Cara V. James, PhD, President and CEO, Grantmakers In Health
In 2021, 1 in 6 high school students was electronically bullied or bullied at school. That same year, 22 percent of high school students, and 45 percent of students who identified as LGBTQ+, seriously considered attempting suicide. We know this information because of the Youth Risk Behavior Survey (YRBS), which along with other state and local surveys, comprises the Youth Risk Behavior Surveillance System (YRBSS).[1] This survey is one of the few that provides a comprehensive view of the behaviors of the nation’s youth. It explores mental health, safety, and health behaviors. The information gleaned from the survey has been used to identify problems, monitor progress, change policy, and garner resources. For these reasons, I am deeply concerned that several states have notified the Centers for Disease Control and Prevention (CDC) that they will not be participating in 2023.
As reported by Kaiser Health News last fall, seven states—Colorado, Florida, Idaho, Minnesota, Oregon, Washington, and Wyoming—will not be participating in YRBSS surveys in 2023. Other states, including Alabama, Iowa, and South Carolina, have also notified CDC that they do not plan to participate this year. Collectively, these states represent 18 percent of the population under the age of 18, or a little more than 13 million people.[2] These states include many diverse communities, experience significant inequities, and do not all have robust health, education, and social service programs to meet the needs of their residents.
The reasons why states are not participating vary. Minnesota, Oregon, Washington, and Wyoming have not participated for many years because they utilize their own surveys. Colorado is opting out in lieu of its own Healthy Kids Colorado survey, which it says covers a larger sample of Colorado students than the YRBS, while Florida’s rationale is more opaque. Both Idaho and Florida say they intend to create their own surveys, but good surveys cannot be created overnight—they take time and expertise to implement. The YRBS took more than a year to develop and test, and a gap in our understanding of the youth behaviors, even for a year or two at a time of an unprecedented youth mental health crisis, is a problem. Not measuring something does not mean we do not have a problem. Not having data does make it harder to solve a problem and harder to achieve health equity.
Since 1990, the YRBS has been an essential tool for understanding behaviors that contribute to youth health in the United States. The YRBS captures information on sexual behaviors, substance use, mental health and suicidality, violence and other health-related behaviors. The survey was developed through a rigorous process and has evolved during its 30-year history, in content and methodology, to reflect changes in youth behavior, such as vaping, and moving from paper to electronic administration. The YRBS collects information from a representative sample of public and private school students in grades 9-12, and the data provides us with a comprehensive understanding of youth mental and behavioral health across the country. While the survey is not perfect, it is a critical tool.
Unlike other federal surveys, states and local jurisdictions are not required to use the entire survey. They only have to use 60 percent of the survey. This provides a lot of flexibility to state and local jurisdictions, and several states have exercised that flexibility to remove questions related to sexual orientation, gender identity, and sexual behaviors. The ability to adapt the YRBS to meet local needs is another reason the complete withdrawal of a state is deeply concerning.
The loss of data from states not participating in the YRBS affects the state offices and nonprofits trying to improve the lives of the youth living in their states. The loss of data makes it harder for these organizations to create robust grant proposals, know whether their work is making a difference, and harder for them to show the impact of their work. More importantly, the loss of data ultimately hurts the very youth we profess to care about.
The data captured in the YRBSS are used by state and local jurisdictions, nonprofits, and other stakeholders in many ways. Beyond shedding light on youth behaviors, the data have been used to plan and evaluate school-based health interventions, inform school policies and practices, support public health laws, strengthen funding proposals, and inform teacher professional development.[3] Some specific examples of how the data have been used include in Montana, where the legislature passed a bill banning electronic vaping devices on school property; Idaho, where the data were used to get an $11 million grant to help students who have attempted or are contemplating suicide; and the District of Columbia, where the data were used to inform guidelines for student mental health support. Additionally, YRBS and profile coordinators reported significant increases in data usage between 2010 and 2021, across all categories except support of health-related policies and legislation.[4]
The COVID-19 pandemic disrupted the lives of millions of children and accelerated trends that were already underway. Although the public health emergency is ending, and many of us are returning to pre-pandemic life, young people in the US are struggling to recover. Instead of making it harder to address a current crisis, we should leverage every tool at our disposal, and data is a critical tool.
All of us, but especially philanthropy, has an important role in addressing the impending data gap. We can start by reaching out to our states to find out what their plans are for the 2023 YRBS. Even among the states that have said they do not plan to participate this year, there is still time for the state to reverse course and implement the survey. Next, organizations in states that are opting out and do not have another robust tool in place, should raise awareness about the decision and what it means for those working to improve outcomes for our youth. Some stakeholders may not be aware of their state’s decision. In addition, funders concerned about this should work with their states and local jurisdictions to improve the YRBS and increase data collection at local levels. Finally, I invite those interested in strengthening our youth data infrastructure to connect with GIH at president@gih.org. We will be convening interested funders to address this critical issue. Together we can ensure that we have a clear understanding of the challenges our youth are experiencing and can effectively monitor progress so we can adjust our plans in order to fix the problems so the youth of today grow into healthy and thriving adults tomorrow.
References
[1] Centers for Disease Control and Prevention (CDC). Youth Risk Behavior Survey Data Summary & Trends Report: 2011-2021.
[2] American Community Survey. Population Under the Age of 18 Years by Age, 2021. Census Bureau.
[3] Smith Grant J, Pierre K, Stinson J, et al. The increasing utility of school health data to guide evidence-based interventions. J Sch Health. 2022; 92: 1214-1216. DOI: 10.1111/josh.13259.
[4] Smith Grant J, Pierre K, Stinson J, et al. The increasing utility of school health data to guide evidence-based interventions. J Sch Health. 2022; 92: 1214-1216. DOI: 10.1111/josh.13259.