Teen-age Trends of Risky Behavior a 'Mixed Bag'

From the WebMD Archives

June 8, 2000 -- As any parent knows, getting teens to listen to an adult message is difficult at best. But in some areas of risky behavior, it seems the tide may be turning, according to a new government report.

It's called the youth risk behavior surveillance system report, and the CDC releases it every two years. The most recent report compiles information from 1999. Since 1991, the statistics show risky sexual behavior is down, while other activities like smoking and drug and alcohol use continue, for the most part, to stay the same or increase.

The results "are probably more of a mixed bag," says Laura Kann, PhD, lead author of the report. "We see the prevalence of many injury-related behaviors, and sexual behaviors are improving among high school students. ... At the same time, all the rates are too high, and some are actually heading in the other direction." Kann is chief of the surveillance and evaluation research branch at the CDC's division of adolescent and school health.

More than 15,000 students in grades nine through 12 nationwide completed surveys that covered six areas of health risk behavior: intentional and unintentional injuries, tobacco use, alcohol and other drug use, sexual behaviors, dietary behaviors, and physical activity.

Nationwide, about half the teens reported having had sex, but that was down about 8% from 1991. The percentages also dropped slightly among those who were more sexually active, meaning they had four or more sexual partners. Condom use increased 26%.

"The percentage of kids who've ever had sex is down, and, simultaneously, the percent of those who use a condom is increasing, and that's a really nice combination because it means, overall, we've got less kids at risk for things like unintended pregnancy and sexually transmitted diseases, including HIV infection," Kann tells WebMD.

The number of teens learning about HIV and AIDS in school also increased. "It's real clear an awful lot of people have been very committed to addressing sexual risk behaviors among kids. Families, schools, community organizations, and kids themselves have worked collectively for many years now to address this problem, and consequently we are seeing some improvements," Kann says.

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But four out of 10 students were still not using sexual protection, and the rates for tobacco and drug use went in the opposite direction of sexual behavior. Current marijuana use almost doubled to about one in four students, and those that had at least tried marijuana once in their lifetime was up by 50%. Although current cocaine use was lower, at 4% of the teens, that number had more than doubled since 1991. The number of teens that had at least tried cocaine also was up significantly.

Current and frequent cigarette use both went up over the course of the decade by around 30%. The only tobacco product that saw a dip in usage was smokeless tobacco, down since 1995. But there is more to be thankful for than just that, says Kann: "From '91 to '99, it [tobacco use] has increased, but in the last half of the decade, it's leveled off. Compared to just a straight increase, that's also an improvement."

Alcohol use stayed relatively steady over the decade, with about half the teens reporting current alcohol use. About one in three of the students had recently had at least five or more alcoholic drinks on one occasion. That would meet the definition of binge drinking. The number of teens who had recently been in a car when the driver was drinking alcohol was about one out of three, but that was an improvement since 1991.

Many other injury-related behaviors improved, some significantly. The number of kids who carried a gun or some other weapon to school decreased, and the number of kids who got in fights was lower. However, slightly more kids felt less safe at school.

More teens wore their seatbelts and bike helmets, and more participated in strengthening exercises, but far less attended physical education classes daily. Only one in four ate enough fruits and vegetables, and 10% were overweight.

Many of the rates varied greatly, depending upon where the teens lived. Smoking, some drug use, and smokeless tobacco use varied more than five-fold or greater among some states. Sexual intercourse before age 13 also varied between states, by as much as 3% to 16%. Whereas 2% of the teens in Nebraska felt unsafe at school, that number went up to 16% in Florida.

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"Any time you take a portrait of youth risk taking, you will never find consistency across the board because you will always find a mixed portrait of what is going on with young people, so I've got to say that's not particularly a surprise," Michael Resnick, PhD, a sociologist and professor of pediatrics at the University of Minnesota's Adolescent Health Program, tells WebMD.

"I'm heartened by the good news that in some areas, such as sexual behavior and decision making, it looks like a growing number of young people get the message about not placing themselves at risk. But I have to qualify that by saying that at the same time ... our rates are still stunningly higher than our European counterparts, so we shouldn't be too self- congratulatory about this stuff," Resnick says. Resnick also is director of the National Teen Pregnancy Prevention Research Center.

Kann says the statistics offer no easy answers or obvious reasons. "Health risk behaviors are determined by a real complex interaction of personal factors, social, cultural, economic, environmental, things like peer norms, adult practices, media influences in the broadest sense of the word, including the web, availability of effective programs, state and local laws, and enforcement practices. All those things together determine whether or not a kid practices the behavior in the first place, and then whether or not we can be successful in improving the overall rate of those behaviors over time."

Time is important, says Resnick, as the change in sexual attitudes took place over many years, and "had time to trickle down that unthinking behavior could be lethal." He predicts cocaine use also will decrease in the coming years because of what he called the "younger sibling syndrome." Basically, younger siblings will see how the drugs, especially crack, messed up their older sibling's lives, and will choose to break the cycle.

Breaking the cycle and lowering risky behavior is, after all, the overall goal, according to Kann. "I think this report helps us understand what kids are doing, and with that information, we can develop programs and policies that will address their needs. It's far better to build programs based on knowing what kids are really doing rather than what us grownups might think they're doing," Kann tells WebMD, noting that there has been progress in the last decade.

Resnick says a key to more progress is enhancing the "protective factors" in teen-agers' lives. "Kids who report a strong sense of connection to parents, to family, to school -- and I should add that this sense of connectedness cross-cuts all family forms, single parent, dual parent foster families, adoptive families -- when kids report this sense of connection and closeness ... they engage in less risk taking behavior," Resnick tells WebMD. "The good news is there are strategies we can use that will have multiple payoffs on multiple levels for all of our kids, whether they're black, white, Asian, Hispanic or American Indian, boys or girls."

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Vital Information:

  • The CDC reports that when it comes to reducing risky behaviors, teens are showing "a mixed bag." The recent report shows since 1991, risky sexual behavior is declining and condom use is increasing, but smoking and use of drugs and alcohol are not.
  • An observer notes he is encouraged to see some decline in teens' risky behavior but adds compared to Europe, the U.S. still could make a lot of improvement.
  • Experts say education is working but needs to continue and time is needed for change to take place, along with helping teens feel connected to their parents and values.
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