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Youth Risk Behavior Surveillance — United States, 2011

Danice K. Eaton, PhD,1 Laura Kann, PhD,1 Steve Kinchen,1 Shari Shanklin, MS,1 Katherine H. Flint, MS,2 Joseph Hawkins, MA,3 William A. Harris, MM,1 Richard Lowry, MD,1 Tim McManus, MS,1 David Chyen, MS,1 Lisa Whittle, MPH,1 Connie Lim, MPA,1

Howell Wechsler, EdD1

1Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC

2ICF Macro, Calverton, Maryland

3Westat, Rockville, Maryland

Abstract

Problem: Priority health-risk behaviors, which are behaviors that contribute to the leading causes of morbidity and mortality among youth and adults, often are established during childhood and adolescence, extend into adulthood, and are interrelated and preventable.

Reporting Period Covered: September 2010–December 2011.

Description of the System: The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health-risk behaviors among youth and young adults: 1) behaviors that contribute to unintentional injuries and violence; 2) tobacco use; 3) alcohol and other drug use; 4) sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infection; 5) unhealthy dietary behaviors; and 6) physical inactivity. In addition, YRBSS monitors the prevalence of obesity and asthma. YRBSS includes a national school-based Youth Risk Behavior Survey (YRBS) conducted by CDC and state and large urban school district school-based YRBSs conducted by state and local education and health agencies. This report summarizes results from the 2011 national survey, 43 state surveys, and 21 large urban school district surveys conducted among students in grades 9–12.

Results: Results from the 2011 national YRBS indicated that many high school students are engaged in priority health-risk behaviors associated with the leading causes of death among persons aged 10–24 years in the United States. During the 30 days before the survey, 32.8% of high school students nationwide had texted or e-mailed while driving, 38.7% had drunk alcohol, and 23.1% had used marijuana. During the 12 months before the survey, 32.8% of students had been in a physical fight, 20.1% had ever been bullied on school property, and 7.8% had attempted suicide. Many high school students nationwide are engaged in sexual risk behaviors associated with unintended pregnancies and STDs, including HIV infection. Nearly half (47.4%) of students had ever had sexual intercourse, 33.7% had had sexual intercourse during the 3 months before the survey (i.e., currently sexually active), and 15.3% had had sexual intercourse with four or more people during their life. Among currently sexually active students, 60.2% had used a condom during their last sexual intercourse. Results from the 2011 national YRBS also indicate many high school students are engaged in behaviors associated with the leading causes of death among adults aged ≥25 years in the United States. During the 30 days before the survey, 18.1% of high school students had smoked cigarettes and 7.7% had used smokeless tobacco. During the 7 days before the survey, 4.8% of high school students had not eaten fruit or drunk 100% fruit juices and 5.7% had not eaten vegetables. Nearly one-third (31.1%) had played video or computer games for 3 or more hours on an average school day.

Interpretation: Since 1991, the prevalence of many priority health-risk behaviors among high school students nationwide has decreased. However, many high school students continue to engage in behaviors that place them at risk for the leading causes of morbidity and mortality. Variations were observed in many health-risk behaviors by sex, race/ethnicity, and grade. The prevalence of some health-risk behaviors varied substantially among states and large urban school districts.

Public Health Action: YRBS data are used to measure progress toward achieving 20 national health objectives for Healthy People 2020 and one of the 26 leading health indicators; to assess trends in priority health-risk behaviors among high school students; and to evaluate the impact of broad school and community interventions at the national, state, and local levels. More effective school health programs and other policy and programmatic interventions are needed to reduce risk and improve health outcomes among youth.

Introduction

In the United States, 72% of all deaths among youth and young adults aged 10–24 years result from four causes: motor vehicle crashes (26%), other unintentional injuries (17%), homicide (16%), and suicide (13%) (1). Substantial morbidity and social problems also result from the estimated 410,000 births (2); 517,174 cases of chlamydia, gonorrhea, and syphilis (3); and 2,036 cases of human immunodeficiency virus (HIV) (4) reported in 2009 among youth aged 15–19 years. Among adults aged ≥25 years, 57% of all deaths in the United States result from cardiovascular disease (34%) and cancer (23%) (1). These leading causes of morbidity and mortality among youth and adults in the United States are related to six categories of priority health-risk behaviors: 1) behaviors that contribute to unintentional injuries and violence; 2) tobacco use; 3) alcohol and other drug use; 4) sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases (STDs), 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-risk behaviors in each of these six categories and obesity and asthma 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 district surveys have been conducted biennially since 1991 (Table 1). Additional information about the YRBSS is available at http://www.cdc.gov/yrbs.

This report summarizes results from the 2011 national YRBS and trends in health-risk behaviors during 1991–2011. Data from the 43 state and 21 large urban school district surveys with weighted data for the 2011 YRBSS cycle (Figure) also are included in this report. Data from the remaining four state surveys and one large urban school district survey with unweighted data are not included. Among those with weighted data for 2011, one state and five large urban school district surveys were conducted during fall 2010; the national survey, 39 state surveys, and 15 large urban school district surveys were conducted during spring 2011; and three state surveys and one large urban school district survey were conducted during fall 2011.

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 2011 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 obtained from the Market Data Retrieval (MDR) database (6). The MDR database 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 1,276 primary sampling units (PSUs), consisting of counties, subareas of large counties, or groups of smaller, adjacent counties. The 1,276 PSUs were categorized into 16 strata according to their metropolitan statistical area (MSA) status (i.e., urban city) and the percentages of black and Hispanic students in the PSUs. From the 1,276 PSUs, 57 were sampled with probability proportional to overall school enrollment size for the PSU.

In the second stage of sampling, 194 schools with any of grades 9–12 were sampled with probability proportional to school enrollment size. 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, three strategies were used to oversample these 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.

State and Large Urban School District Youth Risk Behavior Surveys

In 2011, a two-stage cluster sample design was used to produce a representative sample of public school students in grades 9–12 in 41 states and 21 large urban school districts and of public and private school students in grades 9–12 in two states (Ohio and South Dakota). In the first sampling stage, schools with any of grades 9–12 were sampled with probability proportional to school enrollment size in 42 states and four large urban school districts; all schools with any of grades 9–12 were invited to participate in one state and 17 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 42 states and 21 large urban school districts, and all students in the sampled classes were eligible to participate. In one state, 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 2011 YRBS standard questionnaire contained 86 questions. States and large urban school districts could add or delete questions from the standard questionnaire. For the national questionnaire, 11 questions were added to the standard questionnaire. Skip patterns 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. For state and large urban school district surveys, only data from standard questions are presented in this report. Information about the reliability of the standard questionnaire has been published elsewhere (8). The standard and national YRBS questionnaires are available at http://www.cdc.gov/healthyyouth/yrbs/questionnaire_rationale.htm.

Data Processing Procedures and Response Rates

For the 2011 national YRBS, 15,503 questionnaires were completed in 158 schools. The national data set was cleaned and edited for inconsistencies. Missing data were not statistically imputed. Among the 15,503 completed questionnaires, 78 failed quality control* and were excluded from analysis, leaving 15,425 usable questionnaires (Table 2). The school response rate was 81%; the student response rate was 87%; the overall response rate was 71%† (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 number of completed questionnaires that failed quality control checks and were excluded from analysis ranged from 0 to 351 (median: 13) across the state surveys and from 0 to 231 (median: 13) across the large urban school district surveys. The student sample sizes ranged from 1,147 to 13,201 (median: 2,170) across the state surveys and from 1,013 to 11,570 (median: 1,767) across the large urban school district surveys (Table 2). Among the state surveys, the school response rates ranged from 73% to 100%; student response rates ranged from 60% to 88%; and overall response rates ranged from 60% to 84%, and among the large urban school district surveys, the school response rates ranged from 84% to 100%; student response rates ranged from 61% to 86%; and overall response rates ranged from 61% to 86% (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 were 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 were 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 obese or overweight based on their body mass index (kg/m2) (BMI), which was calculated from self-reported height and weight. The BMI values were compared with sex- and age-specific reference data from the 2000 CDC growth charts (9). Obese 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 school in the United States.

State and large urban school district surveys that had a representative sample of students, appropriate documentation, and an overall response rate of 60% or higher were weighted. A weight was applied to each record to adjust for student nonresponse and the distribution of students by grade, sex, and race/ethnicity in each jurisdiction. Data from 43 state and 21 large urban school district surveys were weighted. In 41 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 two states (Ohio and South Dakota), weighted estimates are representative of all students in grades 9–12 attending public and private schools in each jurisdiction.

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 prevalence estimates are reported in the following order: sex, sex by race/ethnicity, sex by grade, race/ethnicity, race/ethnicity by sex, grade, and grade by sex.

To identify long-term temporal changes in health-risk behaviors nationwide, prevalence estimates from the earliest year of data collection to 2011 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 simultaneously assess orthogonal linear and quadratic time effects (12). Cubic and other higher order time effects are not reported here. A quadratic time effect indicates a significant but nonlinear trend in prevalence over time. A temporal change that includes a significant linear and quadratic time effect demonstrates nonlinear variation (e.g., leveling off or change in direction) in addition to an overall increase or decrease over time. In this report, if both linear and quadratic time effects are significant only the quadratic time effect is reported. In addition, to identify 2-year temporal changes in health-risk behaviors nationwide, prevalence estimates from 2009 and 2011 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 temporal changes are described first, followed by 2-year (from 2009 to 2011) temporal changes.

Results

Behaviors that Contribute to Unintentional Injuries

Rarely or Never Wore a Bicycle Helmet

Among the 70.2% of students nationwide who had ridden a bicycle during the 12 months before the survey, 87.5% had rarely or never worn a bicycle helmet (Table 3). Overall, the prevalence of having rarely or never worn a bicycle helmet was higher among male (88.8%) than female (85.9%) students; higher among white male (87.1%) and black male (94.4%) than white female (83.9%) and black female (89.4%) students, respectively; and higher among 12th-grade male (92.0%) than 12th-grade female (87.3%) students. Overall, the prevalence of having rarely or never worn a bicycle helmet was higher among black (92.3%) and Hispanic (92.1%) than white (85.7%) students; higher among Hispanic female (92.0%) than white female (83.9%) students; and higher among black male (94.4%) and Hispanic male (92.2%) than white male (87.1%) students. Overall, the prevalence of having rarely or never worn a bicycle helmet was higher among 12th-grade (89.9%) than 9th-grade (86.6%), 10th-grade (86.7%), and 11th-grade (87.7%) students and higher among 12th-grade male (92.0%) than 9th-grade male (87.2%), 10th-grade male (87.9%), and 11th-grade male (89.2%) students. The prevalence of having rarely or never worn a bicycle helmet among students who had ridden a bicycle during the 12 months before the survey ranged from 52.7% to 95.1% across state surveys (median: 87.1%) and from 59.3% to 94.3% across large urban school district surveys (median: 89.7%) (Table 4).

Among students nationwide who had ridden a bicycle, the prevalence of rarely or never wearing a bicycle helmet decreased during 1991–2001 (96.2%–84.7%) and then did not change significantly during 2001–2011 (84.7%–87.5%). The prevalence of rarely or never wearing a bicycle helmet also did not change significantly from 2009 (84.7%) to 2011 (87.5%).

Rarely or Never Wore a Seat Belt

Nationwide, 7.7% of students rarely or never wore a seat belt when riding in a car driven by someone else (Table 3). Overall, the prevalence of rarely or never wearing a seat belt was higher among male (8.9%) than female (6.3%) students; higher among white male (7.3%) and black male (12.6%) than white female (5.1%) and black female (8.0%) students, respectively; and higher among 10th-grade male (9.0%), 11th-grade male (7.0%), and 12th-grade male (8.5%) than 10th-grade female (5.9%), 11th-grade female (4.9%), and 12th-grade female (5.5%) students, respectively. Overall, the prevalence of rarely or never wearing a seat belt was higher among black (10.3%) and Hispanic (9.3%) than white (6.3%) students; higher among black female (8.0%) and Hispanic female (8.4%) than white female (5.1%) students; and higher among black male (12.6%) than white male (7.3%) students. Overall, the prevalence of rarely or never wearing a seat belt was higher among 9th-grade (9.5%) than 10th-grade (7.5%), 11th-grade (6.0%), and 12th-grade (7.1%) students; higher among 10th-grade (7.5%) than 11th-grade (6.0%) students; higher among 9th-grade female (8.4%) than 10th-grade female (5.9%), 11th-grade female (4.9%), and 12th-grade female (5.5%) students; and higher among 9th-grade male (10.3%) than 11th-grade male (7.0%) students. The prevalence of rarely or never wearing a seat belt ranged from 4.4% to 20.1% across state surveys (median: 10.3%) and from 4.1% to 25.8% across large urban school district surveys (median: 10.9%) (Table 4).

During 1991–2011, among students nationwide, a significant linear decrease occurred in the prevalence of rarely or never wearing a seat belt (25.9%–7.7%). The prevalence of rarely or never wearing a seat belt also decreased from 2009 (9.7%) to 2011 (7.7%).

Rode with a Driver Who Had Been Drinking Alcohol

During the 30 days before the survey, 24.1% of students nationwide had ridden one or more times in a car or other vehicle driven by someone who had been drinking alcohol (Table 5). The prevalence of having ridden with a driver who had been drinking alcohol was higher among white female (23.8%) than white male (20.5%) students. Overall, the prevalence of having ridden with a driver who had been drinking alcohol was higher among Hispanic (30.7%) than white (22.1%) and black (22.8%) students; higher among Hispanic female (30.7%) than white female (23.8%) and black female (23.2%) students; and higher among Hispanic male (30.7%) than white male (20.5%) and black male (22.5%) students. Overall, the prevalence of having ridden with a driver who had been drinking alcohol was higher among 12th-grade (27.7%) than 9th-grade (21.8%), 10th-grade (23.3%), and 11th-grade (23.8%) students; higher among 12th-grade female (28.0%) than 9th-grade female (22.9%) and 10th-grade female (23.5%) students; and higher among 12th-grade male (27.4%) than 9th-grade male (20.7%), 10th-grade male (23.1%), and 11th-grade male (22.4%) students. The prevalence of having ridden with a driver who had been drinking alcohol ranged from 13.5% to 32.2% across state surveys (median: 23.2%) and from 17.6% to 34.2% across large urban school district surveys (median: 24.2%) (Table 6).

During 1991–2011, among students nationwide, a significant linear decrease occurred in the prevalence of riding with a driver who had been drinking alcohol (39.9%–24.1%). The prevalence of riding with a driver who had been drinking alcohol also decreased from 2009 (28.3%) to 2011 (24.1%).

Drove When Drinking Alcohol

During the 30 days before the survey, 8.2% of students nationwide had driven a car or other vehicle one or more times when they had been drinking alcohol (Table 5). Overall, the prevalence of having driven when they had been drinking alcohol was higher among male (9.5%) than female (6.7%) students; higher among white male (8.9%), black male (7.8%), and Hispanic male (11.5%) than white female (7.0%), black female (4.0%), and Hispanic female (7.8%) students, respectively; and higher among 9th-grade male (6.1%), 11th-grade male (10.4%), and 12th-grade male (16.0%) than 9th-grade female (3.3%), 11th-grade female (7.8%), and 12th-grade female (11.2%) students, respectively. Overall, the prevalence of having driven when they had been drinking alcohol was higher among white (8.0%) than black (5.9%) students; higher among Hispanic (9.7%) than white (8.0%) and black (5.9%) students; higher among white female (7.0%) and Hispanic female (7.8%) than black female (4.0%) students; and higher among Hispanic male (11.5%) than white male (8.9%) and black male (7.8%) students. Overall, the prevalence of having driven when they had been drinking alcohol was higher among 11th-grade (9.1%) and 12th-grade (13.6%) than 9th-grade (4.7%) and 10th-grade (5.6%) students; higher among 12th-grade (13.6%) than 11th-grade (9.1%) students; higher among 10th-grade female (5.2%), 11th-grade female (7.8%), and 12th-grade female (11.2%) than 9th-grade female (3.3%) students; higher among 11th-grade female (7.8%) and 12th-grade female (11.2%) than 10th-grade female (5.2%) students; higher among 12th-grade female (11.2%) than 11th-grade female (7.8%) students; higher among 11th-grade male (10.4%) and 12th-grade male (16.0%) than 9th-grade male (6.1%) and 10th-grade male (6.0%) students; and higher among 12th-grade male (16.0%) than 11th-grade male (10.4%) students. The prevalence of having driven a car when they had been drinking alcohol ranged from 4.0% to 11.7% across state surveys (median: 7.7%) and from 2.9% to 11.9% across large urban school district surveys (median: 6.8%) (Table 6).

Among students nationwide, the prevalence of having driven a car when they had been drinking alcohol did not change significantly during 1991–1997 (16.7%–16.9%) and then decreased during 1997–2011 (16.9%–8.2%). The prevalence of having driven a car when they had been drinking alcohol also decreased from 2009 (9.7%) to 2011 (8.2%).

Texted or E-mailed While Driving

Nationwide, 32.8% of students 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). Overall, the prevalence of having texted or e-mailed while driving was higher among male (34.9%) than female (30.4%) students; higher among black male (29.3%) and Hispanic male (35.2%) than black female (19.0%) and Hispanic female (26.3%) students, respectively; and higher among 9th-grade male (13.9%) and 10th-grade male (25.6%) than 9th-grade female (9.4%) and 10th-grade female (20.6%) students, respectively. Overall, the prevalence of having texted or e-mailed while driving was higher among white (36.2%) than black (24.1%) and Hispanic (30.9%) students; higher among Hispanic (30.9%) than black (24.1%) students; higher among white female (35.4%) than black female (19.0%) and Hispanic female (26.3%) students; higher among Hispanic female (26.3%) than black female (19.0%) students; and higher among white male (36.9%) and Hispanic male (35.2%) than black male (29.3%) students. Overall, the prevalence of having texted or e-mailed while driving was higher among 10th-grade (23.2%), 11th-grade (42.9%), and 12th-grade (58.0%) than 9th-grade (11.7%) students; higher among 11th-grade (42.9%) and 12th-grade (58.0%) than 10th-grade (23.2%) students; higher among 12th-grade (58.0%) than 11th-grade (42.9%) students; higher among 10th-grade female (20.6%), 11th-grade female (40.6%), and 12th-grade female (55.9%) than 9th-grade female (9.4%) students; higher among 11th-grade female (40.6%) and 12th-grade female (55.9%) than 10th-grade female (20.6%) students; higher among 12th-grade female (55.9%) than 11th-grade female (40.6%) students; higher among 10th-grade male (25.6%), 11th-grade male (45.0%), and 12th-grade male (60.0%) than 9th-grade male (13.9%) students; higher among 11th-grade male (45.0%) and 12th-grade male (60.0%) than 10th-grade male (25.6%) students; and higher among 12th-grade male (60.0%) than 11th-grade male (45.0%) students.

Behaviors that Contribute to Violence

Carried a Weapon

Nationwide, 16.6% of students had carried a weapon (e.g., a gun, knife, or club) on at least 1 day during the 30 days before the survey (Table 8). Overall, the prevalence of having carried a weapon was higher among male (25.9%) than female (6.8%) students; higher among white male (27.2%), black male (21.0%), and Hispanic male (24.5%) than white female (6.2%), black female (7.5%), and Hispanic female (7.5%) students, respectively; and higher among 9th-grade male (26.6%), 10th-grade male (26.4%), 11th-grade male (25.9%), and 12th-grade male (24.1%) than 9th-grade female (7.6%), 10th-grade female (6.1%), 11th-grade female (6.2%), and 12th-grade female (7.1%) students, respectively. The prevalence of having carried a weapon was higher among white male (27.2%) and Hispanic male (24.5%) than black male (21.0%) students. The prevalence of having carried a weapon ranged from 9.6% to 27.1% across state surveys (median: 17.6%) and from 9.1% to 18.9% across large urban school district surveys (median: 13.8%) (Table 9).

Among students nationwide, the prevalence of having carried a weapon decreased during 1991–1999 (26.1%–17.3%) and then did not change significantly during 1999–2011 (17.3%–16.6%). The prevalence of having carried a weapon also did not change significantly from 2009 (17.5%) to 2011 (16.6%).

Carried a Gun

Nationwide, 5.1% of students had carried a gun on at least 1 day during the 30 days before the survey (Table 8). Overall, the prevalence of having carried a gun was higher among male (8.6%) than female (1.4%) students; higher among white male (7.2%), black male (10.3%), and Hispanic male (9.2%) than white female (1.1%), black female (1.7%), and Hispanic female (1.4%) students, respectively; and higher among 9th-grade male (7.7%), 10th-grade male (9.4%), 11th-grade male (8.6%), and 12th-grade male (8.2%) than 9th-grade female (1.4%), 10th-grade female (1.6%), 11th-grade female (1.1%), and 12th-grade female (1.0%) students, respectively. Overall, the prevalence of having carried a gun was higher among black (6.1%) than white (4.3%) students and higher among black male (10.3%) than white male (7.2%) students. The prevalence of having carried a gun ranged from 2.5% to 10.8% across state surveys (median: 6.0%) and from 2.3% to 7.5% across large urban school district surveys (median: 5.0%) (Table 9).

Among students nationwide, the prevalence of having carried a gun decreased during 1993–1999 (7.9%–4.9%) and then did not change significantly during 1999–2011 (4.9%–5.1%). The prevalence of having carried a gun also did not change significantly from 2009 (5.9%) to 2011 (5.1%).

Carried a Weapon on School Property

Nationwide, 5.4% 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 10). Overall, the prevalence of having carried a weapon on school property was higher among male (8.2%) than female (2.3%) students; higher among white male (7.8%), black male (6.7%), and Hispanic male (8.8%) than white female (2.3%), black female (2.5%), and Hispanic female (2.6%) students, respectively; and higher among 9th-grade male (7.4%), 10th-grade male (9.4%), 11th-grade male (7.5%), and 12th-grade male (8.2%) than 9th-grade female (2.1%), 10th-grade female (2.5%), 11th-grade female (1.8%), and 12th-grade female (2.8%) students, respectively. The prevalence of having carried a weapon on school property ranged from 3.1% to 10.5% across state surveys (median: 5.7%) and from 2.1% to 8.1% across large urban school district surveys (median: 4.5%) (Table 11).

Among students nationwide, the prevalence of having carried a weapon on school property decreased during 1993–2003 (11.8%–6.1%) and then did not change significantly during 2003–2011 (6.1%–5.4%). The prevalence of having carried a weapon on school property also did not change significantly from 2009 (5.6%) to 2011 (5.4%).

Threatened or Injured with a Weapon on School Property

During the 12 months before the survey, 7.4% of students nationwide had been threatened or injured with a weapon (e.g., a gun, knife, or club) on school property one or more times (Table 10). Overall, the prevalence of having been threatened or injured with a weapon on school property was higher among male (9.5%) than female (5.2%) students; higher among white male (8.0%), black male (11.2%), and Hispanic male (12.1%) than white female (4.2%), black female (6.6%), and Hispanic female (6.0%) students, respectively; and higher among 9th-grade male (10.3%), 10th-grade male (9.7%), 11th-grade male (9.2%), and 12th-grade male (8.3%) than 9th-grade female (6.2%), 10th-grade female (5.3%), 11th-grade female (5.3%), and 12th-grade female (3.4%) students, respectively. Overall, the prevalence of having been threatened or injured with a weapon on school property was higher among black (8.9%) and Hispanic (9.2%) than white (6.1%) students; higher among black female (6.6%) and Hispanic female (6.0%) than white female (4.2%) students; and higher among black male (11.2%) and Hispanic male (12.1%) than white male (8.0%) students. Overall, the prevalence of having been threatened or injured with a weapon on school property was higher among 9th-grade (8.3%) and 10th-grade (7.7%) than 12th-grade (5.9%) students and higher among 9th-grade female (6.2%), 10th-grade female (5.3%), and 11th-grade female (5.3%) than 12th-grade female (3.4%) students. The prevalence of having been threatened or injured with a weapon on school property ranged from 5.1% to 11.7% across state surveys (median: 6.8%) and from 6.7% to 11.1% across large urban school district surveys (median: 8.2%) (Table 11).

Among students nationwide, the prevalence of having been threatened or injured with a weapon on school property did not change significantly during 1993–2003 (7.3%–9.2%) and then decreased during 2003–2011 (9.2%–7.4%). The prevalence of having been threatened or injured with a weapon on school property did not change significantly from 2009 (7.7%) to 2011 (7.4%).

In a Physical Fight

Nationwide, 32.8% of students had been in a physical fight one or more times during the 12 months before the survey (Table 12). Overall, the prevalence of having been in a physical fight was higher among male (40.7%) than female (24.4%) students; higher among white male (37.7%), black male (45.8%), and Hispanic male (44.4%) than white female (20.4%), black female (32.3%), and Hispanic female (28.7%) students, respectively; and higher among 9th-grade male (46.0%), 10th-grade male (44.2%), 11th-grade male (36.3%), and 12th-grade male (34.1%) than 9th-grade female (28.8%), 10th-grade female (25.5%), 11th-grade female (22.7%), and 12th-grade female (19.4%) students, respectively. Overall, the prevalence of having been in a physical fight was higher among black (39.1%) and Hispanic (36.8%) than white (29.4%) students; higher among black female (32.3%) and Hispanic female (28.7%) than white female (20.4%) students; higher among black female (32.3%) than Hispanic female (28.7%) students; and higher among black male (45.8%) and Hispanic male (44.4%) than white male (37.7%) students. Overall, the prevalence of having been in a physical fight was higher among 9th-grade (37.7%) and 10th-grade (35.3%) than 11th-grade (29.7%) and 12th-grade (26.9%) students; higher among 9th-grade female (28.8%) than 11th-grade female (22.7%) and 12th-grade female (19.4%) students; higher among 10th-grade female (25.5%) than 12th-grade female (19.4%) students; and higher among 9th-grade male (46.0%) and 10th-grade male (44.2%) than 11th-grade male (36.3%) and 12th-grade male (34.1%) students. The prevalence of having been in a physical fight ranged from 19.5% to 36.0% across state surveys (median: 26.8%) and from 18.7% to 42.2% across large urban school district surveys (median: 31.9%) (Table 13).

Among students nationwide, the prevalence of having been in a physical fight decreased during 1991–2009 (42.5%–31.5%), and then did not change significantly during 2009–2011 (31.5%–32.8%).

Injured in a Physical Fight

During the 12 months before the survey, 3.9% 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 12). Overall, the prevalence of having been injured in a physical fight was higher among male (5.1%) than female (2.6%) students; higher among white male (3.5%), black male (8.1%), and Hispanic male (7.0%) than white female (1.9%), black female (3.2%), and Hispanic female (3.7%) students, respectively; and higher among 9th-grade male (5.9%), 10th-grade male (5.1%), 11th-grade male (4.8%), and 12th-grade male (4.3%) than 9th-grade female (2.7%), 10th-grade female (3.0%), 11th-grade female (2.2%), and 12th-grade female (2.1%) students, respectively. Overall, the prevalence of having been injured in a physical fight was higher among black (5.7%) and Hispanic (5.5%) than white (2.8%) students; higher among black female (3.2%) and Hispanic female (3.7%) than white female (1.9%) students; and higher among black male (8.1%) and Hispanic male (7.0%) than white male (3.5%) students. The prevalence of having been injured in a physical fight was higher among 9th-grade male (5.9%) than 12th-grade male (4.3%) students. The prevalence of having been injured in a physical fight ranged from 2.1% to 5.2% across state surveys (median: 3.5%) and from 3.5% to 7.2% across large urban school district surveys (median: 4.4%) (Table 13).

During 1991–2011, among students nationwide, a significant linear decrease occurred in the prevalence of having been injured in a physical fight (4.4%–3.9%). The prevalence of having been injured in a physical fight did not change significantly from 2009 (3.8%) to 2011 (3.9%).

In a Physical Fight on School Property

Nationwide, 12.0% of students had been in a physical fight on school property one or more times during the 12 months before the survey (Table 14). Overall, the prevalence of having been in a physical fight on school property was higher among male (16.0%) than female (7.8%) students; higher among white male (13.8%), black male (19.6%), and Hispanic male (19.4%) than white female (5.6%), black female (13.1%), and Hispanic female (9.0%) students, respectively; and higher among 9th-grade male (21.7%), 10th-grade male (17.0%), 11th-grade male (12.3%), and 12th-grade male (11.4%) than 9th-grade female (10.4%), 10th-grade female (8.0%), 11th-grade female (6.0%), and 12th-grade female (6.1%) students, respectively. Overall, the prevalence of having been in a physical fight on school property was higher among black (16.4%) and Hispanic (14.4%) than white (9.9%) students; higher among black female (13.1%) and Hispanic female (9.0%) than white female (5.6%) students; higher among black female (13.1%) than Hispanic female (9.0%) students; and higher among black male (19.6%) and Hispanic male (19.4%) than white male (13.8%) students. Overall, the prevalence of having been in a physical fight on school property was higher among 9th-grade (16.2%) than 10th-grade (12.8%), 11th-grade (9.2%), and 12th-grade (8.8%) students; higher among 10th-grade (12.8%) than 11th-grade (9.2%) and 12th-grade (8.8%) students; higher among 9th-grade female (10.4%) than 11th-grade female (6.0%) and 12th-grade female (6.1%) students; higher among 9th-grade male (21.7%) than 10th-grade male (17.0%), 11th-grade male (12.3%), and 12th-grade male (11.4%) students; and higher among 10th-grade male (17.0%) than 11th-grade male (12.3%) and 12th-grade male (11.4%) students. The prevalence of having been in a physical fight on school property ranged from 7.1% to 15.7% across state surveys (median: 9.4%) and from 7.6% to 18.9% across large urban school district surveys (median: 13.2%) (Table 15).

Among students nationwide, the prevalence of having been in a physical fight on school property decreased during 1993–2009 (16.2%–11.1%) and then did not change significantly during 2009–2011 (11.1%–12.0%).

Bullied on School Property

Nationwide, 20.1% of students had been bullied on school property during the 12 months before the survey (Table 14). Overall, the prevalence of having been bullied on school property was higher among female (22.0%) than male (18.2%) students; higher among white female (25.2%) than white male (20.7%) students; and higher among 9th-grade female (27.1%), 10th-grade female (24.6%), and 12th-grade female (17.2%) than 9th-grade male (21.5%), 10th-grade male (20.4%), and 12th-grade male (13.4%) students, respectively. Overall, the prevalence of having been bullied on school property was higher among white (22.9%) than black (11.7%) and Hispanic (17.6%) students; higher among Hispanic (17.6%) than black (11.7%) students; higher among white female (25.2%) than black female (12.2%) and Hispanic female (19.3%) students; higher among Hispanic female (19.3%) than black female (12.2%) students; higher among white male (20.7%) than black male (11.1%) and Hispanic male (16.0%) students; and higher among Hispanic male (16.0%) than black male (11.1%) students. Overall, the prevalence of having been bullied on school property was higher among 9th-grade (24.2%) and 10th-grade (22.4%) than 11th-grade (17.1%) and 12th-grade (15.2%) students; higher among 9th-grade female (27.1%) and 10th-grade female (24.6%) than 11th-grade female (17.5%) and 12th-grade female (17.2%) students; higher among 9th-grade male (21.5%) than 11th-grade male (16.7%) and 12th-grade male (13.4%) students; and higher among 10th-grade male (20.4%) and 11th-grade male (16.7%) than 12th-grade male (13.4%) students. The prevalence of having been bullied on school property ranged from 14.0% to 26.7% across state surveys (median: 20.3%) and from 9.7% to 19.5% across large urban school district surveys (median: 13.8%) (Table 15).

The prevalence of having been bullied on school property did not change significantly from 2009 (19.9%) to 2011 (20.1%).

Electronically Bullied

Nationwide, 16.2% of students had been electronically bullied, including being bullied through e-mail, chat rooms, instant messaging, websites, or texting, during the 12 months before the survey (Table 16). Overall, the prevalence of having been electronically bullied was higher among female (22.1%) than male (10.8%) students; higher among white female (25.9%), black female (11.0%), and Hispanic female (18.0%) than white male (11.8%), black male (6.9%), and Hispanic male (9.5%) students, respectively; and higher among 9th-grade female (22.6%), 10th-grade female (24.2%), 11th-grade female (19.8%), and 12th-grade female (21.5%) than 9th-grade male (8.9%), 10th-grade male (12.6%), 11th-grade male (12.4%), and 12th-grade male (8.8%) students, respectively. Overall, the prevalence of having been electronically bullied was higher among white (18.6%) than black (8.9%) and Hispanic (13.6%) students; higher among Hispanic (13.6%) than black (8.9%) students; higher among white female (25.9%) than black female (11.0%) and Hispanic female (18.0%) students; higher among Hispanic female (18.0%) than black female (11.0%) students; and higher among white male (11.8%) and Hispanic male (9.5%) than black male (6.9%) students. Overall, the prevalence of having been electronically bullied was higher among 10th-grade (18.1%) than 9th-grade (15.5%) and 12th-grade (15.0%) students; higher among 10th-grade female (24.2%) than 11th-grade female (19.8%) students; and higher among 10th-grade male (12.6%) and 11th-grade male (12.4%) than 9th-grade male (8.9%) students. The prevalence of having been electronically bullied ranged from 12.3% to 21.6% across state surveys (median: 15.6%) and from 8.2% to 16.1% across large urban school district surveys (median: 11.0%) (Table 17).

Did Not Go to School Because of Safety Concerns

Nationwide, 5.9% 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 (Table 16). The prevalence of having not gone to school because of safety concerns was higher among black male (8.0%) than black female (5.3%) students. Overall, the prevalence of having not gone to school because of safety concerns was higher among black (6.7%) and Hispanic (9.1%) than white (4.4%) students; higher among Hispanic (9.1%) than black (6.7%) students; higher among Hispanic female (9.6%) than white female (4.7%) and black female (5.3%) students; and higher among black male (8.0%) and Hispanic male (8.5%) than white male (4.0%) students. Overall, the prevalence of having not gone to school because of safety concerns was higher among 10th-grade (6.8%) than 11th-grade (5.2%) students and higher among 10th-grade female (7.1%) than 11th-grade female (5.1%) students. The prevalence of having not gone to school because of safety concerns ranged from 3.4% to 9.0% across state surveys (median: 5.2%) and from 5.1% to 20.9% across large urban school district surveys (median: 8.2%) (Table 17).

Among students nationwide, the prevalence of having not gone to school because of safety concerns did not change significantly during 1993–2011 (4.4%–5.9%). The prevalence of having not gone to school because of safety concerns also did not change significantly from 2009 (5.0%) to 2011 (5.9%).

Had Property Stolen or Damaged on School Property

Nationwide, 26.1% of students had had their property (e.g., car, clothing or books) stolen or deliberately damaged on school property one or more times during the 12 months before the survey (Table 18). Overall, the prevalence of having property stolen or damaged on school property was higher among male (28.8%) than female (23.4%) students; higher among white male (26.8%) and Hispanic male (33.3%) than white female (21.0%) and Hispanic female (27.8%) students, respectively; and higher among 11th-grade male (26.7%) and 12th-grade male (26.9%) than 11th-grade female (20.1%) and 12th-grade female (19.5%) students, respectively. Overall, the prevalence of having property stolen or damaged on school property was higher among black (27.3%) and Hispanic (30.7%) than white (24.0%) students; higher among Hispanic (30.7%) than black (27.3%) students; higher among Hispanic female (27.8%) than white female (21.0%) students; and higher among Hispanic male (33.3%) than white male (26.8%) and black male (28.7%) students. Overall, the prevalence of having property stolen or damaged on school property was higher among 10th-grade (30.6%) than 9th-grade (26.6%) students; higher among 9th-grade (26.6%) and 10th-grade (30.6%) than 11th-grade (23.5%) and 12th-grade (23.3%) students; higher among 9th-grade female (25.5%) and 10th-grade female (27.4%) than 11th-grade female (20.1%) and 12th-grade female (19.5%) students; and higher among 10th-grade male (33.4%) than 11th-grade male (26.7%) and 12th-grade male (26.9%) students.

During 2003–2011, among students nationwide, a significant linear decrease occurred in the prevalence of having property stolen or damaged on school property (29.8%–26.2%).

Dating Violence

During the 12 months before the survey, 9.4% of students nationwide had been hit, slapped, or physically hurt on purpose by their boyfriend or girlfriend (i.e., dating violence) (Table 19). Overall, the prevalence of dating violence was higher among black (12.2%) and Hispanic (11.4%) than white (7.6%) students; higher among black female (11.8%) and Hispanic female (10.6%) than white female (7.7%) students; and higher among black male (12.4%) and Hispanic male (12.1%) than white male (7.4%) students. Overall, the prevalence of dating violence was higher among 10th-grade (9.6%), 11th-grade (10.3%), and 12th-grade (10.3%) than 9th-grade (7.5%) students; higher among 10th-grade female (9.8%) and 12th-grade female (10.7%) than 9th-grade female (7.6%) students; and higher among 11th-grade male (11.2%) and 12th-grade male (10.0%) than 9th-grade male (7.4%) students. The prevalence of dating violence ranged from 6.5% to 16.1% across state surveys (median: 11.0%) and from 7.6% to 24.2% across large urban school district surveys (median: 11.6%) (Table 20).

Among students nationwide, the prevalence of dating violence did not change significantly during 1999–2011 (8.8%–9.4%) or from 2009 (9.8%) to 2011 (9.4%).

Forced to Have Sexual Intercourse

Nationwide, 8.0% of students had ever been physically forced to have sexual intercourse when they did not want to (Table 19). Overall, the prevalence of having been forced to have sexual intercourse was higher among female (11.8%) than male (4.5%) students; higher among white female (12.0%), black female (11.0%), and Hispanic female (11.2%) than white male (3.2%), black male (6.1%), and Hispanic male (5.4%) students, respectively; and higher among 9th-grade female (8.2%), 10th-grade female (12.2%), 11th-grade female (12.7%), and 12th-grade female (14.5%) than 9th-grade male (3.5%), 10th-grade male (4.2%), 11th-grade male (5.2%), and 12th-grade male (4.7%) students, respectively. The prevalence of having been forced to have sexual intercourse was higher among black male (6.1%) and Hispanic male (5.4%) than white male (3.2%) students. Overall, the prevalence of having been forced to have sexual intercourse was higher among 10th-grade (8.0%), 11th-grade (8.8%), and 12th-grade (9.5%) than 9th-grade (5.8%) students; higher among 10th-grade female (12.2%), 11th-grade female (12.7%), and 12th-grade female (14.5%) than 9th-grade female (8.2%) students; and higher among 11th-grade male (5.2%) than 9th-grade male (3.5%) students. The prevalence of having been forced to have sexual intercourse ranged from 5.6% to 12.2% across state surveys (median: 8.4%) and from 6.5% to 12.6% across large urban school district surveys (median: 8.1%) (Table 20).

Among students nationwide, the prevalence of having been forced to have sexual intercourse did not change significantly during 2001–2011 (7.7%–8.0%) or from 2009 (7.4%) to 2011 (8.0%).

Felt Sad or Hopeless

During the 12 months before the survey, 28.5% 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 21). Overall, the prevalence of having felt sad or hopeless almost every day for 2 or more weeks in a row was higher among female (35.9%) than male (21.5%) students; higher among white female (34.3%), black female (31.4%), and Hispanic female (41.4%) than white male (20.7%), black male (18.0%), and Hispanic male (24.4%) students, respectively; and higher among 9th-grade female (37.4%), 10th-grade female (37.2%), 11th-grade female (34.3%), and 12th-grade female (34.4%) than 9th-grade male (18.2%), 10th-grade male (21.1%), 11th-grade male (23.6%), and 12th-grade male (23.6%) students, respectively. Overall, the prevalence of having felt sad or hopeless almost every day for 2 or more weeks in a row was higher among Hispanic (32.6%) than white (27.2%) and black (24.7%) students; higher among Hispanic female (41.4%) than white female (34.3%) and black female (31.4%) students; and higher among Hispanic male (24.4%) than black male (18.0%) students. The prevalence of having felt sad or hopeless almost every day for 2 or more weeks in a row was higher among 11th-grade male (23.6%) and 12th-grade male (23.6%) than 9th-grade male (18.2%) students. The prevalence of having felt sad or hopeless almost every day for 2 or more weeks in a row ranged from 19.2% to 33.6% across state surveys (median: 25.8%) and from 21.7% to 32.8% across large urban school district surveys (median: 27.6%) (Table 22).

During 1999–2011, among students nationwide, the prevalence of having felt sad or hopeless almost every day for 2 or more weeks in a row did not change significantly (28.3%–28.5%). The prevalence of having felt sad or hopeless almost every day for 2 or more weeks in a row increased from 2009 (26.1%) to 2011 (28.5%).

Seriously Considered Attempting Suicide

Nationwide, 15.8% of students had seriously considered attempting suicide during the 12 months before the survey (Table 23). Overall, the prevalence of having seriously considered attempting suicide was higher among female (19.3%) than male (12.5%) students; higher among white female (18.4%), black female (17.4%), and Hispanic female (21.0%) than white male (12.8%), black male (9.0%), and Hispanic male (12.6%) students, respectively; and higher among 9th-grade female (21.5%), 10th-grade female (22.3%), and 12th-grade female (15.8%) than 9th-grade male (12.9%), 10th-grade male (11.4%), and 12th-grade male (11.5%) students, respectively. Overall, the prevalence of having seriously considered attempting suicide was higher among white (15.5%) and Hispanic (16.7%) than black (13.2%) students; higher among Hispanic female (21.0%) than black female (17.4%) students; and higher among white male (12.8%) and Hispanic male (12.6%) than black male (9.0%) students. Overall, the prevalence of having seriously considered attempting suicide was higher among 9th-grade (17.1%) and 10th-grade (16.5%) than 12th-grade (13.6%) students and higher among 9th-grade female (21.5%) and 10th-grade female (22.3%) than 11th-grade female (16.7%) and 12th-grade female (15.8%) students. The prevalence of having seriously considered attempting suicide ranged from 11.4% to 18.9% across state surveys (median: 14.6%) and from 10.7% to 15.7% across large urban school district surveys (median: 13.2%) (Table 24).

Among students nationwide, the prevalence of having seriously considered attempting suicide decreased during 1991–2009 (29.0%–13.8%) and then increased during 2009 –2011(13.8%–15.8%).

Made a Suicide Plan

During the 12 months before the survey, 12.8% of students nationwide had made a plan about how they would attempt suicide (Table 23). Overall, the prevalence of having made a suicide plan was higher among female (15.0%) than male (10.8%) students; higher among white female (13.7%), black female (13.9%), and Hispanic female (17.6%) than white male (10.6%), black male (8.4%), and Hispanic male (11.1%) students, respectively; and higher among 9th-grade female (16.9%), 10th-grade female (17.9%), and 12th-grade female (12.0%) than 9th-grade male (10.4%), 10th-grade male (11.3%), and 12th-grade male (9.5%) students, respectively. Overall, the prevalence of having made a suicide plan was higher among Hispanic (14.3%) than white (12.1%) and black (11.1%) students and higher among Hispanic female (17.6%) than white female (13.7%) and black female (13.9%) students. Overall, the prevalence of having made a suicide plan was higher among 9th-grade (13.6%) and 10th-grade (14.4%) than 12th-grade (10.7%) students; higher among 10th-grade (14.4%) than 11th-grade (11.9%) students; and higher among 9th-grade female (16.9%) and 10th-grade female (17.9%) than 11th-grade female (12.3%) and 12th-grade female (12.0%) students. The prevalence of having made a suicide plan ranged from 8.4% to 16.3% across state surveys (median: 12.3%) and from 8.6% to 14.9% across large urban school district surveys (median: 11.4%) (Table 24).

During 1991–2011, among students nationwide, a significant linear decrease occurred in the prevalence of having made a suicide plan (18.6%–12.8%). The prevalence of having made a suicide plan increased from 2009 (10.9%) to 2011 (12.8%).

Attempted Suicide

Nationwide, 7.8% of students had attempted suicide one or more times during the 12 months before the survey (Table 25). Overall, the prevalence of having attempted suicide was higher among female (9.8%) than male (5.8%) students; higher among white female (7.9%) and Hispanic female (13.5%) than white male (4.6%) and Hispanic male (6.9%) students, respectively; and higher among 9th-grade female (11.8%), 10th-grade female (11.6%), and 12th-grade female (7.7%) than 9th-grade male (6.8%), 10th-grade male (5.1%), and 12th-grade male (5.0%) students, respectively. Overall, the prevalence of having attempted suicide was higher among black (8.3%) and Hispanic (10.2%) than white (6.2%) students; higher among Hispanic female (13.5%) than white female (7.9%) and black female (8.8%) students; and higher among black male (7.7%) and Hispanic male (6.9%) than white male (4.6%) students. Overall, the prevalence of having attempted suicide was higher among 9th-grade (9.3%) and 10th-grade (8.2%) than 11th-grade (6.6%) and 12th-grade (6.3%) students and higher among 9th-grade female (11.8%) and 10th-grade female (11.6%) than 11th-grade female (7.4%) and 12th-grade female (7.7%) students. The prevalence of having attempted suicide ranged from 3.6% to 11.3% across state surveys (median: 7.8%) and from 6.0% to 15.8% across large urban school district surveys (median: 9.2%) (Table 26).

Among students nationwide, the prevalence of having attempted suicide did not change significantly during 1991–2001 (7.3%–8.8%) and then decreased during 2001–2011 (8.8%–7.8%). The prevalence of having attempted suicide increased from 2009 (6.3%) to 2011 (7.8%).

Suicide Attempt Treated by a Doctor or Nurse

During the 12 months before the survey, 2.4% 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 25). Overall, 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 (2.9%) than male (1.9%) students; higher among white female (2.2%) and Hispanic female (4.1%) than white male (1.5%) and Hispanic male (2.2%) students, respectively; and higher among 9th-grade female (3.7%) and 10th-grade female (3.4%) than 9th-grade male (2.0%) and 10th-grade male (1.8%) students, respectively. Overall, 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 (3.2%) than white (1.9%) students and higher among Hispanic female (4.1%) than white female (2.2%) and black female (2.4%) students. Overall, 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 (2.8%) than 11th-grade (1.9%) and 12th-grade (2.0%) students; higher among 10th-grade (2.6%) than 11th-grade (1.9%) students; higher among 9th-grade female (3.7%) than 11th-grade female (2.0%) and 12th-grade female (2.3%) students; and higher among 10th-grade female (3.4%) than 11th-grade female (2.0%) 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 ranged from 1.1% to 5.4% across state surveys (median: 2.7%) and from 1.6% to 5.6% across large urban school district surveys (median: 3.4%) (Table 26).

Among students nationwide, 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 increased during 1991–1995 (1.7%–2.8%) and then decreased during 1995–2011 (2.8%–2.4%). 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 2009 (1.9%) to 2011 (2.4%).

Tobacco Use

Ever Smoked Cigarettes

Nationwide, 44.7% of students had ever tried cigarette smoking (even one or two puffs) (i.e., ever smoked cigarettes) (Table 27). Overall, the prevalence of having ever smoked cigarettes was higher among male (46.3%) than female (42.9%) students; higher among Hispanic male (51.5%) than Hispanic female (45.5%) students; and higher among 11th-grade male (50.2%) than 11th-grade female (43.9%) students. Overall, the prevalence of having ever smoked cigarettes was higher among white (44.2%) and Hispanic (48.6%) than black (39.1%) students; higher among Hispanic female (45.5%) than black female (38.0%) students; higher among white male (45.6%) than black male (40.0%) students; and higher among Hispanic male (51.5%) than white male (45.6%) and black male (40.0%) students. Overall, the prevalence of having ever smoked cigarettes was higher among 11th-grade (47.1%) and 12th-grade (54.5%) than 9th-grade (37.6%) and 10th-grade (41.0%) students; higher among 12th-grade (54.5%) than 11th-grade (47.1%) students; higher among 10th-grade female (40.8%), 11th-grade female (43.9%), and 12th-grade female (53.6%) than 9th-grade female (35.0%) students; higher among 12th-grade female (53.6%) than 10th-grade female (40.8%) and 11th-grade female (43.9%) students; and higher among 11th-grade male (50.2%) and 12th-grade male (55.3%) than 9th-grade male (40.0%) and 10th-grade male (41.1%) students. The prevalence of having ever smoked cigarettes ranged from 23.1% to 59.5% across state surveys (median: 46.4%) and from 28.9% to 51.1% across large urban school district surveys (median: 41.0%) (Table 28).

Among students nationwide, the prevalence of having ever smoked cigarettes did not change significantly during 1991–1999 (70.1%–70.4%) and then decreased during 1999–2011 (70.4%–44.7%). The prevalence of having ever smoked cigarettes did not change significantly from 2009 (46.3%) to 2011 (44.7%).

Ever Smoked Cigarettes Daily

Nationwide, 10.2% of students had ever smoked at least one cigarette every day for 30 days (i.e., ever smoked cigarettes daily) (Table 27). Overall, the prevalence of having ever smoked cigarettes daily was higher among male (11.0%) than female (9.2%) students; higher among Hispanic male (9.0%) than Hispanic female (6.4%) students; and higher among 9th-grade male (6.8%) than 9th-grade female (5.0%) students. Overall, the prevalence of having ever smoked cigarettes daily was higher among white (12.0%) than black (5.3%) and Hispanic (7.8%) students; higher among Hispanic (7.8%) than black (5.3%) students; higher among white female (11.4%) than black female (4.3%) and Hispanic female (6.4%) students; higher among white male (12.5%) than black male (6.3%) and Hispanic male (9.0%) students; and higher among Hispanic male (9.0%) than black male (6.3%) students. Overall, the prevalence of having ever smoked cigarettes daily was higher among 10th-grade (8.4%), 11th-grade (11.1%), and 12th-grade (15.7%) than 9th-grade (6.0%) students; higher among 11th-grade (11.1%) and 12th-grade (15.7%) than 10th-grade (8.4%) students; higher among 12th-grade (15.7%) than 11th-grade (11.1%) students; higher among 10th-grade female (8.6%), 11th-grade female (9.7%), and 12th-grade female (14.1%) than 9th-grade female (5.0%) students; higher among 12th-grade female (14.1%) than 10th-grade female (8.6%) and 11th-grade female (9.7%) students; higher among 11th-grade male (12.3%) and 12th-grade male (17.3%) than 9th-grade male (6.8%) and 10th-grade male (8.3%) students; and higher among 12th-grade male (17.3%) than 11th-grade male (12.3%) students. The prevalence of having ever smoked cigarettes daily ranged from 4.2% to 19.4% across state surveys (median: 10.5%) and from 3.0% to 8.1% across large urban school district surveys (median: 6.0%) (Table 28).

During 2001–2011, among students nationwide, a significant linear decrease occurred in the prevalence of having ever smoked cigarettes daily (20.0%–10.2%). The prevalence of having ever smoked cigarettes daily did not change significantly from 2009 (11.2%) to 2011 (10.2%).

Smoked a Whole Cigarette Before Age 13 Years

Nationwide, 10.3% of students had smoked a whole cigarette for the first time before age 13 years (Table 29). Overall, the prevalence of having smoked a whole cigarette before age 13 years was higher among male (12.0%) than female (8.4%) students; higher among white male (11.2%), black male (11.1%), and Hispanic male (14.7%) than white female (8.4%), black female (6.6%), and Hispanic female (8.7%) students, respectively; and higher among 9th-grade male (14.8%), 10th-grade male (11.5%), and 12th-grade male (9.6%) than 9th-grade female (9.2%), 10th-grade female (8.5%), and 12th-grade female (6.8%) students, respectively. Overall, the prevalence of having smoked a whole cigarette before age 13 years was higher among Hispanic (11.8%) than black (8.8%) students and higher among Hispanic male (14.7%) than white male (11.2%) and black male (11.1%) students. Overall, the prevalence of having smoked a whole cigarette before age 13 years was higher among 9th-grade (12.1%) than 11th-grade (9.8%) and 12th-grade (8.2%) students; higher among 10th-grade (10.1%) than 12th-grade (8.2%) students; and higher among 9th-grade male (14.8%) than 10th-grade male (11.5%), 11th-grade male (10.9%), and 12th-grade male (9.6%) students. The prevalence of having smoked a whole cigarette before age 13 years ranged from 4.6% to 19.7% across state surveys (median: 10.9%) and from 6.4% to 12.7% across large urban school district surveys (median: 9.1%) (Table 30).

Among students nationwide, the prevalence of having smoked a whole cigarette before age 13 years increased during 1991–1993 (23.8%–26.9%) and then decreased during 1993–2011 (26.9%–10.3%). The prevalence of having smoked a whole cigarette before age 13 years did not change significantly from 2009 (10.7%) to 2011 (10.3%).

Current Cigarette Use

Nationwide, 18.1% of students had smoked cigarettes on at least 1 day during the 30 days before the survey (i.e., current cigarette use) (Table 29). Overall, the prevalence of current cigarette use was higher among male (19.9%) than female (16.1%) students; higher among black male (13.7%) and Hispanic male (19.5%) than black female (7.4%) and Hispanic female (15.2%) students, respectively; and higher among 9th-grade male (15.1%) and 12th-grade male (28.0%) than 9th-grade female (10.9%) and 12th-grade female (22.2%) students, respectively. Overall, the prevalence of current cigarette use was higher among white (20.3%) and Hispanic (17.5%) than black (10.5%) students; higher among white female (18.9%) than black female (7.4%) and Hispanic female (15.2%) students; higher among Hispanic female (15.2%) than black female (7.4%) students; and higher among white male (21.5%) and Hispanic male (19.5%) than black male (13.7%) students. Overall, the prevalence of current cigarette use was higher among 10th-grade (15.6%), 11th-grade (19.3%), and 12th-grade (25.1%) than 9th-grade (13.0%) students; higher among 11th-grade (19.3%) and 12th-grade (25.1%) than 10th-grade (15.6%) students; higher among 12th-grade (25.1%) than 11th-grade (19.3%) students; higher among 10th-grade female (15.1%), 11th-grade female (17.2%), and 12th-grade female (22.2%) than 9th-grade female (10.9%) students; higher among 12th-grade female (22.2%) than 10th-grade female (15.1%) and 11th-grade female (17.2%) students; higher among 11th-grade male (21.2%) and 12th-grade male (28.0%) than 9th-grade male (15.1%) and 10th-grade male (16.1%) students; and higher among 12th-grade male (28.0%) than 11th-grade male (21.2%) students. The prevalence of current cigarette use ranged from 5.9% to 24.1% across state surveys (median: 17.4%) and from 4.8% to 14.7% across large urban school district surveys (median: 11.0%) (Table 30).

Among students nationwide, the prevalence of current cigarette use increased during 1991–1997 (27.5%–36.4%) and then decreased during 1997–2011 (36.4%–18.1%). The prevalence of current cigarette use did not change significantly from 2009 (19.5%) to 2011 (18.1%).

Current Frequent Cigarette Use

Nationwide, 6.4% of students had smoked cigarettes 20 or more days during the 30 days before the survey (i.e., current frequent cigarette use) (Table 31). Overall, the prevalence of current frequent cigarette use was higher among male (7.4%) than female (5.4%) students; higher among Hispanic male (5.8%) than Hispanic female (2.8%) students; and higher among 9th-grade male (4.3%), 11th-grade male (9.2%), and 12th-grade male (12.3%) than 9th-grade female (2.3%), 11th-grade female (6.2%), and 12th-grade female (9.3%) students, respectively. Overall, the prevalence of current frequent cigarette use was higher among white (8.0%) than black (2.6%) and Hispanic (4.4%) students; higher among Hispanic (4.4%) than black (2.6%) students; higher among white female (7.4%) than black female (1.9%) and Hispanic female (2.8%) students; higher among white male (8.6%) than black male (3.4%) and Hispanic male (5.8%) students; and higher among Hispanic male (5.8%) than black male (3.4%) students. Overall, the prevalence of current frequent cigarette use was higher among 11th-grade (7.7%) and 12th-grade (10.8%) than 9th-grade (3.3%) and 10th-grade (4.3%) students; higher among 12th-grade (10.8%) than 11th-grade (7.7%) students; higher among 10th-grade female (4.2%), 11th-grade female (6.2%), and 12th-grade female (9.3%) than 9th-grade female (2.3%) students; higher among 12th-grade female (9.3%) than 10th-grade female (4.2%) and 11th-grade female (6.2%) students; higher among 11th-grade male (9.2%) and 12th-grade male (12.3%) than 9th-grade male (4.3%) and 10th-grade male (4.4%) students; and higher among 12th-grade male (12.3%) than 11th-grade male (9.2%) students. Prevalence of current frequent cigarette use ranged from 2.1% to 11.6% across state surveys (median: 6.3%) and from 0.9% to 5.3% across large urban school district surveys (median: 3.2%) (Table 32).

Among students nationwide, the prevalence of current frequent cigarette use increased during 1991–1999 (12.7%–16.8%) and then decreased during 1999–2011 (16.8%–6.4%). The prevalence of current frequent cigarette use did not change significantly from 2009 (7.3%) to 2011 (6.4%).

Smoked More than 10 Cigarettes per Day

Among the 18.1% of students nationwide who currently smoked cigarettes, 7.8% of students had smoked more than 10 cigarettes per day on the days they smoked during the 30 days before the survey (Table 31). Overall, the prevalence of having smoked more than 10 cigarettes per day was higher among male (9.4%) than female (5.7%) students; higher among Hispanic male (8.8%) than Hispanic female (2.7%) students; and higher among 11th-grade male (11.6%) than 11th-grade female (3.9%) students. Overall, the prevalence of having smoked more than 10 cigarettes per day was higher among white (8.5%) than black (4.6%) students and higher among white female (7.4%) than Hispanic female (2.7%) students. The prevalence of having smoked more than 10 cigarettes per day ranged from 3.5% to 18.2% across state surveys (median: 7.8%) and from 1.9% to 12.9% across large urban school district surveys (median: 8.3%) (Table 32).

During 1991–2011, among students nationwide, a significant linear decrease occurred in the prevalence of having smoked more than 10 cigarettes per day (18.0%–7.8%). The prevalence of having smoked more than 10 cigarettes per day did not change significantly from 2009 (7.8%) to 2011 (7.8%).

Smoked Cigarettes on School Property

Nationwide, 4.9% of students had smoked cigarettes on school property on at least 1 day during the 30 days before the survey (Table 33). Overall, the prevalence of having smoked cigarettes on school property was higher among male (5.7%) than female (4.1%) students; higher among black male (4.3%) and Hispanic male (5.5%) than black female (1.8%) and Hispanic female (3.1%) students, respectively; and higher among 12th-grade male (8.5%) than 12th-grade female (4.7%) students. Overall, the prevalence of having smoked cigarettes on school property was higher among white (5.4%) than black (3.0%) students and higher among white female (5.0%) than black female (1.8%) and Hispanic female (3.1%) students. Overall, the prevalence of having smoked cigarettes on school property was higher among 10th-grade (4.4%), 11th-grade (5.9%), and 12th-grade (6.6%) than 9th-grade (2.8%) students; higher among 11th-grade (5.9%) and 12th-grade (6.6%) than 10th-grade (4.4%) students; higher among 10th-grade female (4.2%), 11th-grade female (5.2%), and 12th-grade female (4.7%) than 9th-grade female (2.2%) students; higher among 11th-grade male (6.7%) and 12th-grade male (8.5%) than 9th-grade male (3.4%) students; and higher among 12th-grade male (8.5%) than 10th-grade male (4.6%) students. The prevalence of having smoked cigarettes on school property ranged from 2.3% to 9.3% across state surveys (median: 4.3%) and from 1.5% to 6.1% across large urban school district surveys (median: 3.7%) (Table 34).

Among students nationwide, the prevalence of having smoked cigarettes on school property did not change significantly during 1993–1995 (13.2%–16.0%) and then decreased during 1995–2011 (16.0%–4.9%). The prevalence of having smoked cigarettes on school property did not change significantly from 2009 (5.1%) to 2011 (4.9%).

Bought Cigarettes in a Store or Gas Station

Among the 14.2% of students nationwide who currently smoked cigarettes and were aged <18 years, 14.0% 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 33). Overall, the prevalence of having bought their own cigarettes in a store or gas station was higher among male (17.1%) than female (10.2%) students; higher among white male (17.5%) and Hispanic male (20.8%) than white female (9.8%) and Hispanic female (7.5%) students, respectively; and higher among 10th-grade male (16.1%) than 10th-grade female (6.6%) students. Overall, the prevalence of having bought their own cigarettes in a store or gas station was higher among 11th-grade (18.3%) and 12th-grade (18.1%) than 9th-grade (8.7%) students; higher among 11th-grade (18.3%) than 10th-grade (11.8%) students; higher among 11th-grade female (13.4%) than 10th-grade female (6.6%) students; and higher among 11th-grade male (22.4%) and 12th-grade male (20.8%) than 9th-grade male (10.3%) students. The prevalence of having bought their own cigarettes in a store or gas station ranged from 3.0% to 25.5% across state surveys (median: 12.3%) and from 10.3% to 30.1% across large urban school district surveys (median: 18.0%) (Table 34).

During 2001–2011, among students nationwide who currently smoked cigarettes and were aged <18 years, a significant linear decrease occurred in the prevalence of having bought their own cigarettes in a store or gas station (19.0%–14.0%). The prevalence of having bought their own cigarettes in a store or gas station did not change significantly from 2009 (14.1%) to 2011 (14.0%).

Tried to Quit Smoking Cigarettes

Among the 18.1% of students nationwide who currently smoked cigarettes, 49.9% had tried to quit smoking cigarettes during the 12 months before the survey (Table 35). Overall, the prevalence of having tried to quit smoking cigarettes was higher among female (53.9%) than male (47.0%) students; higher among white female (54.0%) and Hispanic female (55.9%) than white male (46.3%) and Hispanic male (44.7%) students, respectively; and higher among 11th-grade female (55.1%) and 12th-grade female (52.6%) than 11th-grade male (43.1%) and 12th-grade male (44.1%) students, respectively. Overall, the prevalence of having tried to quit smoking cigarettes was higher among 10th-grade (55.9%) than 12th-grade (47.8%) students and higher among 10th-grade male (53.9%) than 11th-grade male (43.1%) and 12th-grade male (44.1%) students. The prevalence of having tried to quit smoking cigarettes ranged from 44.3% to 68.0% across state surveys (median: 52.1%) and from 40.5% to 61.6% across large urban school district surveys (median: 53.3%) (Table 36).

During 2001–2011, among students nationwide who currently smoke cigarettes, a significant linear decrease occurred in the prevalence of having ever tried to quit smoking cigarettes (57.4%–49.9%). The prevalence of having ever tried to quit smoking cigarettes did not change significantly from 2009 (50.8%) to 2011 (49.9%).

Current Smokeless Tobacco Use

Nationwide, 7.7% 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 37). Overall, the prevalence of current smokeless tobacco use was higher among male (12.8%) than female (2.2%) students; higher among white male (15.6%), black male (5.4%), and Hispanic male (8.7%) than white female (2.4%), black female (0.8%), and Hispanic female (2.8%) students, respectively; and higher among 9th-grade male (9.6%), 10th-grade male (12.1%), 11th-grade male (14.5%), and 12th-grade male (15.0%) than 9th-grade female (2.0%), 10th-grade female (2.1%), 11th-grade female (2.3%), and 12th-grade female (2.2%) students, respectively. Overall, the prevalence of current smokeless tobacco use was higher among white (9.3%) than black (3.1%) and Hispanic (5.9%) students; higher among Hispanic (5.9%) than black (3.1%) students; higher among white female (2.4%) and Hispanic female (2.8%) than black female (0.8%) students; higher among white male (15.6%) than black male (5.4%) and Hispanic male (8.7%) students; and higher among Hispanic male (8.7%) than black male (5.4%) students. Overall, the prevalence of current smokeless tobacco use was higher among 11th-grade (8.6%) and 12th-grade (8.8%) than 9th-grade (5.9%) students; higher among 11th-grade male (14.5%) and 12th-grade male (15.0%) than 9th-grade male (9.6%) students; and higher among 12th-grade male (15.0%) than 10th-grade male (12.1%) students. The prevalence of current smokeless tobacco use ranged from 3.5% to 16.9% across state surveys (median: 8.8%) and from 1.4% to 7.5% across large urban school district surveys (median: 3.8%) (Table 38).

Among students nationwide, the prevalence of current smokeless tobacco use decreased during 1995–2003 (11.4%–6.7%) and then did not change significantly during 2003–2011 (6.7%–7.7%). The prevalence of current smokeless tobacco use also did not change significantly from 2009 (8.9%) to 2011 (7.7%).

Used Smokeless Tobacco on School Property

Nationwide, 4.8% of students had used smokeless tobacco (e.g., chewing tobacco, snuff, or dip) on school property on at least 1 day during the 30 days before the survey (Table 37). Overall, the prevalence of having used smokeless tobacco on school property was higher among male (8.4%) than female (0.9%) students; higher among white male (10.1%), black male (3.4%), and Hispanic male (5.7%) than white female (0.8%), black female (0.4%), and Hispanic female (1.4%) students, respectively; and higher among 9th-grade male (6.4%), 10th-grade male (7.8%), 11th-grade male (9.1%), and 12th-grade male (10.4%) than 9th-grade female (0.9%), 10th-grade female (1.0%), 11th-grade female (0.8%), and 12th-grade female (0.7%) students, respectively. Overall, the prevalence of having used smokeless tobacco on school property was higher among white (5.6%) than black (1.9%) and Hispanic (3.7%) students; higher among Hispanic (3.7%) than black (1.9%) students; higher among white male (10.1%) than black male (3.4%) and Hispanic male (5.7%) students; and higher among Hispanic male (5.7%) than black male (3.4%) students. Overall, the prevalence of having used smokeless tobacco on school property was higher among 12th-grade (5.7%) than 9th-grade (3.8%) students; higher among 11th-grade male (9.1%) and 12th-grade male (10.4%) than 9th-grade male (6.4%) students; and higher among 12th-grade male (10.4%) than 10th-grade male (7.8%) students. The prevalence of having used smokeless tobacco on school property ranged from 2.3% to 11.6% across state surveys (median: 5.1%) and from 0.7% to 3.5% across large urban school district surveys (median: 2.2%) (Table 38).

Among students nationwide, the prevalence of having used smokeless tobacco on school property did not change significantly during 1995–2011 (6.3%–4.8%) or from 2009 (5.5%) to 2011 (4.8%).

Current Cigar Use

Nationwide, 13.1% 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). Overall, the prevalence of current cigar use was higher among male (17.8%) than female (8.0%) students; higher among white male (19.0%), black male (15.1%), and Hispanic male (17.2%) than white female (7.5%), black female (8.5%), and Hispanic female (9.1%) students, respectively; and higher among 9th-grade male (12.3%), 10th-grade male (15.4%), 11th-grade male (20.4%), and 12th-grade male (23.9%) than 9th-grade female (5.5%), 10th-grade female (8.1%), 11th-grade female (8.4%), and 12th-grade female (10.2%) students, respectively. The prevalence of current cigar use was higher among white male (19.0%) than black male (15.1%) students. Overall, the prevalence of current cigar use was higher among 10th-grade (11.9%), 11th-grade (14.5%), and 12th-grade (17.3%) than 9th-grade (9.0%) students; higher among 11th-grade (14.5%) and 12th-grade (17.3%) than 10th-grade (11.9%) students; higher among 10th-grade female (8.1%), 11th-grade female (8.4%), and 12th-grade female (10.2%) than 9th-grade female (5.5%) students; higher among 10th-grade male (15.4%), 11th-grade male (20.4%), and 12th-grade male (23.9%) than 9th-grade male (12.3%) students; and higher among 11th-grade male (20.4%) and 12th-grade male (23.9%) than 10th-grade male (15.4%) students. The prevalence of current cigar use ranged from 5.0% to 18.3% across state surveys (median: 13.9%) and from 6.0% to 15.7% across large urban school district surveys (median: 10.4%) (Table 40).

Among students nationwide, the prevalence of current cigar use decreased during 1997–2005 (22.0%–14.0%) and then did not change significantly during 2005–2011 (14.0%–13.1%). The prevalence of current cigar use also did not change significantly from 2009 (14.0%) to 2011 (13.1%).

Current Tobacco Use

Nationwide, 23.4% of students had reported current cigarette use, current smokeless tobacco use, or current cigar use (i.e., current tobacco use) (Table 39). Overall, the prevalence of current tobacco use was higher among male (28.1%) than female (18.5%) students; higher among white male (31.5%), black male (18.8%), and Hispanic male (24.4%) than white female (21.2%), black female (12.3%), and Hispanic female (16.3%) students, respectively; and higher among 9th-grade male (19.7%), 10th-grade male (25.3%), 11th-grade male (31.6%), and 12th-grade male (37.1%) than 9th-grade female (12.4%), 10th-grade female (17.2%), 11th-grade female (19.8%), and 12th-grade female (25.4%) students, respectively. Overall, the prevalence of current tobacco use was higher among white (26.5%) than black (15.4%) and Hispanic (20.5%) students; higher among Hispanic (20.5%) than black (15.4%) students; higher among white female (21.2%) than black female (12.3%) and Hispanic female (16.3%) students; higher among Hispanic female (16.3%) than black female (12.3%) students; higher among white male (31.5%) than black male (18.8%) and Hispanic male (24.4%) students; and higher among Hispanic male (24.4%) than black male (18.8%) students. Overall, the prevalence of current tobacco use was higher among 10th-grade (21.5%), 11th-grade (25.8%), and 12th-grade (31.4%) than 9th-grade (16.1%) students; higher among 11th-grade (25.8%) and 12th-grade (31.4%) than 10th-grade (21.5%) students; higher among 12th-grade (31.4%) than 11th-grade (25.8%) students; higher among 10th-grade female (17.2%), 11th-grade female (19.8%), and 12th-grade female (25.4%) than 9th-grade female (12.4%) students; higher among 12th-grade female (25.4%) than 10th-grade female (17.2%) and 11th-grade female (19.8%) students; higher among 10th-grade male (25.3%), 11th-grade male (31.6%), and 12th-grade male (37.1%) than 9th-grade male (19.7%) students; and higher among 11th-grade male (31.6%) and 12th-grade male (37.1%) than 10th-grade male (25.3%) students. The prevalence of current tobacco use ranged from 7.8% to 31.9% across state surveys (median: 23.9%) and from 9.3% to 20.0% across large urban school district surveys (median: 14.9%) (Table 40).

Among students nationwide, the prevalence of current tobacco use decreased during 1997–2007 (43.4%–25.7%) and then did not change significantly during 2007–2011 (25.7%–23.4%). The prevalence of current tobacco use also did not change significantly from 2009 (26.0%) to 2011 (23.4%).

Alcohol and Other Drug Use

Ever Drank Alcohol

Nationwide, 70.8% of students had had at least one drink of alcohol on at least 1 day during their life (i.e., ever drank alcohol) (Table 41). The prevalence of having ever drunk alcohol was higher among black female (66.1%) than black male (60.9%) students. Overall, the prevalence of having ever drunk alcohol was higher among white (71.7%) and Hispanic (73.2%) than black (63.5%) students; higher among Hispanic female (74.1%) than black female (66.1%) students; and higher among white male (72.3%) and Hispanic male (72.4%) than black male (60.9%) students. Overall, the prevalence of having ever drunk alcohol was higher among 10th-grade (69.2%), 11th-grade (75.3%), and 12th-grade (79.0%) than 9th-grade (61.7%) students; higher among 11th-grade (75.3%) and 12th-grade (79.0%) than 10th-grade (69.2%) students; higher among 12th-grade (79.0%) than 11th-grade (75.3%) students; higher among 10th-grade female (69.1%), 11th-grade female (74.8%), and 12th-grade female (80.0%) than 9th-grade female (61.9%) students; higher among 11th-grade female (74.8%) and 12th-grade female (80.0%) than 10th-grade female (69.1%) students; higher among 12th-grade female (80.0%) than 11th-grade female (74.8%) students; higher among 10th-grade male (69.2%), 11th-grade male (75.7%), and 12th-grade male (78.0%) than 9th-grade male (61.6%) students; and higher among 11th-grade male (75.7%) and 12th-grade male (78.0%) than 10th-grade male (69.2%) students. The prevalence of having ever drunk alcohol ranged from 35.1% to 75.6% across state surveys (median: 66.3%) and from 49.1% to 72.2% across large urban school district surveys (median: 65.2%) (Table 42).

Among students nationwide, the prevalence of having ever drunk alcohol did not change significantly during 1991–1999 (81.6%–81.0%) and then decreased during 1999–2011 (81.0%–70.8%). The prevalence of having ever drunk alcohol did not change significantly from 2009 (72.5%) to 2011 (70.8%).

Drank Alcohol Before Age 13 Years

Nationwide, 20.5% of students had drunk alcohol (other than a few sips) for the first time before age 13 years (Table 41). Overall, the prevalence of having drunk alcohol before age 13 years was higher among male (23.3%) than female (17.4%) students; higher among white male (21.1%), black male (24.1%), and Hispanic male (27.2%) than white female (14.8%), black female (19.4%), and Hispanic female (23.0%) students, respectively; and higher among 9th-grade male (28.9%), 10th-grade male (24.3%), 11th-grade male (20.9%), and 12th-grade male (17.9%) than 9th-grade female (24.1%), 10th-grade female (17.6%), 11th-grade female (14.2%), and 12th-grade female (12.2%) students, respectively. Overall, the prevalence of having drunk alcohol before age 13 years was higher among black (21.8%) than white (18.1%) students; higher among Hispanic (25.2%) than white (18.1%) and black (21.8%) students; higher among black female (19.4%) than white female (14.8%) students; higher among Hispanic female (23.0%) than white female (14.8%) and black female (19.4%) students; and higher among Hispanic male (27.2%) than white male (21.1%) students. Overall, the prevalence of having drunk alcohol before age 13 years was higher among 9th-grade (26.6%) than 10th-grade (21.1%), 11th-grade (17.6%), and 12th-grade (15.1%) students; higher among 10th-grade (21.1%) than 11th-grade (17.6%) and 12th-grade (15.1%) students; higher among 11th-grade (17.6%) than 12th-grade (15.1%) students; higher among 9th-grade female (24.1%) than 10th-grade female (17.6%), 11th-grade female (14.2%), and 12th-grade female (12.2%) students; higher among 10th-grade female (17.6%) than 11th-grade female (14.2%) and 12th-grade female (12.2%) students; higher among 9th-grade male (28.9%) than 10th-grade male (24.3%), 11th-grade male (20.9%), and 12th-grade male (17.9%) students; and higher among 10th-grade male (24.3%) and 11th-grade male (20.9%) than 12th-grade male (17.9%) students. The prevalence of having drunk alcohol before age 13 years ranged from ranged from 10.7% to 27.4% across state surveys (median: 19.0%) and from 16.2% to 26.4% across large urban school district surveys (median: 21.9%) (Table 42).

Among students nationwide, the prevalence of having drunk alcohol before age 13 years did not change significantly during 1991–1999 (32.7%–32.2%) and then decreased during 1999–2011 (32.2%–20.5%). The prevalence of having drunk alcohol before age 13 years did not change significantly from 2009 (21.1%) to 2011 (20.5%).

Current Alcohol Use

Nationwide, 38.7% 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 43). The prevalence of current alcohol use was higher among 11th-grade male (45.2%) and 12th-grade male (51.2%) than 11th-grade female (40.1%) and 12th-grade female (45.4%) students, respectively. Overall, the prevalence of current alcohol use was higher among white (40.3%) and Hispanic (42.3%) than black (30.5%) students; higher among white female (38.8%) and Hispanic female (42.4%) than black female (31.6%) students; and higher among white male (41.6%) and Hispanic male (42.1%) than black male (29.5%) students. Overall, the prevalence of current alcohol use was higher among 10th-grade (35.7%), 11th-grade (42.7%), and 12th-grade (48.4%) than 9th-grade (29.8%) students; higher among 11th-grade (42.7%) and 12th-grade (48.4%) than 10th-grade (35.7%) students; higher among 12th-grade (48.4%) than 11th-grade (42.7%) students; higher among 10th-grade female (37.1%), 11th-grade female (40.1%), and 12th-grade female (45.4%) than 9th-grade female (30.3%) students; and higher among 12th-grade female (45.4%) than 10th-grade female (37.1%) and 11th-grade female (40.1%) students; higher among 10th-grade male (34.4%), 11th-grade male (45.2%), and 12th-grade male (51.2%) than 9th-grade male (29.3%) students; higher among 11th-grade male (45.2%) and 12th-grade male (51.2%) than 10th-grade male (34.4%) students; and higher among 12th-grade male (51.2%) than 11th-grade male (45.2%) students. The prevalence of current alcohol use ranged from 15.0% to 44.4% across state surveys (median: 36.2%) and from 21.0% to 43.5% across large urban school district surveys (median: 33.0%) (Table 44).

Among students nationwide, the prevalence of current alcohol use did not change significantly during 1991–1999 (50.8%–50.0%) and then decreased during 1999–2011 (50.0%–38.7%). The prevalence of current alcohol use also decreased from 2009 (41.8%) to 2011 (38.7%).

Binge Drinking

Nationwide, 21.9% 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 (i.e., binge drinking) (Table 43). Overall, the prevalence of binge drinking was higher among male (23.8%) than female (19.8%) students; higher among white male (26.1%) and black male (14.5%) than white female (21.7%) and black female (10.3%) students, respectively; and higher among 11th-grade male (27.9%) and 12th-grade male (35.7%) than 11th-grade female (22.6%) and 12th-grade female (27.0%) students, respectively. Overall, the prevalence of binge drinking was higher among white (24.0%) and Hispanic (24.2%) than black (12.4%) students; higher among white female (21.7%) and Hispanic female (22.4%) than black female (10.3%) students; and higher among white male (26.1%) and Hispanic male (25.9%) than black male (14.5%) students. Overall, the prevalence of binge drinking was higher among 10th-grade (18.4%), 11th-grade (25.2%), and 12th-grade (31.5%) than 9th-grade (14.0%) students; higher among 11th-grade (25.2%) and 12th-grade (31.5%) than 10th-grade (18.4%) students; higher among 12th-grade (31.5%) than 11th-grade (25.2%) students; higher among 10th-grade female (17.8%), 11th-grade female (22.6%), and 12th-grade female (27.0%) than 9th-grade female (13.0%) students; higher among 11th-grade female (22.6%) and 12th-grade female (27.0%) than 10th-grade female (17.8%) students; higher among 12th-grade female (27.0%) than 11th-grade female (22.6%) students; higher among 10th-grade male (19.0%), 11th-grade male (27.9%), and 12th-grade male (35.7%) than 9th-grade male (15.0%) students; higher among 11th-grade male (27.9%) and 12th-grade male (35.7%) than 10th-grade male (19.0%) students; and higher among 12th-grade male (35.7%) than 11th-grade male (27.9%) students. The prevalence of binge drinking ranged from 9.1% to 26.5% across state surveys (median: 21.8%) and from 7.4% to 25.2% across large urban school district surveys (median: 17.5%) (Table 44).

Among students nationwide, the prevalence of binge drinking did not change significantly during 1991–1997 (31.3%–33.4%) and then decreased during 1997–2011 (33.4%–21.9%). The prevalence of binge drinking also decreased from 2009 (24.2%) to 2011 (21.9%).

Drank Alcohol on School Property

Nationwide, 5.1% of students had drunk at least one drink of alcohol on school property on at least 1 day during the 30 days before the survey (Table 45). The prevalence of having drunk alcohol on school property was higher among black male (6.5%) than black female (3.8%) students and higher among 12th-grade male (6.4%) than 12th-grade female (3.8%) students. Overall, the prevalence of having drunk alcohol on school property was higher among Hispanic (7.3%) than white (4.0%) and black (5.1%) students; higher among Hispanic female (6.6%) than white female (3.8%) and black female (3.8%) students; and higher among black male (6.5%) and Hispanic male (7.9%) than white male (4.2%) students. The prevalence of having drunk alcohol on school property ranged from 2.0% to 6.4% across state surveys (median: 4.1%) and from 2.6% to 10.7% across large urban school district surveys (median: 5.3%) (Table 46).

During 1993–2011, among students nationwide, a significant linear decrease occurred in the prevalence of having drunk alcohol on school property (5.2%–5.1%). The prevalence of having drunk alcohol on school property did not change significantly from 2009 (4.5%) to 2011 (5.1%).

Someone Gave Alcohol to Them

Among the 38.7% of students nationwide who currently drank alcohol, 40.0% had usually obtained the alcohol they drank by someone giving it to them during the 30 days before the survey (Table 45). Overall, the prevalence of having someone give alcohol to them was higher among female (45.7%) than male (35.0%) students; higher among white female (43.9%), black female (50.6%), and Hispanic female (46.9%) than white male (34.4%), black male (39.1%), and Hispanic male (33.1%) students, respectively; and higher among 9th-grade female (49.4%), 11th-grade female (43.7%), and 12th-grade female (47.3%) than 9th-grade male (29.4%), 11th-grade male (32.9%), and 12th-grade male (36.3%) students, respectively. Overall, the prevalence of having someone give alcohol to them was higher among black (44.9%) than white (38.8%) students. The prevalence of having someone give alcohol to them was higher among 10th-grade male (41.8%) than 9th-grade male (29.4%) and 11th-grade male (32.9%) students. The prevalence of having someone give alcohol to them ranged from 31.2% to 44.2% across state surveys (median: 38.5%) and from 26.5% to 44.8% across large urban school district surveys (median: 36.3%) (Table 46).

Among students nationwide who currently drank alcohol, the prevalence of having someone give alcohol to them did not change significantly during 2007–2011 (41.7%–40.0%) or from 2009 (42.2%) to 2011 (40.0%).

Ever Used Marijuana

Nationwide, 39.9% of students had used marijuana one or more times during their life (i.e., ever used marijuana) (Table 47). Overall, the prevalence of having ever used marijuana was higher among male (42.5%) than female (37.2%) students; higher among white male (40.3%), black male (48.5%), and Hispanic male (45.0%) than white female (35.4%), black female (37.7%), and Hispanic female (39.1%) students, respectively; and higher among 9th-grade male (34.9%) and 11th-grade male (48.7%) than 9th-grade female (26.4%) and 11th-grade female (42.1%) students, respectively. Overall, the prevalence of having ever used marijuana was higher among black (43.0%) and Hispanic (42.1%) than white (37.9%) students and higher among black male (48.5%) and Hispanic male (45.0%) than white male (40.3%) students. Overall, the prevalence of having ever used marijuana was higher among 10th-grade (36.4%), 11th-grade (45.5%), and 12th-grade (48.9%) than 9th-grade (30.8%) students; higher among 11th-grade (45.5%) and 12th-grade (48.9%) than 10th-grade (36.4%) students; higher among 10th-grade female (35.2%), 11th-grade female (42.1%), and 12th-grade female (47.1%) than 9th-grade female (26.4%) students; higher among 11th-grade female (42.1%) and 12th-grade female (47.1%) than 10th-grade female (35.2%) students; higher among 12th-grade female (47.1%) than 11th-grade female (42.1%) students; and higher among 11th-grade male (48.7%) and 12th-grade male (50.8%) than 9th-grade male (34.9%) and 10th-grade male (37.5%) students. The prevalence of having ever used marijuana ranged from 19.6% to 46.0% across state surveys (median: 37.3%) and from 30.1% to 54.1% across large urban school district surveys (median: 40.5%) (Table 48).

Among students nationwide, the prevalence of having ever used marijuana increased during 1991–1999 (31.3%–47.2%) and then decreased during 1999–2011 (47.2%–39.9%). The prevalence of having ever used marijuana increased from 2009 (36.8%) to 2011 (39.9%).

Tried Marijuana Before Age 13 Years

Nationwide, 8.1% of students had tried marijuana for the first time before age 13 years (Table 47). Overall, the prevalence of having tried marijuana before age 13 years was higher among male (10.4%) than female (5.7%) students; higher among white male (8.5%), black male (14.2%), and Hispanic male (11.6%) than white female (4.4%), black female (6.9%), and Hispanic female (7.1%) students, respectively; and higher among 9th-grade male (12.7%), 10th-grade male (10.1%), 11th-grade male (9.6%), and 12th-grade male (8.7%) than 9th-grade female (6.6%), 10th-grade female (4.8%), 11th-grade female (5.6%), and 12th-grade female (5.3%) students, respectively. Overall, the prevalence of having tried marijuana before age 13 years was higher among black (10.5%) and Hispanic (9.4%) than white (6.5%) students; higher among black female (6.9%) and Hispanic female (7.1%) than white female (4.4%) students; and higher among black male (14.2%) and Hispanic male (11.6%) than white male (8.5%) students. Overall, the prevalence of having tried marijuana before age 13 years was higher among 9th-grade (9.7%) than 10th-grade (7.5%), 11th-grade (7.6%), and 12th-grade (7.0%) students; higher among 9th-grade female (6.6%) than 10th-grade female (4.8%) students; and higher among 9th-grade male (12.7%) than 11th-grade male (9.6%) and 12th-grade male (8.7%) students. The prevalence of having tried marijuana before age 13 years ranged from 4.3% to 18.5% across state surveys (median: 7.8%) and from 6.3% to 15.2% across large urban school district surveys (median: 10.1%) (Table 48).

Among 