Changes in Risk-taking Among High School Students, 1991-1997: Evidence From Youth Risk Behavior Studies

Changes in Risk-Taking among High School Students, 1991ΣΣ1997: Evidencefrom the Youth Risk Behavior SurveysScott Boggess, Laura Duberstein Lindberg, and Laura PorterThe Urban InstituteThis report was produced under a contract from the Office of the Assistant Secretary for Planning andEvaluation (ASPE), “Co-Occurrence of Youth Risky Behavior,” Contract No. HHS-100-95-0021.January 21, 2000 1Changes in Risk-Taking among High School Students, 1991ΣΣ1997: Evidencefrom the Youth Risk Behavior SurveysA handful of preventable health-risk behaviors—violence, substance use, suicide, and sexual activity—are responsible for much of the mortality and morbidity experienced in adolescence and earlyadulthood.1 Adolescents’ participation in many of these health-risk behaviors has changed in recentyears. Newspapers report increases in marijuana use among high school students one day and declinesin their sexual or criminal activity another. Because changes in the prevalence of specific health-riskbehaviors vary, some increasing and some declining, shifts in adolescents’ overall exposure to health-risks are difficult to pinpoint. While it is well established that many risk behaviors co-occur—teens whoengage in one are likely to engage in another2—changes in the extent and patterns of multiple risk-takingare unknown.The purpose of this chapter is to identify changes in overall risk-taking among high school studentsduring the recent decade. As background, we show changes in the prevalence of specific riskbehaviors between 1991 and 1997. The second, and central, part of this investigation is an examinationof the patterns of and changes in high school students’ multiple risk-taking over this period. Thisinformation is an important part of understanding adolescents’ overall exposure to health-risks andmonitoring efforts to reduce those risks. Measuring Health-risk BehaviorsUsing nationally representative data from students in grades 9 to 12 from the national Youth RiskBehavior Surveys (YRBS) of 1991, 1993, 1995, and 1997, we examine changes in high schoolstudents’ participation in health-risk behaviors. The surveys are designed to track changes in behaviorover time among high school students, using comparable measures and samples in each year (see box1). These changes are measured at the aggregate level; the surveys cannot monitor changes over time inan individual student’s behavior. 2We identify 10 specific health-risk behaviors: regular alcohol use, binge drinking, regular tobacco use,marijuana use, cocaine use, physical fighting, carrying a weapon, suicidal thoughts, suicide attempt, andsexual intercourse (see table 1 for complete definitions). While these behaviors do not comprise anexhaustive list of adolescent health-risks, they reflect areas of critical public concern.3 Theconsequences associated with these 10 behaviors vary considerably, but each poses a range of potentialimmediate and long-term health problems. YRBS is an important national data source for monitoring levels and changes in adolescent health.4However, measures from the YRBS will not necessarily yield the same estimated prevalence of riskbehaviors as other surveys do, given differences in samples, questionnaire details, and surveyadministration. For example, the YRBS is administered in school; other studies suggest that in-schoolsurveys tend to obtain higher estimates of adolescent risk taking than household surveys.5 In addition,normal sampling variance and measurement error are likely to result in some differences betweensurveys. While the findings of this study should not be expected to precisely match estimates from othersamples, YRBS provides an internally consistent source of data on a range of adolescent risk behaviorsfor examination of changes over time. This chapter focuses on changes between 1991 and 1997.All tables and figures in this chapter are descriptive in nature. They describe associations only; causalinferences should not be drawn. Establishing that one behavior occurs with another does not mean thatone causes the other. In addition, all behaviors are not measured with reference to the same timeperiod. Questions about substance use and weapon-carrying refer to the 30 days prior to the survey;those about suicidal thoughts, suicide attempts, and fighting refer to the year before the survey; andsexual intercourse is a lifetime measure. Changes in Single Risk Behaviors 3The 1990s have been a period of substantial change, some good and some bad, instudents’ participation in specific health-risk behaviors.Between 1991 and 1997, substantial changes occurred in students’ participation in key health-riskbehaviors.6 For example, there was an unprecedented but modest decline in the proportion of studentswith past sexual experience (see figure 1a). This reduction in sexual activity, and changes incontraceptive use, were accompanied by declines in the teen pregnancy rate, birthrate, and sexuallytransmitted disease rat