Over the past few months, the U.S. Centers for Disease Control has been releasing, piece by piece, the results of the largest federal effort to date to gather information about the health status of teenagers: the Youth Risk Behavior Survey.
Based upon a nationally representative sample of 11,631 students in grades 9 through 12, the survey includes questions about a range of health issues, including substance abuse, suicide, and sexual behaviors. Similar surveys based on the national model have been conducted in 30 states and 10 cities.
The first national survey was conducted last year, and federal officials are planning to conduct the survey again to new groups of students this year and in two-year intervals during the rest of the decade.
Laura Kann, the chief of the surveillance research section in the division of adolescent and school health at the C.D.C., spoke to Staff Writer Ellen Flax about the surveys.
Q. Why is the C.D.C. conducting these surveys?
A. The purposes of the youth risk-behavior- surveillance system are threefold. First of all, to focus the nation on behaviors among youths that cause the most important health problems. Second, to assess how [the incidence oil risk behaviors change over time … And last, to provide comparable data at the national, state, and local levels, and among youth who attend school, as well as among those who do not.
Q. What is the C.D.C going to be doing with these results?
A. The youth risk-behavior-surveillance system results are being used ... to monitor progress in achieving 26 national health-promotion and disease-prevention objectives, and to monitor progress in achieving 28 Healthy Community 2000 [a C.D.C. initiative] model standards.
In addition, the ... results are being used to monitor progress in achieving national education goal six, which focuses on safe, disciplined, and drug-free schools, and to monitor student drug use for the the Public Health Service’s illicit drug demand- reduction plan.
And then finally, at the state and local level in particular, the results are being used to focus school health-education teacher training and instructional programs, and to support comprehensive school-health programs.
Q. What are some of the gaps we have in our knowledge about the health status of adolescents?
A. Historically, we have not had a lot of data available about priority health risk behaviors among youths, and in particular, we have not conducted surveys that have let us look across behavior areas.
Surveys in the past tended to be categorical, i.e., focusing on just one particular health topic, rather than looking looking at a wide range of health topics. We know from research that kids who are at risk in one particular area are often at risk in many other areas.
Q. Are parents or local educators allowed to review the questions be. fore kids answer them?
A. It varies by city and state, but, generally speaking, states clear the survey first at the state level, through state school boards or state superintendents, or other state-level administrators, and then at the district level, and then at the school level with the principal. In most places, some kind of parental permission is used as well, and, of course, students themselves have a right to refuse whether or not to take this survey.
Q. How are the state and local surveys different from the national one?
A. The national survey involve a national probability sample of schools and it provides us with data that will allow us to talk about kids nationwide. The state-level and the local-level surveys only include samples of a particular state or a particular city, and, consequently, can only be generalized to kids in those particular cities or states. Because states use different types of samples, and different survey- administration procedures to some extent, it doesn’t allow us to combine the state-level samples to make a national-level result.
[At both the national and local level), we’re hoping to keep the same basic core questionnaire each year through the rest of the decade to allow us to track the behaviors over time. If we keep on changing the questionnaire, it will be quite difficult to do that, but each city and state has an option of whether to include particular questions or add additional questions. They don’t have to use the standard questionnaire.
Q. How does the C.D.C. envision state and local officials using these data?
A. This type of data is often real useful to policymakers who are unaware of the extent of the problem or the degree to which kids are practicing these high risk behaviors. It will help make them more aware. It can also be used by school boards [or] local legislatures, in asking for increases in funding for these programs or additional resources or staffing.
Q. What have been the most surprising finding to date?
A. I guess the finding [that concerns us the most] is that ... risk behaviors are being practiced throughout the country ... at a fairly high level.
From the state and local surveys, we find that the prevalence of priority health-risk behaviors are really quite high nationwide, not just, for example, in urban areas, but throughout the country. That’s what concerns us the most, whether we are talking about attempted suicide, weapon carrying, or alcohol or other drug use. The prevalence rates are far higher than we would like them to be.
