CDC Telebriefing – 2013 National Youth Risk Behavior Survey results

OPERATOR: Welcome, everyone, and thank you for standing by.  All of the participants have been placed on the listen-only mode until the question and answer session.  To as a question please press star on your touch tone phone. Today’s conference is being recorded, if you have any objections please disconnect at this time.  And I would now like to turn the conference over to Llelwyn Grant, Chief of the News Media Branch.  You may begin. 

LLELWYN GRANT: Thank you, Wendy.  Good afternoon.  I wish to thank you all for joining us for today’s release of the 2013 National Youth Risk Behavior Survey, a survey conducted among high school students grades nine through twelfth every other year.  Here to discuss the survey are CDC Director Tom Frieden and Dr. Stephanie Zaza, Director of CDC’s Division of Adolescent and School Health. Dr. Zaza’s last name is spelled Z-A-Z-A. Following their remarks we will take questions. At this time I would like to turn the call over to Dr. Frieden. 

TOM FRIEDEN: Hello everybody and thank you very much for joining us. I’m Tom Frieden, Director of the Centers for Disease Control and Prevention.  Today, we’re releasing results from the 2013 National Youth Risk Behavior Survey, what we call the YRBS. YRBS is really important because it tells us what high school kids across the country are doing relating to the things that most affect their health.  The data being released today helps us understand how risky behaviors among youth vary across the country and over time.  The bottom line is that we’re encouraged to see that high school students are making better choices in some areas like smoking and fighting and alcohol use.  For the first time since the survey began, current cigarette smoking levels among high school students have dropped to 15.7 percent.  That meets the healthy people 2020 objective of under 16 percent.  And that is good news.  But we still face big challenges in reducing overall tobacco use, because cigars and smokeless tobacco and e-cigarette use are very concerning trends.  We know it’s easier and more effective to develop healthy behaviors during childhood rather than trying to change them in adulthood, or another way to put it, it is a whole lot easier to never start smoking than it is to quit.  Preventable risk behaviors such as smoking are often established during childhood or adolescence and they continue into. We know that hard-hitting media campaigns such as the Tips from Former Smokers campaign and the FDA’s new youth-focused campaign help to prevent kids from starting to smoke and help smokers quit.  And while this particular report doesn't have data on e-cigarette use among high school students, we know that use of e-cigarettes is skyrocketing, and we are concerned about that, and we are particularly concerned with e-cigarettes re-glamorizing smoking traditional cigarettes and maybe making it more complicated to enforce smoke-free laws that protect all nonsmokers.  Young people are highly vulnerable to social, environmental, and physical influences that encourage them to start smoking and no kids should be exposed to advertising that glorifies the use of nicotine or be able to easily buy e-cigarettes because their sales have not been restricted.  In addition to smoking, I’m also encouraged to see the reduction in the proportion of high school kids who are currently sexually active which is defined as having had sex in the previous three months. That portion has gone down from almost 38 percent to 34 percent.  We still think it is too high, but at least it is a trend that is going in the right direction.  However, among the kids who are currently sexually active, condom use has declined slightly in the past decade after seeing increases throughout the 1990s.  It has gone from 63 percent in 2003 to 59 percent in 2013.  That shows the need for continued efforts from parents, schools and communities to educate and ensure that staff have the knowledge and skills they need to protect themselves from HIV, STDs, and teen pregnancy. There is no one simple solution to the reducing the prevalence of health risk behaviors among high school students, but we owe it to our kids to help them to make healthy choices easier.  Families, schools and communities, and young people all play a part in helping the next generation.  It is not too much to ask that every kid born in the country reaches adulthood without an infection they will have to deal with for the rest of their lives, without nicotine addiction and at a healthy weight.  On that, I will turn it over to Dr. Stephanie Zaza for further remarks. 

STEPHANIE ZAZA: Thank you, Dr. Frieden and thank you all for joining us for today's call.  This is Stephanie Zaza; I’m Director of the Division of Adolescent and School Health at CDC.  CDC conducts the national YRBS among a national sample of approximately 13,000 U.S. high school students.  In addition 42 states and 21 large urban school districts conducted their own YRBS and results from these surveys are also included in the report that we are releasing today.  The YRBS tells us what kids do but not why.  Its purpose is to identify the major public health risk behaviors among our nation's high school students and to track those behaviors over time.  These health risk behaviors include unintentional injury and violence, sexual behaviors that contribute to unintended pregnancies and sexually transmitted diseases including HIV infection,  tobacco, alcohol, and other drug use, unhealthy dietary behaviors, and physical inactivity.  I would like to again thank Dr. Frieden for sharing the important findings on smoking and sexual behavior among youth. As he mentioned in his overview there are encouraging improvements in cigarette smoking among high school students but so not many changes in other uses of tobacco. There are similarly encouraging findings in that fewer students are sexually active but among those students fewer are using condoms.  I would like to now share a few additional findings from this year's report.  Other promising news is that physical fighting has declined substantially during the last 20 years.  The percent of the students nationwide who had been in a physical fight one or more time during the last 12 months before the survey went from 42 percent in 1991 to 25 percent in 2013.  Also, fights on school property were cut in half from 16 percent in 1993 to 8 percent in 2013.  These findings show that violence prevention is possible, and more work is needed to bring these rates even lower.  Texting while driving continues to be a concern.  Teen drivers have the highest proportion of distraction-related fatal crashes, and among those distractions, texting while driving can take the driver's attention away from driving more frequently and for longer periods than other distractions.  This puts them and other drivers at risk.  Nationwide, 41 percent of students who had driven a car or other vehicle during the past 30 days reported texting or e-mailing while driving. Teen drivers need to avoid any task that takes their attention away from driving including texting or e-mailing while driving.  Parents can play an active role in keeping their teen driver safe by close monitoring, frequent discussions, parent/teen driving agreements, and acting as a role model of good driving habits.  Other technology also affects youth risk behaviors.  We know that excessive screen time such as TV, computer, or video game use is associated to chronic disease risk factors such as obesity.  While TV watching for more than three hours a day decreased from 43 percent in 1999 to 32 percent in 2013, computer use for more than three hours a day for non-school-related work nearly doubled from 22 percent in 2003 to 41 percent in 2013.  This year's YRBS report clearly shows that fewer high school students are engaging in some very important health risk behaviors, but there is progress to be made.  Although there is no single solution to reducing health risk behaviors among high school students, we can all work collaboratively to address the health risks using interventions that are based on the best science available.  To aid these efforts, CDC works with other federal agencies, national and nongovernmental agencies, state and local education health agencies to do a number of things.  First, to identify and monitor school health policies and programs.  Second, to conduct research, to increase the effectiveness of interventions. Third, enable partners to plan programs and implement interventions that benefit students. And finally, to evaluate the impact of those interventions over time.  The YRBS is an important tool to understanding health risk behaviors among youth. As such, we are encouraged by the improvements that we see in many of the health risk behaviors highlighted in the report including the decrease of current cigarette use, current sexual behavior, and physical fighting among youth.  We hope that public health professionals, educators, youth service providers, policy makers, and parents can use these data to guide their planning decisions.  Schools and communities can also work to reduce youth risk health behaviors that are still prevalent and monitor those that are newly emerging.  So thanks again for joining us today, and I can turn it back over to the coordinator.  Thank you. 

LLELWYN GRANT: Thank you, Dr. Frieden, and thank you, Dr. Zaza, and operator at this time, we are ready for questions. 

OPERATOR: Thank you.  At this time to ask a question, please press star followed by one on your touch tone phone. You will be prompted to record your name.  One moment please for the first question.  First question today is from Mike Stobbe with the Associated Press. 

MIKE STOBBE: Hi, thank you for taking my question.  I had two actually.  The first one, this survey was done during the time period of September 2012 through all of 2013, if I read that correctly.  That was a time period that included the killings the school in Newtown, Connecticut.  I was wondering if you can comment on whether you thought that incident or gun violence in other in U.S. schools had impacted any of the statistics specifically fights in schools or the increase in the kids who said they did not go to school because of safety concerns? 

TOM FRIEDEN: I will begin, and Dr. Zaza may want to say more.  It is striking while we have had terrible incidents around the U.S., at the same time that the findings on the physical fighting are really quite encouraging, and they are consistent over time.  So, we think that they are a reliable indicator of what has happened.  Basically, we have seen the proportion of kids in a physical fight in school or elsewhere during the previous year down from 42.5 percent in 1991 to 32.8 percent in 2011, and these are substantial declines that show that violence prevention is possible. What is more striking is that in the past 20 years, fights on school property have been cut in half, exactly half, from 16.2 percent to 8.1 percent.  But even with those declines, one in four high school students report in being in at least one physical fight in the past year, and there is more that is needed.  I will highlight one of the other trends here having to do with alcohol use.  We do see a reduction in alcohol use in some of the measures and we know that alcohol use contributes to large numbers of risky behaviors including fighting.  Dr. Zaza?  

STEPHANIE ZAZA: Thank you, Dr. Frieden . First, just a correction, the national survey was conducted in the spring and fall terms of 2013 only.  Spring only of 2013, I apologize.  So, just to put the timing of the survey in context time wise.  These data also cannot tell us the why, as you know.  They tell us what students are doing, but can't really give us a sense of why these behaviors are happening.  I would also point to some of the other data on violence that indicate a stable sort of unchanging effect in some of the other areas of violence such as carrying weapons, and I think that there are sort of mixed findings here while physical fighting demonstrates that there are things that clearly are working, there are other areas that we have quite a bit to do. 

MIKE STOBBE:  May I ask one more to follow-up.  You all adding a question on bullying a few years ago, and did that someone suggested to me that maybe the appearance of a question on bullying on the survey, I don't know if it was earlier in the survey than the question on have you been in a fight, may have caused some kids to think of an incident and using the bullying descriptor to describe it rather than a physical fight descriptor, and is that -- is that, do you think that was a factor or no? 

STEPHANIE ZAZA:  I don't think it is possible to say.  In terms of how the students responded to that.  The bullying question does come after the physical fighting question on the questionnaire, so it is hard to know if the students are reading ahead, for example, how they would read into that. 

LLELWYN GRANT:  The next question, operator. 

OPERATOR:  The next question is from David Beasley with Reuters News Service. 

DAVID BEASLEY: Yes, is the texting while driving up or down or is this the first time it is on the survey?  I looked through it, and I could not see a number for the previous 2011. 

TOM FRIEDEN: Dr. Zaza. 

STEPHANIE ZAZA:  Yes.  This is a relatively newly changed question, and so we don't have long-term trends on that. 

DAVID BEASLEY:  Okay.  So around 40 percent I think you said? 

STEPHANIE ZAZA: Yes, 41 percent. 

DAVID BEASLEY:  Okay.  Thank you. 

LLELWYN GRANT:  We are ready for the next question, operator. 

OPERATOR:  The next is from Mike Estrel with the Wall Street Journal.

MIKE ESTREL: Thank you.  I wanted to ask about these long term decline in the alcohol use and what you think is causing that.  There is obviously the increase in the minimum drinking age in the mid- to late 1980s, but nothing happened in the 1990s and then the sharp decline throughout the 2000s and what do you attribute that to? 

TOM FRIEDEN: Well, in terms of -- I will start.  Clearly, the graduated driver licenses and rise in the legal age of consumption has made a big difference in youth smoking, and if you look at the alcohol-impaired driving, of course, any alcohol on board for someone who is under 21 and driving is illegal.  If you look at that, those trends are really encouraging.  We have seen very substantial decreases in the portion of kids who are driving under the influence.  So we do see positive trends there.  Let me ask Dr. Zaza to say more and I will say more at the end.  Dr. Zaza? 

STEPHANIE ZAZA: I agree.  I think that the important findings of students reporting ever having drunk alcohol, and the students reporting currently drinking alcohol, and the students reporting binge drinking have made tremendous decreases over the past decade, and that is important.  Again, it is very, it is impossible to attribute why it is -- to attribute why this is happening from these data, but there are a number of important changes that speak to the possible impact of the new laws and the public health intervention. 

MIKE ESTREL: Thank you. 

LLELWYN GRANT:  And ready for our next question. 

OPERATOR:  The next question is come from Kim Painter with USA Today

TOM FRIEDEN:  Before we get to the next question, actually, I would just comment that one of the hints here is a huge difference between jurisdictions.  The rates range quite a bit between different places, and so there are parts of the country that have done a better job with a combination of policies on underage drinking, school policies, parental involvement, and all of these things really can make a difference.  Sorry, next question. 

OPERATOR:  Thank you.  The next question is from Kim Painter from USA today. 

KIM PAINTER:  Yes, hi.  My question was also about the texting and driving looking for some comparison data.  I believe you first asked the question nationally in 2011, and I don't see that number in the report, so I am wondering if you even have that one-time comparison between 2011 and 2013? 

STEPHANIE ZAZA:  Thank you for that question.  We actually changed the question between 2011 and 2013, so we can't report a trend on that. 

KIM PAINTER: Okay. 

LLELWYN GRANT:  Next question, please. 

OPERATOR:  As a reminder to ask a question, you may press star one. And the next question is from Michael Smith with Medpage Today. 

MICHAEL SMITH: Yeah.  Good afternoon.  I'm just -- the whole TV screen time and computer screen time thing.  I wanted to know if that is broken down at all, because I know that many young people of my acquaintance don't watch television anymore, but they watch television on the computers so I wonder if we are seeing a shift of television watching from one medium to another.  Can you make any look at that? 

STEPHANIE ZAZA: Well, this is two separate questions.  So when we asked about the time that students watched TV, what we are seeing is a dramatic drop in students who watched 3 or.  Or more hours of TV on a average school day, and that has dropped from 33 percent to 32 percent, but unfortunately, the students may be replacing the behavior with using a computer for three or more hours a day for non-school related school and that has more than doubled.  So you are right, those are two separate questions, and we can look at them separately.  But I can also mention, the computer question includes a set of examples that includes a lot of things like computers, tablets, smartphones, and sort of anything that is an interactive type technology that involves screen time. 

TOM FRIEDEN:  I would add to that that we are concerned about the amount of screen time, because it cuts into the time for the physical activity and cuts into the time for sleep, and cuts into the time for interacting in a healthy way with friends and learning.  It is a trend that we are noting, and some of this is undoubtedly as your friends or the teens that you know indicate a shift from watching the TV on the television to watching it on the computer screen, but it is still a whole lot of time being inactive, and that is a concern. 

LLELWYN GRANT:  We ready for the next question. 

OPERATOR:  The next question is from Alice Park with Time 

ALICE PARK: I wanted to talk about the sexual activity front and the screen time, and what does that change or the changes that you are seeing there, does it seem that in some cases the teens are switching or turning from one type of behavior to another like with the sexual activity for example, does that indicate at all how public messaging or the public health messaging might be more refined or any lessons there to learn about how those things might be reformulated in a way to addressing lower condom use even if they are having less sex? 

TOM FRIEDEN: Well, in terms of the screen time, I’ll have to drop off of the call shortly, but in terms of the screen time, it does highlight new areas where we need to focus on promoting health and limiting negative influences on kids, and this is a place where parents have a as throughout a kid's life, the parents have a very important role to play, and I think that the increase in screens, screen time brings opportunities for kids to learn things, and for kids to engage with others, but it also brings real risks that we need to be alert to and a role for parents to be very involved.  Dr. Zaza? 

STEPHANIE ZAZA:  Thank you, Dr. Frieden.  Alice, you have struck upon a important use of the data which is to be able to watch these trends over time, and to be able to address continuing issues of risk behavior, but also to be aware of what's changing in the way students behave and make sure they are asking the right question, and as the questions evolve over time, make sure that we are asking new questions about new behaviors and keeping up with those so that we can use the data to target the messages appropriately to work with the people who can influence teens such as their parents, their schools and their communities and the other mens or the and so it is an important, and these data are important for all of those reasons. 

LLELWYN GRANT:  We are ready for the next question. 

OPERATOR:  I have no further questions. 

LLELWYN GRANT:  If there are no further questions, I wish to thank you all for participating in today's media briefing.  For more information about the Youth Risk Behavior Study, go to www.cdc.gov/healthyyouth/yrbs.  And if you have more questions contact the press office at 404-639-2836 and this concludes the media briefing and thanks for joining us. 

OPERATOR:  Thank you.  This concludes today's conference and thank you for joining, and you may disconnect at this time.    

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES