 11th-grade male (25.2%), and 12th-grade male (25.0%) students, respectively. The prevalence of students describing themselves as overweight was higher among Hispanic (36.4%) than white (30.3%) and black (27.0%) students, higher among Hispanic female (45.3%) than white female (35.7%) and black female (34.9%) students, and higher among white male (24.9%) and Hispanic male (28.0%) than black male (20.0%) students.

During 1991–2015, a significant linear decrease occurred overall in the prevalence of students describing themselves as overweight (31.8%–31.5%). A significant quadratic trend also was identified. The prevalence of students describing themselves as overweight decreased during 1991–1995 (31.8%–27.6%) and then increased during 1995–2015 (27.6%–31.5%). The prevalence of students describing themselves as overweight did not change significantly from 2013 (31.1%) to 2015 (31.5%).

Across 32 states, the prevalence of students describing themselves as overweight ranged from 26.2% to 33.4% (median: 30.6%) ( Table 118). Across 18 large urban school districts, the prevalence ranged from 24.2% to 35.9% (median: 29.8%).

Were Trying to Lose Weight

Nationwide, 45.6% of students were trying to lose weight (Table 117). The prevalence of trying to lose weight was higher among female (60.6%) than male (31.4%) students; higher among white female (59.5%), black female (54.2%), and Hispanic female (66.4%) than white male (28.8%), black male (26.2%), and Hispanic male (40.0%) students, respectively; and higher among 9th-grade female (59.4%), 10th-grade female (59.3%), 11th-grade female (61.7%), and 12th-grade female (62.6%) than 9th-grade male (31.1%), 10th-grade male (32.0%), 11th-grade male (31.0%), and 12th-grade male (31.9%) students, respectively. The prevalence of trying to lose weight was higher among white (44.1%) and Hispanic (53.1%) than black (39.4%) students, higher among Hispanic (53.1%) than white (44.1%) students, higher among Hispanic female (66.4%) than white female (59.5%) and black female (54.2%) students, and higher among Hispanic male (40.0%) than white male (28.8 %) and black male (26.2%) students.

During 1991–2015, a significant linear increase occurred overall in the prevalence of trying to lose weight (41.8%–45.6%). A significant quadratic trend was not identified. The prevalence of trying to lose weight did not change significantly from 2013 (47.7%) to 2015 (45.6%).

Across 30 states, the prevalence of trying to lose weight ranged from 40.7% to 49.5% (median: 45.2%) (Table 118). Across 17 large urban school districts, the prevalence ranged from 41.1% to 55.1% (median: 45.9%).

Other Health-Related Topics

Ever Had Asthma

Nationwide, 22.8% of students had ever been told by a doctor or nurse that they had asthma (i.e., ever had asthma) ( Table 119). The prevalence of having ever had asthma was higher among white female (23.7%) than white male (20.4%) students. The prevalence of having ever had asthma was higher among black (27.8%) than white (22.1%) and Hispanic (22.5%) students and higher among black male (28.4%) than white male (20.4%) and Hispanic male (23.0%) students.

During 2003–2015, a significant linear increase occurred overall in the prevalence of having ever had asthma (18.9%–22.8%). A significant quadratic trend was not identified. The prevalence of having ever had asthma also increased significantly from 2013 (21.0%) to 2015 (22.8%).

Across 29 states, the prevalence of having ever had asthma ranged from 19.3% to 31.3% (median: 24.3%) ( Table 120). Across 17 large urban school districts, the prevalence ranged from 19.0% to 34.4% (median: 23.7%).

Saw a Dentist

Nationwide, 74.4% of students saw a dentist for a check-up, exam, teeth cleaning, or other dental work during the 12 months before the survey (Table 119). The prevalence of having seen a dentist was higher among white (81.0%) than black (62.5%) and Hispanic (66.4%) students, higher among white female (80.9%) than black female (64.2%) and Hispanic female (68.1%) students and higher among white male (81.3%) than black male (61.1%) and Hispanic male (64.8%) students. The prevalence of having seen a dentist was higher among 9th-grade male (76.5%) than 12th-grade male (70.5%) students. Because the question measuring the prevalence of having seen a dentist was used for the first time in the 2015 national YRBS, long-term temporal trends and 2-year temporal changes are not available.

Across 31 states, the prevalence of having seen a dentist ranged from 65.7% to 82.7% (median: 73.6%) (Table 120). Across 17 large urban school districts, the prevalence ranged from 55.1% to 72.6% (median: 65.7%).

Eight or More Hours of Sleep

Nationwide, 27.3% of students got 8 or more hours of sleep on an average school night ( Table 121). The prevalence of getting 8 or more hours of sleep was higher among male (30.1%) than female (24.4%) students; higher among white male (31.1%), black male (25.6%), and Hispanic male (32.9%) than white female (24.9%), black female (20.6%), and Hispanic female (26.8%) students, respectively; and higher among 9th-grade male (39.3%) and 10th-grade male (33.8%) than 9th-grade female (29.1%) and 10th-grade female (23.1%) students, respectively. The prevalence of getting 8 or more hours of sleep was higher among white (28.0%) and Hispanic (29.8%) than black (23.5%) students, higher among Hispanic female (26.8%) than black female (20.6%) students, and higher among white male (31.1%) and Hispanic male (32.9%) than black male (25.6%) students. The prevalence of getting 8 or more hours of sleep was higher among 9th-grade (34.4%) than 10th-grade ( 28.4%), 11th-grade (22.9%), and 12th-grade (22.4%) students; higher among 10th-grade (28.4%) than 11th-grade (22.9%) and 12th-grade (22.4%) students; higher among 9th-grade female (29.1%) than 10th-grade female (23.1%), 11th-grade female (23.0%), and 12th-grade female (22.2%) students; higher among 9th-grade male (39.3%) than 10th-grade male (33.8%), 11th-grade male (22.9%), and 12th-grade male (22.6%) students, and higher among 10th-grade male (33.8%) than 11th-grade male (22.9%) and 12th-grade male (22.6%) students.

During 2007–2015, a significant linear decrease occurred overall in the prevalence of getting 8 or more hours of sleep (31.1%–27.3%). A significant quadratic trend was not identified. The prevalence of getting 8 or more hours of sleep also decreased significantly from 2013 (31.7%) to 2015 (27.3%).

Across 30 states, the prevalence of getting 8 or more hours of sleep ranged from 17.5% to 38.2% (median: 26.5%) ( Table 122). Across 19 large urban school districts, the prevalence ranged from 14.4% to 31.3% (median: 20.6%).

Indoor Tanning Device Use

Nationwide, 7.3% of students had used an indoor tanning device, such as a sunlamp, sunbed, or tanning booth (not counting getting a spray-on tan), one or more times during the 12 months before the survey (i.e., indoor tanning device use) ( Table 123). The prevalence of indoor tanning device use was higher among female (10.6%) than male (4.0%) students; higher among white female (15.2%) than white male (3.7%) students; and higher among 9th-grade female (6.0%), 10th-grade female (7.1%), 11th-grade female (14.0%), and 12th-grade female (16.2%) than 9th-grade male (2.7%), 10th-grade male (3.5%), 11th-grade male (3.9%), and 12th-grade male (5.8%) students, respectively. The prevalence of indoor tanning device use was higher among white (9.4%) than black (3.7%) and Hispanic (4.7%) students, higher among white female (15.2%) and Hispanic female (5.8%) than black female (2.1%) students, and higher among white female (15.2%) than Hispanic fem ale (5.8%) students. The prevalence of indoor tanning device use was higher among 11th-grade (9.0%) and 12th-grade (10.9%) than 9th-grade (4.2%) and 10th-grade (5.3%) students, higher among 11th-grade female (14.0%) and 12th-grade female (16.2%) than 9th-grade female (6.0%) and 10th-grade female (7.1%) students, and higher among 12th-grade male (5.8%) than 9th-grade male (2.7%) students.

During 2009–2015, a significant linear decreased occurred overall in the prevalence of indoor tanning device use (15.6%–7.3%). A significant quadratic trend was not identified. The prevalence of indoor tanning device use also decreased significantly from 2013 (12.8%) to 2015 (7.3%).

This question was not included in the standard questionnaire used in the state and large urban school district surveys in 2015. As a result, the range and median prevalence estimates across states and large urban school districts for the prevalence of indoor tanning device use are not available.

Had a Sunburn

Nationwide, 55.8% of students had a sunburn (counting even a small part of their skin turning red or hurting for 12 hours or more after being outside in the sun or after using a sunlamp or other indoor tanning device) one or more times during the 12 months before the survey (i.e., had a sunburn) (Table 123). The prevalence of having had a sunburn was higher among female (59.8%) than male (52.0%) students; higher among white female (77.7%) and Hispanic female (43.8%) than white male (67.6%) and Hispanic male (38.0%) students, respectively; and higher among 9th-grade female (60.0%), 10th-grade female (58.9%), and 11th-grade female (60.7%) than 9th-grade male (50.4%), 10th-grade male (52.9%), and 11th-grade male (52.4%) students, respectively. The prevalence of having had a sunburn was higher among white (72.5%) and Hispanic (40.8%) than black (15.0%) students, higher among white (72.5%) than Hispanic (40.8%) students, higher among whi te female (77.7%) and Hispanic female (43.8%) than black female (16.2%) students, higher among white female (77.7%) than Hispanic female (43.8%) students, higher among white male (67.6%) and Hispanic male (38.0%) than black male (13.4%) students, and higher among white male (67.6%) than Hispanic male (38.0%) students. Because the question measuring the prevalence of having had a sunburn was used for the first time in the 2015 national YRBS, long-term temporal trends and 2-year temporal changes are not available.

This question was not included in the standard questionnaire used in the state and large urban school district surveys in 2015. As a result, the range and median prevalence estimates across states and large urban school districts for the prevalence of having had a sunburn are not available.

Avoided Food Because of Allergic Reaction Risk

Nationwide, 16.0% of students avoided some foods because eating the food could cause an allergic reaction (such as skin rashes, swelling, itching, vomiting, coughing, or trouble breathing) ( Table 124). The prevalence of avoiding food because eating the food could cause an allergic reaction was higher among female (19.9%) than male (12.0%) students; higher among white female (19.5%) and Hispanic female (18.2%) than white male (11.3%) and Hispanic male (10.2%) students, respectively; and higher among 9th-grade female (24.3%), 10th-grade female (17.6%), 11th-grade female (19.0%), and 12th-grade female (18.8%) than 9th-grade male (13.5%), 10th-grade male (12.5%), 11th-grade male (10.7%), and 12th-grade male (11.3%) students, respectively. The prevalence of avoiding food because eating the food could cause an allergic reaction was higher among black (20.7%) than white (15.4%) and Hispanic (14.1%) students and higher among black male (18. 8%) than white male (11.3%) and Hispanic male (10.2%) students. The prevalence of avoiding food because eating the food could cause an allergic reaction was higher among 9th-grade (18.7%) than 10th-grade (15.2%), 11th-grade (14.8%), and 12th-grade (14.9%) students and higher among 9th-grade female (24.3%) than 10th-grade female (17.6%), 11th-grade female (19.0%), and 12th-grade female (18.8%) students. Because the question measuring the prevalence of avoiding food because eating the food could cause an allergic reaction was used for the first time in the 2015 national YRBS, long-term temporal trends and 2-year temporal changes are not available.

This question was not included in the standard questionnaire used in the state and large urban school district surveys in 2015. As a result, the range and median prevalence estimates across states and large urban school districts for the prevalence of avoiding food because eating the food could cause an allergic reaction are not available.

Discussion

YRBSS is the largest public health surveillance system in the United States monitoring a broad range of health behaviors among high school students. YRBSS data are used widely to compare the prevalence of health behaviors among subpopulations of students; assess trends in health behaviors over time; monitor progress toward achieving national health objectives; provide comparable state and large urban school district data; and help develop, assess, and improve school and community policies, programs, and practices designed to decrease health-risk behaviors and improve health outcomes among youth.

Compare Health Behavior Prevalence Among Subpopulations of Students

YRBSS is designed to identify how health behaviors vary by subpopulations of high school students defined by sex and race/ethnicity. Understanding these variations (or lack of variation) in health behaviors might help design, target, and identify the impact of school and community policies, programs, and practices. However, YRBSS data cannot isolate the effects of sex and race/ethnicity from the effects of socioeconomic status (SES) or culture on the prevalence of health behaviors. For example, in a national study, the likelihood of behavioral cardiovascular disease risks, including obesity, sedentary behaviors, and tobacco exposure, increased among adolescents aged 12–17 years as the SES based on poverty-income ratio decreased (14).

Variations by Sex

The prevalence of most health behaviors varies by sex. For example, the prevalence of two injury-related behaviors (rarely or never wearing a seatbelt and driving when drinking alcohol) was higher among male than female students. The prevalence of seven violence-related behaviors (carrying a weapon, carrying a gun, carrying a weapon on school property, being threatened or injured with a weapon on school property, being in a physical fight, being injured in a physical fight, and being in a physical fight on school property) was also higher among male than female students. However, the prevalence of having not gone to school because of safety concerns, being electronically bullied, being bullied on school property, being forced to have sexual intercourse, physical dating violence, and sexual dating violence was higher among female than male students. The prevalence of all five suicide-related behaviors (feeling sad or hopeless, seriously considering attempting suicide, havin g made a suicide plan, attempting suicide, and making a suicide attempt resulting in an injury, poisoning, or overdose that had to be treated by a doctor or nurse) also was higher among female than male students. Rarely or never wearing a bicycle helmet, riding with a driver who had been drinking alcohol, and texting or e-mailing while driving did not vary by sex.

The prevalence of nine tobacco use risk behaviors (smoking a whole cigarette before age 13 years; current cigarette use; usually obtaining their own cigarettes by buying them in a store or gas station; current smokeless tobacco use; current cigar use; current electronic vapor product use; current cigarette or cigar use; current cigarette, cigar, or smokeless tobacco use; and current cigarette, cigar, smokeless tobacco, or electronic vapor product use) was higher among male than female students. Having tried to quit smoking cigarettes, the only health promoting tobacco use behavior, had a higher prevalence among female than male students. However, the prevalence of six tobacco use behaviors (ever trying cigarette smoking, current frequent cigarette use, smoking more than 10 cigarettes per day, currently smoking cigarettes daily, usually obtaining their own cigarettes by buying them on the Internet, and ever use of electronic vapor products) did not vary by sex.

The prevalence of 14 of the 21 alcohol and other drug use behaviors (drinking alcohol before age 13 years; having 10 or more as the largest number of drinks of alcohol in a row; trying marijuana before age 13 years; current marijuana use; ever using synthetic marijuana; ever using hallucinogenic drugs; ever using cocaine; ever using ecstasy; ever using heroin; ever using methamphetamines; ever taking steroids without a doctor’s prescription; ever taking prescription drugs without a doctor’s prescription; ever injecting any illegal drug; and being offered, sold, or given an illegal drug on school property) was higher among male than female students. However, the prevalence of ever drinking alcohol, usually obtaining the alcohol they drank by someone giving it to them, and usually using marijuana by smoking it was higher among female than male students. Four alcohol and other drug use behaviors (current alcohol use, having five or more drinks of alcohol in a ro w, ever using marijuana, and ever using inhalants) did not vary by sex.

The prevalence of four risk (ever having had sexual intercourse, having sexual intercourse before age 13 years, having sexual intercourse with four or more persons during their life, and drinking alcohol before last sexual intercourse) and one protective (condom use) sexual behavior was higher among male than female students, while the prevalence of five protective sexual behaviors (birth control pill use; IUD or implant use; shot, patch, or birth control ring use; birth control pill, IUD or implant, or shot, patch, or birth control ring use; and both condom use and birth control pill; IUD or implant; or shot, patch, or birth control ring use) was higher among female than male students. Current sexual activity, not using any method to prevent pregnancy, and having ever been tested for HIV did not vary by sex.

The prevalence of 17 of the 26 dietary behaviors (not eating fruit or drinking 100% fruit juices; eating fruit or drinking 100% fruit juices two or more times and three or more times per day; not eating vegetables; eating vegetables two or more times and three or more times per day; drinking one or more, two or more, and three or more glasses of milk per day; drinking soda or pop one or more, and two or more, and three or more times per day; drinking sports drinks one or more, two or more, and three or more times per day; drinking three or more glasses of water per day; and eating breakfast on all 7 days) was higher among male than female students. In contrast, the prevalence of only three dietary behaviors (not drinking milk, not drinking soda or pop, and not drinking sports drinks) was higher among female than male students. Eating fruit or drinking 100% fruit juices one or more times per day, eating vegetables one or more times per day, not drinking water, drinking one or more and two or more glasses of water per day, and not eating breakfast did not vary by sex.

The prevalence of six of the nine physical activity behaviors (being physically active at least 60 minutes per day on 5 or more days, being physically active at least 60 minutes per day on all 7 days, participating in muscle strengthening activities, attending physical education classes, attending physical education classes daily, and playing on at least one sports team) was higher among male than female students. Only one physical activity behavior (not participating in at least 60 minutes of physical activity on at least 1 day) had a higher prevalence among female than male students. Using computers 3 or more hours per day and watching television 3 or more hours per day did not vary by sex.

The prevalence of obesity was higher among male than female students, and the prevalence of overweight did not vary by sex. The prevalence of describing themselves as overweight and trying to lose weight was higher among female than male students. Male students had a higher prevalence than female students of getting eight or more hours of sleep on an average school night, while female students had a higher prevalence than male students of using an indoor tanning device, having had a sunburn, and avoiding foods because of the risk of allergic reactions. Ever having had asthma and having seen a dentist did not vary by sex.

Variations by Race/Ethnicity

The prevalence of most health behaviors varies by race/ethnicity. The prevalence of 24 behaviors (12 risk and 12 protective) was higher among white than black and Hispanic students, the prevalence of 12 risk behaviors was higher among black than white and Hispanic students, and the prevalence of 10 risk behaviors was higher among Hispanic than white and black students. Twenty-three behaviors did not vary by race/ethnicity.

White students had a higher prevalence than black and Hispanic students of four injury-related risk behaviors (texting or e-mailing while driving, carrying a weapon, being electronically bullied, and bullying on school property), six tobacco-use related risk behaviors (current cigarette use; current frequent cigarette use; currently smoked cigarettes daily; current smokeless tobacco use; current cigarette or cigar use; and current cigarette, cigar, or smokeless tobacco use), three protective sexual behaviors (birth control pill use; birth control pill, IUD or implant, or shot, patch, or birth control ring use; and both condom use and birth control pill, IUD or implant, or shot, patch, or birth control ring use), six protective dietary behaviors (eating vegetables one or more times per day, drinking one or more and two or more glasses of milk per day, not drinking soda or pop, not drinking sports drinks, and drinking one or more glasses of water per day), two protective ph ysical activity behaviors (being physically active at least 60 minutes per day on 5 or more days and being physically active at least 60 minutes per day on all 7 days), and three additional behaviors (having seen a dentist, indoor tanning device use, and having had a sunburn).

Black students had a higher prevalence than white and Hispanic students of two injury-related risk behaviors (rarely or never wearing a seatbelt and being in a physical fight), two sexual risk behaviors (having sexual intercourse before age 13 years and having sexual intercourse with four or more persons during their life), four dietary risk behaviors (not eating vegetables, not drinking milk, drinking sports drinks two or more times per day, and not drinking water), two physical activity risk behaviors (not participating in at least 60 minutes of physical activity on at least 1 day and watching television 3 or more hours per day), having had asthma, and avoiding food because eating the food could cause an allergic reaction.

Hispanic students had a higher prevalence than white and black students of riding with a driver who had been drinking alcohol, feeling sad or hopeless, ever using electronic vapor products, five alcohol or other drug use behaviors (drinking alcohol before age 13 years; ever using synthetic marijuana; ever using cocaine; ever using ecstasy; and being offered, sold or given an illegal drug on school property), describing themselves as overweight, and trying to lose weight.

The prevalence of seven injury-related behaviors (driving when drinking alcohol, carrying a gun, carrying a weapon on school property, being forced to have sexual intercourse, physical dating violence, sexual dating violence, and having made a suicide plan), six tobacco-related behaviors (ever tried cigarette smoking, smoking a whole cigarette before age 13 years, smoking more than 10 cigarettes per day, usually obtaining their own cigarettes by buying them on the Internet, having tried to quit smoking cigarettes, and current cigar use), two drug-related behaviors (usually using marijuana by smoking it and ever using inhalants), three sexual behaviors (currently sexually active, IUD or implant use, and drinking alcohol or using drugs before last sexual intercourse), four dietary behaviors (not eating fruit or drinking 100% fruit juices, eating fruit or drinking 100% fruit juices one or more times per day, and drinking soda or pop one or more and two or more times per day), and participating in muscle strengthening exercises did not at all vary by race/ethnicity.

Assess Trends in Health Behaviors Over Time

Because YRBSS has been implemented since 1991, YRBSS data can be used to assess both long-term temporal trends (i.e., as long as 24 years) and more recent 2-year temporal changes in health behaviors. This reports describes many long-term linear increases and decreases in prevalence, which reflect real reductions in risk behaviors and potential improvements in health outcomes among high school students nationwide.

Long-term linear decreases occurred overall in the prevalence of all three behaviors (for which long-term trend data were available) that contribute to unintentional injuries (rarely or never wore a bicycle helmet, rarely or never wore a seatbelt, and rode with a driver who had been drinking alcohol). However, based on significant quadratic trends, the prevalence of rarely or never wearing a bicycle helmet has not changed since 2001. Long-term linear decreases also occurred overall in the prevalence of eight of the 11 violence-related behaviors for which long-term trend data were available (carrying a weapon, carrying a gun, carrying a weapon on school property, being threatened or injured with a weapon on school property, being in a physical fight, being injured in a physical fight, being in a physical fight on school property, and being forced to have sexual intercourse). However, a long-term linear increase was identified in the prevalence of having not gone to school b ecause of safety concerns; no long-term linear changes were identified in the prevalence of being electronically bullied and being bullied on school property; and, based on significant quadratic trends, the prevalence of carrying a weapon and carrying gun has not changed since 1997. In addition, long-term linear decreases occurred overall in the prevalence of three of the five suicide-related behaviors (seriously considering attempting suicide, making a suicide plan, and attempting suicide). Based on significant quadratic trends, the prevalence of having made a suicide plan and attempting suicide increased since 2009.

Long-term linear decreases occurred overall in the prevalence of nine of the 10 tobacco use-related risk behaviors (for which long-term trend data were available) (ever trying cigarette smoking; smoking a whole cigarette before age 13 years; current cigarette use; current frequent cigarette use; smoking more than 10 cigarettes per day; currently smoking cigarettes daily; current cigar use; current cigarette or cigar use; and current cigarette, cigar, or smokeless tobacco use). The prevalence of current smokeless tobacco use was the only tobacco-use related risk behavior for which a long-term linear decrease was not identified. In addition, a long-term linear decrease was identified in the prevalence of the one tobacco use-related protective behavior (having tried to quit smoking cigarettes).

Long-term linear decreases occurred overall in the prevalence of 13 of the 18 alcohol- and other drug use-related behaviors (for which long-term trend data were available) (ever drinking alcohol; drinking alcohol before age 13 years; current alcohol use; having five or more drinks of alcohol in a row; trying marijuana before age 13 years; ever using hallucinogenic drugs; ever using cocaine; ever using ecstasy; ever using heroin; ever using methamphetamines; ever taking prescription drugs without a doctor’s prescription; ever using inhalants; and being offered, sold, or given an illegal drug on school property). No long-term linear trends were identified in the prevalence of usually obtaining the alcohol they drank by someone giving it to them, ever using marijuana, current marijuana use, ever taking steroids without a doctor’s prescription, and ever injecting any illegal drug. However, based on significant quadratic trends, ever using marijuana decreased sinc e 1997, current marijuana use decreased since 1995, ever taking steroids without a doctor’s prescription decreased since 2001, and ever injecting any illegal drug decreased since 2011.

Long-term linear decreases occurred overall in the prevalence of five sexual risk behaviors (ever having had sexual intercourse, having sexual intercourse before age 13 years, having sexual intercourse with four or more partners, being currently sexually active, and not using any method to prevent pregnancy) and a long-term linear increase occurred overall in the prevalence of condom use; IUD or implant use; and birth control pill, IUD or implant, or shot, patch, or birth control ring use. However, although a long-term linear increase in the prevalence of condom use was identified, a significant quadratic trend indicated that the prevalence of condom use decreased since 2003. In addition, a long-term linear decrease occurred in the prevalence of having ever been tested for HIV.

Long-term linear decreases in the prevalence of not eating fruit or drinking 100% fruit juices and drinking soda or pop one or more, two or more, and three or more times per day and long-term linear increases in eating vegetables three or more times per day and not drinking soda or pop are positive trends. However, long-term linear decreases in the prevalence of eating fruit or drinking 100% fruit juices three or more times per day and long-term linear increases in not eating vegetables are negative trends. Similarly, the long-term linear decrease in the prevalence of watching television 3 or more hours per day which represents a decrease in sedentary behaviors is probably offset by the long-term linear increase in the prevalence of using computers three or more hours per day.

Monitor Progress Toward Achieving National Health Objectives

The national YRBS is the primary source of data to measure 21 Healthy People 2020 objectives, including one leading health indicator (15). The Healthy People 2020 objectives provide a comprehensive agenda for improving the health of all persons in the United States during 2011–2020. This report provides the Healthy People 2020 targets and data from the 2015 national YRBS for 18 of the 21 objectives measured using the national YRBS ( Table 125). The data indicate that, as of 2015, seven of these 18 objectives have been achieved, which is nearly double the number met when the 2013 national YRBS data were reported in 2014 (16). Healthy People 2020 objective C-20.3 is to reduce the proportion of adolescents in grades 9–12 who report using artificial sources of ultraviolet light for tanning to =14.0%. During 2015, 7.3% of high school students nationwide had used an indoor tanning device (e.g., sunlamp, sunbed, or tanning booth) one or more times during the 12 months before the survey. Healthy People 2020 objective IVP-34 is to reduce physical fighting among adolescents to =28.4%. During 2015, 22.6% of high school students nationwide had been in a physical fight one or more times during the 12 months before the survey. Healthy People 2020 objective IVP-36 is to reduce weapon carrying by adolescents on school property to =4.6%. During 2015, 4.1% of high school students nationwide had carried a weapon on school property on at least 1 day during the 30 days before the survey. Healthy People 2020 objective PA-8.2.3 is to increase the proportion of adolescents in grades 9 through 12 who view television, videos, or play video games for no more than 2 hours per day. During 2015, 75.3% of high school students nationwide watched television for no more than 2 hours per day on an average school day. Healthy People 2020 objective SA-1 is to reduce the proportion of adolescents who report that they rode, during the previous 30 days, with a driver who had been drinking alcohol to =25.5%. During 2015, 20.0% of high school students nationwide had ridden in a car or other vehicle driven by someone who had been drinking alcohol one or more times during the 30 days before the survey. Healthy People 2020 objective TU-2.1 is to reduce the proportion of adolescents who use tobacco products during the past 30 days to =21.0%. During 2015, 17.0% of high school students nationwide smoked cigarettes; used chewing tobacco, snuff, or dip; or smoked cigars, cigarillos, or little cigars on at least 1 day during the 30 days before the survey. Healthy People 2020 objective TU-2.2 is to reduce the proportion of adolescents who use cigarettes during the past 30 days to =16.0%. During 2015, 10.8% of high school students smoked cigarettes on at least 1 day during the 30 days before the survey. Although Table 125 indicates that Healthy People 2020 objective PA-3.1 to increase the proportion of adolescents who meet current Federal physical activity guidelines for aerobic activity has been met, the 2015 YRBS prevalence estimate for aerobic physical activity is not comparable to the baseline prevalence estimate upon which the target was set because of a change in the context of the question starting with the 2011 national YRBS questionnaire.

To meet additional Healthy People 2020 objectives, positive changes in school and community policies, programs, and practices might be needed. For example, Healthy People 2020 objective IVP-35 is to reduce bullying among adolescents to =17.9%. During 2015, 20.2% of high school students nationwide were bullied on school property during the 12 months before the survey. Similarly, Healthy People 2020 objective SH-3 is to increase the proportion of students in grades 9 through 12 who get sufficient sleep to =33.2%. During 2015, 27.3% of high school students nationwide got 8 or more hours of sleep on an average school night.

Provide Comparable State and Large Urban School District Data

One of the strengths of YRBSS is that it provides not just national but state and large urban school district data. These data are more likely to be used to develop, improve, and evaluate state and local policies, programs, and practices because they reflect a more relevant population. It is also possible to compare data from the state and large urban school district surveys because they share similar sample designs, questionnaires, data collection procedures, and data processing procedures.

Across states, a range of 25 or more percentage points or a fivefold variation or greater was identified for the following 15 behaviors:

• rarely or never wore a bicycle helmet (minimum: 53.0%; maximum: 94.1%);

• texted or e-mailed while driving (minimum: 26.1%; maximum: 63.2%);

• carried a weapon on school property (minimum: 2.0%; maximum: 10.7%);

• smoked more than 10 cigarettes per day (minimum: 2.0%; maximum: 14.6%);

• currently smoked cigarettes daily (minimum: 1.0%; maximum: 5.4%);

• usually obtained their own cigarettes by buying them on the Internet (minimum: 0.0%; maximum: 6.0%);

• ever used heroin (minimum: 0.9%; maximum: 5.9%);

• ever injected any illegal drug (minimum: 1.0%; maximum: 5.4%);

• IUD or implant use (minimum: 1.3%; maximum: 9.7%);

• shot, patch, or birth control ring use (minimum: 1.6%; maximum: 9.5%);

• birth control pill; IUD or implant; or shot, patch, or birth control ring use (minimum: 17.5%; maximum: 47.3%);

• ate vegetables one or more times per day (minimum: 46.7%; maximum: 72.3%);

• drank one or more glasses of milk per day (minimum: 23.0%; maximum: 51.6%);

• attended physical education classes (minimum: 29.9%; maximum: 87.8%); and

• attended physical education classes daily (minimum: 5.8%; maximum: 60.7%).

Across large urban school districts, a range of 25 or more percentage points or a fivefold variation or greater was identified for the following 16 behaviors:

• rarely or never wore a bicycle helmet (minimum: 55.1%; maximum: 95.6%);

• being in a physical fight (minimum: 13.9%; maximum: 42.5%);

• smoked more than 10 cigarettes per day (minimum: 0.9%; maximum: 12.8%);

• currently smoked cigarettes daily (minimum: 0.3%; maximum: 1.6%);

• usually obtained their own cigarettes by buying them in a store or gas station (minimum: 14.9%; maximum: 64.5%);

• tried to quit smoking cigarettes (minimum: 35.7%; maximum: 81.8%);

• ever used heroin (minimum: 1.5%; maximum: 8.3%);

• ever had sexual intercourse (minimum: 25.9%; maximum: 52.4%);

• IUD or implant use (minimum: 0.5%; maximum: 16.9%);

• shot, patch, or birth control ring use (minimum: 1.1%; maximum: 10.5%);

• birth control pill; IUD or implant; or shot, patch, or birth control ring use (minimum: 10.4%; maximum: 37.6%);

• ever been tested for HIV (minimum: 7.0%; maximum: 37.4%);

• drank soda or pop three or more times per day (minimum: 2.6%; maximum: 13.5%);

• ate breakfast on all 7 days (minimum: 16.4%; maximum: 44.6%);

• attended physical education classes (minimum: 33.4%; maximum: 84.0%); and

• attended physical education classes daily (minimum: 8.6%; maximum: 42.7%).

Across states, the health behaviors with a range of 25 or more percentage points or a fivefold variation or greater were fairly evenly distributed across the following categories of behaviors: injury and violence (three), cigarette use (two), other drug use (two), birth control use (three), dietary behaviors (two), and physical activity (two). In contrast, across the large urban school districts, 81% of the health behaviors with a range of 25 or more percentage points or a fivefold variation or greater were distributed across just three categories of behaviors: cigarette use (four), sexual behaviors (four), and dietary behaviors and physical activity (four). The variations in ranges might reflect differences in state and local laws and policies, enforcement practices, access to drugs, availability of effective school and community interventions, prevailing behavioral and social norms, demographic characteristics of the population, and adult practices and health behaviors and also highlight how changes in one or more of these factors might contribute to reductions in health-risk behaviors among high school students.

Develop, Assess, and Improve Health-Related Policies, Programs, and Practices

In addition to measuring progress toward achieving Healthy People 2020 objectives, CDC and other federal agencies use YRBS data in a variety or reports and publications to stimulate support for and improvements in public health interventions, including 2015 NCHHSTP State Health Profiles (17), Indicators for Chronic Disease Surveillance (18), America’s Children: Key National Indicators of Well-Being, 2015 (19), and Prevention Status Reports (20). CDC also uses YRBS data to assess the impact of funding initiatives. More specifically, YRBS data are a primary data source for monitoring the impact of two major CDC cooperative agreements: Promoting Adolescent Health Through School-Based HIV/STD Prevention and School-Based Surveillance (http://www.cdc.gov/healthyyouth/fundedpartners/1308/pdf/rfa-1308.pdf) and State Public Health Actions to Prevent and Control Diabetes, Heart Disease, Obesity and Associated Risk Factors and Promote School Health (http://www.cdc.gov/chronicdisease/about/state-public-health-actions.htm).

At the state and local level, health and education agencies and nongovernmental organizations use YRBS data in a variety of ways to improve health-related policies, programs, and practices. For example, Connecticut’s YRBS data on sexual behaviors were used by the Connecticut State Board of Education to support inclusion of comprehensive sexuality education in their position statement on coordinated school health and by the Connecticut Department of Education to help develop Guidelines for the Sexual Health Education Component of Comprehensive Health Education for local school districts on best practice policies, programs, and instruction in sexual health education. Boston Public Schools used their YRBS data on sexual behaviors in an annual presentation to the Boston City Council to demonstrate the need for sexual health education and services and to garner support for the District Wellness Policy requiring schools to teach comprehensive sexual health education and p rovide sexual health services, including distribution of condoms at the high school level. The Hawaii Department of Health used the dietary behavior data from their YRBS to support their public education campaign (on television, in malls, and in movie theaters) to reduce youth consumption of sugar-sweetened beverages and to track the impact of school wellness policies which restrict access to sugar-sweetened beverages on campus and at school-sponsored events. The Los Angeles Unified School District used their YRBS data to support a new Los Angeles County ordinance on electronic vapor products and to support passage of a city-wide ordinance banning electronic vapor products from public spaces, bars, and restaurants. Montana YRBS data on bullying were used to support passage of a new Student Protections Procedures rule requiring schools to address bullying and threatening behavior in schools, on school buses, at school-sponsored activities, and online and to create a BullyFree Montana website and toolkit. The Bureau of Children, Youth, and Families used New York City YRBS data on attempted suicide to support a mental health awareness campaign for teens that included videos and other online resources on New York City’s dedicated website for teens and that is available as part of the Teen Talk Toolkit distributed to health educators in New York City public middle and high schools.

Limitations

The findings in this report are subject to at least four limitations. First, these data apply only to youth who attend school and, therefore, are not representative of all persons in this age group. Nationwide, in 2012, of persons aged 16–17 years, approximately 3% were not enrolled in a high school program and had not completed high school (21). Second, the extent of underreporting or overreporting of behaviors cannot be determined, although the survey questions demonstrate good test-retest reliability (5,8). Third, BMI is calculated on the basis of self-reported height and weight, and, therefore, tends to underestimate the prevalence of obesity and overweight (22). Fourth, not all states and large urban school districts include all of the standar d questions on their YRBS questionnaire.

Conclusions

YRBSS is an ongoing source of high-quality data at the national, state, and large urban school district levels for monitoring health behaviors that contribute to the leading causes of mortality and morbidity among youth and adults in the United States. In 2015, in addition to the national data, 37 states and 19 large urban school districts obtained data representative of their high school students. YRBSS data are an important tool for planning, implementing, and evaluating public health policies, programs, and practices in each of these jurisdictions. Although beyond the scope of this report, a particular strength of YRBSS (as compared with more narrowly focused surveys) is that it allows analysis of the inter-relationships among health behaviors (e.g., how alcohol and other drug use is associated with sexual behaviors). Similarly, because of its long history and consistent methodology, YRBSS can identify not only national long-term temporal trends in health behaviors over all as described in this report, but also long-term trends among subgroups of students (e.g., by sex or race/ethnicity) and long-term temporal trends at the state and large urban school district levels. These trend analyses are particularly valuable for understanding the impact of broad public health and school health policies and practices designed to improve the health outcomes of students.

To maintain the quality of YRBSS data, increased support for YRBSS, enhanced training and technical assistance for participating state and local health and education agencies, an increase in the number of states with representative data, more substate surveys at the large urban school district and county- or school-district level, and more universal use of all standard questions are needed. Further, to sustain the surveillance system over time, it is important to understand the impact of new education and public health laws, policies, and practices related to data collection that might threaten the quality of YRBSS and its ability to generate critical data for informing future efforts to protect and promote the health of youth nationwide.

* Might include charter schools and public alternative, special education, or vocational schools.

^† Might include religious and other private schools, but does not include private alternative, special education, or vocational schools.

^§ Includes regular public schools and might include charter schools; public alternative, special education, or vocational schools; and schools overseen by the Bureau of Indian Education.

^¶ Might include religious and other private schools.

** A questionnaire that fails quality control has <20 remaining responses after editing or has the same answer to =15 consecutive questions.

^†† Overall response rate = (number of participating schools/number of eligible sampled schools) x (number of usable questionnaires/number of eligible students sampled).

^§§ The prevalence of driving a car or other vehicle during the 30 days before the survey varies slightly for driving when drinking alcohol and texting or e-mailing while driving because of differences in the number of usable responses to each question.

^¶¶ The prevalence of dating or going out with someone during the 12 months before the survey varies slightly for physical dating violence and sexual dating violence because of differences in the number of usable responses to each question.

*** Review of only the oldest and most recent data points are not necessarily indicative of long-term temporal trends because the logistic regression analyses take into account all data points and adjust for changes in sex, grade, and race/ethnicity over time.

^††† Pellet-sized pieces of highly purified cocaine.

^§§§ A process in which cocaine is dissolved in ether or sodium hydroxide and the precipitate is filtered off.

^¶¶¶ Green salad, potatoes (excluding French fries, fried potatoes, or potato chips), carrots, or other vegetables.