Current Trends Results from the National Adolescent Student Health Survey

The National Adolescent Student Health Survey (NASHS)*, conducted in 1987, is the first national survey since the 1960s to assess both the extent to which adolescent students in the United States may be at risk for several important health problems and their perceptions of these risks. Survey findings provide a national profile of adolescent students' health-related knowledge, beliefs, and behaviors. The survey addressed specific health-related topics for which little or no data exist: unintentional injuries; fighting and violence; suicide; use of tobacco, alcoholic beverages, and drugs; acquired immunodeficiency syndrome (AIDS); sexually transmitted diseases (STDs); nutrition and eating habits; and use of health products and services. Highlights from each of these areas follow.

The survey was administered to eighth- and 10th-grade students in randomly selected classrooms chosen from a national probability sample of 217 schools in 20 states. Trained survey administrators collected data from 11,419 students in an average of three randomly selected classes at each participating school. All students were asked to respond to demographic and behavioral items.

Parents were advised of the content and purpose of the study and could exclude their child from participation. Overall, 9% of the selected students were absent on the day of administration, and 3% were present but did not participate. Sample estimates for each grade and sex are accurate to within 3.5 percentage points with 90% confidence.

Unintentional Injuries. Fifty-six percent of the students indicated they had not worn a seat belt the last time they rode in a car, truck, or van. Forty-four percent of the 10th-grade students and 32% of the eighth-grade students reported having ridden during the past month with a driver who had used alcohol or other drugs before driving.

Fighting and Violence. Forty-nine percent of the boys and 28% of the girls reported having been in at least one physical fight during the past year; 34% of all respondents reported they had been threatened, and 14%, robbed. Thirteen percent of the respondents reported having been physically attacked during the past year while at school or on a school bus, and 16%, having been attacked outside of school during the past year. Six percent of the girls reported that during the past year someone had tried to force them to have sex at school, and 19% reported that during the past year someone had tried to force them to have sex outside of school.

Twenty-three percent of the boys said they had carried a knife at least once during the past year, and 7%, daily. Three percent of the boys said they carried a handgun to school at least once during the past year; 1%, daily. Sixty-four percent of the boys and 19% of the girls reported having used a handgun, rifle, or shotgun for any reason (including hunting or target shooting) in the past year.

Suicide. Twenty-five percent of the boys and 42% of the girls reported they had, at some time during their lives, seriously considered committing suicide. Eighteen percent of the girls and 11% of the boys reported they had actually tried to injure themselves in a way that might have resulted in their death.

Tobacco, Alcoholic Beverages, and Drugs. Fifty-one percent of the eighth-graders and 63% of the 10th-graders reported they had tried smoking tobacco. Thirty-one percent of all respondents reported they had smoked their first cigarette by sixth grade. Sixteen percent of the eighth-graders and 26% of the 10th-graders said they were current smokers (i.e., they had smoked at least once in the preceding month). Two percent of the eighth-graders and 6% of the 10th-graders reported they smoked more than one pack a week.

Seventy-seven percent of the eighth-graders and 89% of the 10th-graders said they had used alcohol; 31% of all respondents said they had used it before or during sixth grade. Twenty-six percent of the eighth-graders and 38% of the 10th-graders reported having had five or more drinks on one occasion during the past 2 weeks.

Fifteen percent of eighth-graders and 35% of 10th-graders said they had used marijuana; approximately 5% of eighth-graders and 15% of 10th-graders reported having used marijuana in the past month. Four percent of eighth-graders and 8% of 10th-graders reported having used cocaine.

AIDS. Ninety-four percent of the respondents believed that having sexual intercourse with someone who has human immunodeficiency virus (HIV) ("AIDS virus") increases the likelihood of becoming infected with the virus; 91% believed that sharing drug needles increases the likelihood of becoming infected; and 86% believed that using condoms during sex decreases the likelihood of becoming infected. However, 47% of the respondents believed that "donating blood" increases the likelihood of becoming infected with HIV, and 51% were either unsure or believed that "washing after having sex" decreases the likelihood of becoming infected.

STDs. Sixty-seven percent of the students knew that "a sore on the sex organs" is one of the "common early signs of STD," and 59% knew that pain when urinating ("going to the bathroom") is another such sign. Fifty-seven percent knew that it is harmful to "wait to see if the signs (of STD) go away on their own." About 45% knew that taking birth-control pills is ineffective in preventing STDs, and 33% knew that washing after having sex is ineffective.

Nutrition and Eating Habits. Thirty-two percent of the boys and 48% of the girls reported having eaten breakfast on less than or equal to2 days during the past week. Eighteen percent reported eating fried foods at least once a day. Over twice as many girls (61%) as boys (28%) reported having dieted during the past year. Of the students who reported dieting, 16% said they had tried to control their weight with methods such as diet pills, 12%, by vomiting, and 8%, with laxatives. Seventy-one percent of the students reported they exercised or played sports vigorously enough to increase their breathing and pulse rates for 20 continuous minutes.

Health Products and Services. Forty-three percent of the students were able to determine from cereal box labels which ingredient was present in the largest amount; 53% could determine which cereal contained less sugar. Forty-two percent knew the meaning of the date stamped on dairy products.

Instruction Received. Respondents also reported whether they had received instruction in school (since the beginning of the seventh grade) on the various health areas covered by the survey. Most had received instruction on the effects of drugs and alcohol (84%), nutrition and choosing healthy foods (74%), and how to prevent unintentional injuries (65%) (Figure 1). Students also received instruction on ways to avoid fighting and violence (43%); on AIDS (35%); on STDs (32%); on suicide pre- vention (28%); and on selecting health products and services (27%). Reported by: Office of Disease Prevention and Health Promotion, Office of the Assistant Secretary for Health. National Institute on Drug Abuse; Alcohol, Drug Abuse, and Mental Health Administration. Div of Adolescent and School Health, Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: Data from the NASHS describe the extent to which adolescents report engaging in behaviors that increase their risks for leading causes of morbidity and mortality in the United States. In 1987, among persons aged 1-24 years, approximately 68% of all deaths were due to only four causes: motor vehicle crashes (33%), other unintentional injuries (15%), homicide (10%), and suicide (10%)**. Problems related to reproductive health and STDs are other major areas of concern: in 1987, an estimated 800,000 teenaged girls became pregnant unintentionally (1), and approximately 2.5 million teenagers had STDs (excluding infection by HIV) (2).

A limited number of behaviors usually established during youth contribute substantially to morbidity and mortality during youth and adulthood. These behaviors include failure to use seat belts, use of alcohol or other drugs, and sexual intercourse that results in unintended pregnancies and STD (including HIV infection).

Among all age groups combined in the United States, almost 60% of all deaths in 1987 were due to only two causes: diseases of the heart (36%) and malignant neoplasms (22%).*** A limited number of behaviors, often established during youth, contribute to these health problems, which generally do not result in morbidity and mortality until adulthood. These behaviors include use of tobacco; excessive consumption of fat, calories, and sodium and insufficient consumption of fiber; and insufficient exercise.

U.S. schools may be able to contribute substantially to reducing morbidity and mortality from these preventable causes by assisting children and adolescents to develop the knowledge, beliefs, and skills necessary to avoid risk behaviors. National, state, and local school-based surveys like the NASHS could provide information about whether risk behaviors among adolescents are increasing, decreasing, or remaining the same over time and could provide information to assist in focusing school health programs.

More detailed information about the NASHS, including data tapes, can be obtained from Becky J. Smith, Ph.D., Project Director of NASHS, c/o American Alliance for Health, Physical Education, Recreation, and Dance, 1900 Association Drive, Reston, VA 22091.

References

1. Hayes C, ed. Risking the future: adolescent sexuality, pregnancy, and childbearing. Vol I-- Final report. Washington, DC: National Academy Press, 1987. 2.CDC. Center for Prevention Services, Division of Sexually Transmitted Diseases: annual report--FY 1988. Atlanta: US Department of Health and Human Services, Public Health Service, 1989. *The survey was initiated by the Association for the Advancement of Health Education, American School Health Association, and the Society for Public Health Education; supported by the U.S. Department of Health and Human Services; and conducted by a contractor under the supervision of a steering committee. **Estimates are based on provisional data provided in CDC, National Center for Health Statistics (NCHS) Monthly Vital Statistics Report, volume 36, no. 13, July 29, 1988 (pp. 18-19) and 1987 population estimates from Current Population Reports, series P-25, no. 1022. ***Percentages are based on data provided by CDC, NCHS, in Monthly Vital Statistics Report, volume 37, no. 1, April 25, 1988 (p. 8).

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