Behaviors That Result in Unintentional Injuries and Violence
QUESTION(S):
8.	When you rode a bicycle during the past 12 months, how often did you wear a 
helmet?
RATIONALE:
This question measures the frequency of helmet use while riding a bicycle.  In 2000-
2001, bicycle activities were the third leading type of sports and recreation-related 
activities in which 15- to 19-year-old males were injured and treated at an emergency 
department.(1)  In 2004, children 14 years and younger accounted for 13% of all bicycle 
fatalities, making this one of the most frequent causes of injury-related deaths for young 
children.(2)  Head injury is the leading cause of death in bicycle crashes(3,4) and use of 
bicycle helmets is the single most effective way of reducing head injuries and fatalities.(2) 
Estimates indicate bicycle helmets may prevent approximately 56% of bicycle-related 
deaths,(5) 65%-88% of bicycle-related brain injuries,(6,7) and 65% of serious facial injuries 
to the upper and middle regions of the face.(8)   In 2007, among the 67% of high school 
students nationwide who had ridden a bicycle during the 12 months before the survey, 
85% had rarely or never worn a bicycle helmet.(9) 
REFERENCES:
1.		Centers for Disease Control and Prevention. Nonfatal sports- and recreation-
related injuries treated in emergency departments - United States, July 2000-July 
2001. Morbidity and Mortality Weekly Report 2002;51(33):736-740.
2. 	National Highway Traffic Safety Administration. Traffic Safety Facts, Laws: 
Bicycle Helmet Use Laws. National Highway Traffic Safety Administration Web 
site. Available at 
http://www.nhtsa.dot.gov/portal/nhtsa_static_file_downloader.jsp?file=/staticfiles/DOT/NH
TSA/Communication%20&%20Consumer%20Information/Articles/Associated%20Files/8
10886.pdf. Accessed May 2, 2008.
3. 	Centers for Disease Control and Prevention. Injury-control recommendations: 
Bicycle helmets. Morbidity and Mortality Weekly Report 1995;44(RR-1):1-17.
4. 	Sosin DM, Sacks JJ, Webb KW. Pediatric head injuries and deaths from bicycling 
in the United States. Pediatrics 1996;98:868-870.
5. 		Rivara FP. Traumatic deaths of children in the United States: currently available 
prevention strategies. Pediatrics 1985;75:456-462.
6.  	Thompson DC, Rivara FP, Thompson RS. Effectiveness of bicycle safety helmets 
in preventing head injuries: a case-control study. Journal of the American Medical 
Association 1996;276:1968-1973.
7.  	Thompson RS, Rivara FP, Thompson DC. A case-control study of the 
effectiveness of bicycle safety helmets. New England Journal of Medicine 
1989;320:1361-1367.
8. 	Thompson DC, Nunn MW, Thompson RS, Rivara FP. Effectiveness of bicycle 
safety helmets in preventing serious facial injury. Journal of the American 
Medical Association 1996;276:1974-1975.
9. 	Eaton DK, Kann L, Kinchen S, et.al. Youth Risk Behavior SurveillanceUnited 
States, 2007. Morbidity and Mortality Weekly Report 2008;57(SS-4):1-131.
 
QUESTION(S):
9.	How often do you wear a seatbelt when riding in a car driven by someone else?
RATIONALE:
This question measures the frequency with which seat belts are worn when riding in a 
car.  Motor-vehicle related injuries kill more young adults aged 15 to19 years than any 
other single cause in the United States.(1)  Safety belts, when used, reduce the risk of fatal 
injury to front-seat passenger car occupants by 45% and the risk of moderate-to-critical 
injury by 50%.(2)  In 2007, 11% of high school students nationwide had rarely or never 
worn a seat belt when riding in a car driven by someone else.(3)  During 19912007, a 
significant linear decrease occurred in the percentage of students who rarely or never 
wore a seat belt (26%11%).(3)
RELATED NATIONAL HEALTH OBJECTIVES FOR THE YEAR 2010
15-19		Increase use of seatbelts to 92%. (4)
REFERENCES: 
1.  	Web-based Injury Statistics Query and Reporting System (WISQARS) [database 
online]. Atlanta, GA: National Center for Injury Prevention and Control, Centers 
for Disease Control and Prevention; 2008. Accessed May 2, 2008.
2.  	National Highway Traffic Safety Administration. Traffic Safety Facts 2004: 
Occupant protection. National Highway Traffic Safety Administration Web site. 
Available at: http://www-nrd.nhtsa.dot.gov/pdf/nrd-
30/NCSA/TSF2004/809909.pdf. Accessed June 6, 2008.
3. 	Eaton DK, Kann L, Kinchen S, et.al. Youth Risk Behavior SurveillanceUnited 
States, 2007. Morbidity and Mortality Weekly Report 2008;57(SS-4):1-131.
4.  		U.S. Department of Health and Human Services. Healthy People 2010. 2nd ed. 
With understanding and improving health and objectives for improving health. 
Washington D.C., Government Printing Office, 2004.
QUESTION(S):
10.	During the past 30 days, how many times did you ride in a car or other vehicle 
driven by someone who had been drinking alcohol?
11.	During the past 30 days, how many times did you drive a car or other vehicle 
when you had been drinking alcohol?
RATIONALE:
These questions measure the frequency with which high school students drove a motor 
vehicle while under the influence of drugs or alcohol or rode as a passenger in a motor 
vehicle operated by someone who was under the influence of alcohol or drugs.  In 2004, 
5% of 15- to 20-year-old drivers who were involved in crashes that resulted in injuries 
had been drinking alcohol.(1) In 2006,  25% of 15- to 20-year-old drivers involved in fatal 
crashes had blood alcohol concentration (BAC) levels of .08 or higher at the time of the 
crash.(2) Alcohol use is associated with 24% of fatalities among those less than 15 years 
old.(3) In 2007, 10% of high school students nationwide had driven a car or other vehicle 
one or more times when they had been drinking alcohol and 29% of high school students 
nationwide had ridden one or more times in a car or other vehicle driven by someone who 
had been drinking alcohol during the 30 days before the survey.(4)   During 19912007, a 
significant linear decrease occurred in the percentage of students who rode with a driver 
who had been drinking alcohol (40%29%).(4)
RELATED NATIONAL HEALTH OBJECTIVES FOR THE YEAR 2010
26-6		Reduce the proportion of adolescents who report that they rode, during the 
previous 30 days, with a driver who had been drinking alcohol to 30 
percent. (5) 
REFERENCES:
1. 	National Highway Traffic Safety Administration. Traffic Safety Facts 2004: A 
Compilation of motor vehicle crash data from the Fatality Analysis Reporting 
System and the General Estimates System. National Highway Traffic Safety 
Administration Web site. Available at: http://www-nrd.nhtsa.dot.gov/pdf/nrd-
30/NCSA/TSFAnn/TSF2004.pdf. Accessed June 6, 2008.
2.	National Highway Traffic Safety Administration. Traffic Safety: Teen Drivers. 
National Highway Traffic Safety Administration Web site. Available at: 
http://www.nhtsa.dot.gov/portal/site/nhtsa/template.MAXIMIZE/menuitem.cd18639c9dadb
abbbf30811060008a0c/?javax.portlet.tpst=4427b997caacf504a8bdba101891ef9a_ws_M
X&javax.portlet.prp_4427b997caacf504a8bdba101891ef9a_viewID=detail_view&itemID=
7f146a7445258110VgnVCM1000002fd17898RCRD&viewType=standard. Accessed 
June 5, 2008.
3.  			Centers for Disease Control and Prevention. Child Passenger Deaths Involving 
Drinking Drivers, 1997-2002. Morbidity and Mortality Weekly Report 2004; 
53(04):77-79.
4. 	Eaton DK, Kann L, Kinchen S, et.al. Youth Risk Behavior SurveillanceUnited 
States, 2007. Morbidity and Mortality Weekly Report 2008;57(SS-4):1-131. 
5.  		U.S. Department of Health and Human Services. Healthy People 2010. 2nd ed. 
With understanding and improving health and objectives for improving health. 
Washington D.C., Government Printing Office, 2004.
QUESTION(S):
12.	During the past 30 days, on how many days did you carry a weapon such as a 
gun, knife, or club?
13.	During the past 30 days, on how many days did you carry a gun?
14.	During the past 30 days, on how many days did you carry a weapon such as a 
gun, knife, or club on school property?
15.	During the past 30 days, on how many days did you not go to school because you 
felt you would be unsafe at school or on your way to or from school?
16.	During the past 12 months, how many times has someone threatened or injured 
you with a weapon such as a gun, knife, or club on school property?
RATIONALE:
These questions measure violence-related behaviors and school-related violent behaviors.  
Homicide is the second leading cause of death among all youth aged 15-19 years (9.6 per 
100,000) and is the leading cause of death among black youth aged 15-19 years (33.8 per 
100,000).(1) Approximately 84% of homicide victims in the United States in 2004 were 
killed with a weapon, such as a gun, knife, or club.(2) In 2005, 84% of homicide victims 
15 to 19 years old were killed with firearms.(1)  Firearms intensify violence and increase 
the likelihood of fatality in a conflict.(3) Of all violent deaths that occurred on school 
property between 1994 and 2006, 65% involved firearms.(4) Nearly 100% of school 
districts have a policy prohibiting weapon possession or use by high school students on 
school property.(5)  Among high school students nationwide in 2007, 18% had carried a 
weapon, 5% had carried a gun, and 6% had carried a weapon on school property on at 
least 1 day during the 30 days before the survey.(6)  The percentage of students who 
carried a weapon decreased during 1991-1999 (26%-17%) and then did not change 
significantly during 1999-2007 (17%-18%).(6) 
RELATED NATIONAL HEALTH OBJECTIVES FOR THE YEAR 2010
15-39		Reduce weapon carrying by adolescents on school property to 4.9%.(7)
REFERENCES:
1.  	Web-based Injury Statistics Query and Reporting System (WISQARS) [database 
online]. Atlanta, GA: National Center for Injury Prevention and Control, Centers 
for Disease Control and Prevention; 2008. Accessed May 7, 2008.
2.  	Department of Justice. Crime in the United States, 2004. Uniform Crime Reports. 
Federal Bureau of Investigation Web site. Available at: 
http://www.fbi.gov/ucr/cius_04/. Accessed June 6, 2008.
3.		Cook PJ, Ludwig J. The costs of gun violence against children. Future of 
Children 2002; 12(2):87-99.
4.			Centers for Disease Control and Prevention. School-Associated Homicides- 
United States 1992-2006. Morbidity and Mortality Weekly Report 
2008;57(02):33-36..
5.			Jones SE, Fisher CJ, Greene BZ, Hertz MF, Pritzl J.  Healthy and safe school 
environment, part I:  results from the School Health Policies and Programs Study 
2006. Journal of School Health 2007;77(8):522-543.
6. 	Eaton DK, Kann L, Kinchen S, et.al. Youth Risk Behavior SurveillanceUnited 
States, 2007. Morbidity and Mortality Weekly Report 2008;57(SS-4):1-131.
7.  		U.S. Department of Health and Human Services. Healthy People 2010. 2nd ed. 
With understanding and improving health and objectives for improving health. 
Washington D.C., Government Printing Office, 2004.
QUESTION(S):
17.	During the past 12 months, how many times were you in a physical fight?
18.	During the past 12 months, how many times were you in a physical fight in which 
you were injured and had to be treated by a doctor or nurse?
19.	During the past 12 months, how many times were you in a physical fight on 
school property?
20.	During the past 12 months, did your boyfriend or girlfriend ever hit, slap, or 
physically hurt you on purpose?
21.	Have you ever been physically forced to have sexual intercourse when you did 
not want to?
22.	During the past 12 months, have you ever been bullied on school property?
RATIONALE:
These questions measure the frequency and severity of physical fights, school-related 
fights, and abusive behavior.  Physical fighting is a marker for other problem behaviors (1) 
and is associated with serious injury-related health outcomes.(2,3) Among high school 
students nationwide in 2007, 36% had been in a physical fight and 12% had been in a 
physical fight on school property one or more times during the 12 months before the 
survey.(4)  The percentage of high school students who were in a physical fight decreased 
during 19912003 (42%33%) and then increased during 20032007 (33%36%).(4)  
Intimate partner abuse victimization is associated with participation in other high risk 
behaviors.(5)  In 2007, 10% of high school students nationwide had been hit, slapped, or 
physically hurt on purpose by their boyfriend or girlfriend during the 12 months before 
the survey.(4)  Forced sexual intercourse is associated with negative psychosocial and 
mental health consequences.(6,7)  In 2007, 8% of high school students nationwide had ever 
been physically forced to have sexual intercourse when they did not want to.(4) 
Approximately 30% of students in grades 6-10 report moderate or frequent involvement 
in bullying, as a victim (11%), perpetrator (13%), or both (6%).(8) Bullying victimization 
is associated with depression,(9) suicidal ideation,(9) increased odds of repeated common 
health problems,(10) school absenteeism,(11) psychological distress,(10) and feeling unsafe 
at school.(11) 
RELATED NATIONAL HEALTH OBJECTIVES FOR THE YEAR 2010
15-38		Reduce physical fighting among adolescents students to 32%.(12)
REFERENCES:
1.  	Sosin DM, Koepsell TD, Rivara FP, Mercy JA. Fighting as a marker for multiple 
problem behaviors in adolescents. Journal of Adolescent Health 1995;16:209-215.
2. 	Borowsky IW, Ireland M. Predictors of future fight-related injury among 
adolescents. Pediatrics 2004;113:530-536.
3.  	Pickett W, Craig W, Harel Y, et al. Cross-national study of fighting and weapon 
carrying as determinants of adolescent injury. Pediatrics 2005;116:855-863.
4. 	Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance
United States, 2007. Morbidity and Mortality Weekly Report 2008;57(SS-4):1-
131. 
5.	Roberts TA, Klein J, Fisher S. Longitudinal effect of intimate partner abuse and 
high-risk behavior among adolescents. Archives of Pediatrics & Adolescent 
Medicine 2003;157:875-881.
6.	Ackard DM, Neumark-Sztainer D. Date violence and date rape among 
adolescents: associations with disordered eating behaviors and psychological 
health. Child Abuse & Neglect 2002;26:455-473.
7.  	Howard DE, Wang MQ. Psychosocial correlates of U.S. adolescents who report a 
history of forced sexual intercourse. Journal of Adolescent Health 2005;36:372-
379.
8.  	Nansel TR, Overpeck M, Pilla RS, Ruan WJ, Simmons-Morton B, Scheidt P. 
Bullying behaviors among US youth: Prevalence and association with 
psychosocial adjustment. Journal of the American Medical Association 
2001;285(16):2094-2100.
9.	Van der Wal MF, de Wit CA, Hirasing RA. Psychosocial health among young 
victims and offenders of direct and indirect bullying. Pediatrics 
2003;111(6):1312-1317.	
10.        Rigby K. Consequences of bullying in school. The Canadian Journal of 
Psychiatry 2003;48(9):583-590.
11. 	Glew GM, Fan MY, Katon W, Rivara FR, Kernic MA. Bullying, psychosocial 
adjustment, and academic performance in elementary school. Archives of 
Pediatrics & Adolescent Medicine 2005;159:1026-1031.
12.	U.S. Department of Health and Human Services. Healthy People 2010. 2nd ed. 
With understanding and improving health and objectives for improving health. 
Washington D.C., Government Printing Office, 2004.
QUESTION(S):
23.	During the past 12 months, did you ever feel so sad or hopeless almost every day 
for two weeks or more in a row that you stopped doing some usual activities?
24.	During the past 12 months, did you ever seriously consider attempting suicide?
25.	During the past 12 months, did you make a plan about how you would attempt 
suicide?
26.	During the past 12 months, how many times did you actually attempt suicide?
27.	If you attempted suicide during the past 12 months, did any attempt result in an 
injury, poisoning, or overdose that had to be treated by a doctor or nurse?
RATIONALE:
These questions measure sadness, suicide ideation, attempted suicide, and the seriousness 
of those attempts.  Suicide is the third leading cause of death among youth aged 15-19.(1)  
The suicide rate for persons aged 15-19 was 7.7 per 100,000 in 2005 down from 8.2 per 
100,000 in 2003.(1)   Among high school students nationwide in 2007, 14% had seriously 
considered attempting suicide, 11% had made a plan about how they would attempt 
suicide, and 7% had attempted suicide one or more times during the 12 months before the 
survey.(2) During 19912007, a significant linear decrease occurred in the percentage of 
students who seriously considered attempting suicide (29%-14%).(2)  
	 
RELATED NATIONAL HEALTH OBJECTIVES FOR THE YEAR 2010
18-02		Reduce the rate of suicide attempts by adolescents to 1%.(3)
REFERENCES:
1.  	Web-based Injury Statistics Query and Reporting System (WISQARS) [database 
online]. Atlanta, GA: National Center for Injury Prevention and Control, Centers 
for Disease Control and Prevention; 2008. Accessed May 7, 2008.
2. 	Eaton DK, Kann L, Kinchen S, et.al. Youth Risk Behavior SurveillanceUnited 
States, 2007. Morbidity and Mortality Weekly Report 2008;57(SS-4):1-131. 
3.  		U.S. Department of Health and Human Services. Healthy People 2010. 2nd ed. 
With understanding and improving health and objectives for improving health. 
Washington D.C., Government Printing Office, 2004.
Tobacco Use
QUESTION(S):
28.	Have you ever tried cigarette smoking, even one or two puffs?
29.	How old were you when you smoked a whole cigarette for the first time?
30.	During the past 30 days, on how many days did you smoke cigarettes?
31.	During the past 30 days, on the days you smoked, how many cigarettes did you 
smoke per day?
32.	During the past 30 days, how did you usually get your own cigarettes?
33.	During the past 30 days, on how many days did you smoke cigarettes on school 
property?
34.	Have you ever smoked cigarettes daily, that is, at least one cigarette every day for 
30 days?
35.	During the past 12 months, did you ever try to quit smoking cigarettes?
RATIONALE:
These questions measure lifetime and current smoking patterns, age of initiation, access 
to cigarettes, smoking on school property, and attempts to quit smoking.  Cigarette 
smoking is the leading cause of preventable death in the United States(1) and accounts for 
approximately 440,000 deaths each year.(2)  Cigarette smoking increases risk of heart 
disease; chronic obstructive pulmonary disease; acute respiratory illness; stroke; and 
cancers of the lung, larynx, oral cavity, pharynx, pancreas, and cervix.(1) In addition, as 
compared to nonsmokers, cigarette smokers are more likely to drink alcohol, use 
marijuana and cocaine, engage in physical fighting, carry a weapon, and attempt 
suicide.(3,4) If current patterns of smoking behavior persist, an estimated 6.4 million U.S. 
persons who were under the age of 18 in 2000 could die prematurely from smoking-
related illnesses.(5)  Approximately 64% of schools had adopted policies that 1) prohibited 
cigarette smoking and smokeless tobacco use among students, faculty and staff, and 
school visitors in school buildings; outside on school grounds; on school buses or other 
vehicles used to transport students; and at off-campus, school-sponsored events; and 2) 
prohibited cigar or pipe smoking by students, faculty and staff, and school visitors.(6) 
Among high school students nationwide in 2007, 50% had ever tried cigarette smoking, 
20% had smoked cigarettes on at least 1 day during the 30 days before the survey, and 
6% had smoked cigarettes on school property on at least 1 day during the 30 days before 
the survey.  The percentage of high school students who had ever tried cigarette smoking 
did not change significantly during 19911999 (70%70%) and then decreased during 
19992007 (70%50%).(7)  The percentage of high school students who had smoked 
cigarettes on at least 1 day during the 30 days before the survey increased significantly 
during 19911997 (28%36%) and then decreased during 19972007 (36%20%).(7)
RELATED NATIONAL HEALTH OBJECTIVES FOR THE YEAR 2010
27-02a		Reduce use of tobacco products in the past month by adolescents to 21%.(8)
27-02b		Reduce use of cigarettes in the past month by adolescents to 16%.(8)
27-07		Increase tobacco use cessation attempts by adolescent smokers to 84%.(8)
RELATED LEADING HEALTH INDICATOR	
Tobacco Use
REFERENCES:
1. 		U.S. Department of Health and Human Services. The Health Consequences of 
Smoking: A Report of the Surgeon General. U.S. Department of Health and 
Human Services; Centers for Disease Control and Prevention; National Center for 
Chronic Disease Prevention and Health Promotion; Office on Smoking and 
Health, 2004. 
2.  	Centers for Disease Control and Prevention. Annual smoking-attributable 
mortality, years of potential life lost, and productivity lossesUnited States, 
19972001. Morbidity and Mortality Weekly Report 2002;54:6258.
3.	Everett SA, Malarcher AM, Sharp DJ, Husten CG, Giovino GA. Relationship 
between cigarette, smokeless tobacco, and cigar use, and other health risk 
behaviors among U.S. high school students. Journal of School Health 
2000;70:234-240.
4.	Substance Abuse and Mental Health Services Administration. Results from the 
2004 National Survey on Drug Use and Health: National Findings. (Office of 
Applied Studies, NSDUH Series H-28, DHHS Publication No. SMA 05-4062). 
Rockville, MD, 2005.
5.	Hahn EJ, Rayens MK, Chaloupka FJ, Okoli CTC, Yang J. Projected smoking-
related deaths among U.S. youth: A 2000 update. ImpacTeen. Research Paper 
Series 2002;22. 
6.  	Kann L, Brener ND, Wechsler H. Overview and Summary: School Health 
Policies and Programs Study 2006. Journal of School Health 2007;77(8):385-397.
7. 	Eaton DK, Kann L, Kinchen S, et al. Youth Risk Behavior Surveillance -- United 
States, 2007.  Morbidity and Mortality Weekly Report 2008:57(SS-4):1-131.
8.  		U.S. Department of Health and Human Services. Healthy People 2010. 2nd ed. 
With understanding and improving health and objectives for improving health. 
Washington D.C., Government Printing Office, 2004.
QUESTION(S):
36.	During the past 30 days, on how many days did you use chewing tobacco, snuff, 
or dip, such as Redman, Levi Garrett, Beechnut, Skoal, Skoal Bandits, or 
Copenhagen?
37.	During the past 30 days, on how many days did you use chewing tobacco, snuff, 
or dip on school property?
38.	During the past 30 days, on how many days did you smoke cigars, cigarillos, or 
little cigars?
RATIONALE:
These questions measure smokeless tobacco use, smokeless tobacco use on school 
property, and cigar use.  Smokeless tobacco contains 28 known human carcinogens.(1)  
Use of smokeless tobacco products increases the risk of developing cancer of the oral 
cavity.(1) Other oral health problems strongly associated with smokeless tobacco use are 
leukoplakia (a lesion of the soft tissue that consists of a white patch or plaque that cannot 
be scraped off) and recession of the gums.(2)  Smokeless tobacco use also causes an 
increased risk of heart disease and stroke.(3)  Among high school students nationwide in 
2007, 8% had used smokeless tobacco (e.g., chewing tobacco, snuff, or dip) on at least 1 
day during the 30 days before the survey and 5% had used smokeless tobacco on school 
property on at least 1 day during the 30 days before the survey.(4)  The overall risk of oral 
and pharyngeal cancer is 7-10 times higher among cigar smokers compared to those who 
never smoked.(5)  Additionally, cigar smoking can cause lung cancer, coronary heart 
disease, and chronic obstructive pulmonary disease.(6,7)  In 2007, 14% of high school 
students nationwide had smoked cigars, cigarillos, or little cigars on at least 1 day during 
the 30 days before the survey.(4) 
	
RELATED NATIONAL HEALTH OBJECTIVES FOR THE YEAR 2010
27-02c		Reduce use of spit tobacco in the past month by adolescents to 1%.(8)
27-02d		Reduce use of cigars in the past month by adolescents to 8%.(8)
REFERENCES:
1.  	National Cancer Institute. Smokeless Tobacco or Health: An International 
Perspective. Bethesda, MD: U.S. Department of Health and Human Services, 
National Institutes of Health, National Cancer Institute; 1992. Available from: 
http://cancercontrol.cancer.gov/tcrb/monographs/2/index.html. Accessed: May 
2008. 
2.  	Johnson GK, Slach NA. Impact of Tobacco Use on Periodontal Status. Journal of 
Dental Education 2001;65:313-321.
3.	Henley SJ, Thun MJ, Connell C, Calle EE. Two large prospective studies of 
mortality among men who use snuff or chewing tobacco (United States). Cancer 
Causes and Control 2005;16:347-358.
4. 	Eaton DK, Kann L, Kinchen S, et al. Youth Risk Behavior Surveillance -- United 
States, 2007.  Morbidity and Mortality Weekly Report 2008:57(SS-4):1-131. 
5.	U.S. Department of Health and Human Services. Oral Health in America: A 
Report of the Surgeon General. Rockville, MD, U.S. Department of Health and 
Human Services, National Institute for Dental and Craniofacial Research, 
National Institutes of Health, 2000.
6.	U.S. Department of Health and Human Services. Smoking and Tobacco Control 
Monograph No. 9: Cigars - Health Effects and Trends. No. 98-4302:217, 1998.
7.	Shaper AG, Wannamethee SG, Walker M. Pipe and cigar smoking and major 
cardiovascular events, cancer incidence and all-cause mortality in middle-age 
British men. International Journal of Epidemiology 2003;32:802-808.
8.  		U.S. Department of Health and Human Services. Healthy People 2010. 2nd ed. 
With understanding and improving health and objectives for improving health. 
Washington D.C., Government Printing Office, 2004.
Alcohol and Other Drug Use
QUESTION(S):
39.	During your life, on how many days have you had at least one drink of alcohol?
40.	How old were you when you had your first drink of alcohol other than a few sips?
41.	During the past 30 days, on how many days did you have at least one drink of 
alcohol?
42.	During the past 30 days, on how many days did you have 5 or more drinks of 
alcohol in a row, that is, within a couple of hours?
43.  	During the past 30 days, how did you usually get the alcohol you drank?
44.	During the past 30 days, on how many days did you have at least one drink of 
alcohol on school property?
RATIONALE:
These questions measure lifetime and current use of alcohol, age of initiation, episodic 
heavy drinking, access to alcohol, and drinking on school property. Alcohol is used by 
more young people than tobacco or illicit drugs.(1)  Heavy alcohol drinking among youth 
is associated with risky sexual behaviors (including sexual initiation, multiple sex 
partners, reduced condom use, and pregnancy)(2) and use of cigarettes,(3,4) marijuana, 
cocaine, and other illegal drugs.(3)  Motor vehicle crashes are the leading cause of death 
among youth aged 1519 years in the United States and alcohol use is associated with 9% 
of all motor vehicle crashes that result in injury and more than one-third of all motor 
vehicle crash fatalities.(5) Persons who begin drinking alcohol before the age of 15 years 
are five times as likely to report alcohol dependence or abuse within the past year than 
those who first drank alcohol at age 21 or older.(6) Limiting youth access to alcohol has 
reduced underage alcohol use and alcohol-related problems.(7)  However, youth continue 
to obtain alcohol from a variety of sources, reflecting the need for improved enforcement 
of underage drinking laws as well as greater public awareness of restrictions on drinking 
alcohol by underage youth. Nearly 100% of school districts in the United States prohibit 
alcohol use by students on school property.(8)  Among high school students nationwide in 
2007, 75% had had at least one drink of alcohol on at least 1 day during their life and 
45% had had at least one drink of alcohol on at least 1 day during the 30 days before the 
survey.  In addition, 26% of high school students had had 5 or more drinks of alcohol in a 
row on at least 1 day during the 30 days before the survey.(9)  The percentage of high 
school students who had had at least one drink of alcohol on at least 1 day during their 
life decreased during 1991-2007 (82%75%).(9)
REFERENCES:
1.  	Substance Abuse and Mental Health Services Administration. Results from the 
2006 National Survey on Drug Use and Health: National Findings. (Office of 
Applied Studies, NSDUH Series H-32, DHHS Publication No. SMA 07-4293).
2.  	Dunn MS, Bartee RT, Perko MA. Self-reported alcohol use and sexual behaviors 
of adolescents. Psychological Reports 2003;92:339-348.
3.  	Everett SA, Oeltmann J, Wilson TW, Brener ND, Hill CV. Binge drinking among 
undergraduate college students in the United States: Implications for other 
substance use. Journal of American College Health 2001;50:33-38.
4.  	Johnson P, Boles SM, Vaughan R, Herbert D. The co-occurrence of smoking and 
binge drinking in adolescence. Addictive Behaviors 2000;25:779-783.
5. 	Web-based Injury Statistics Query and Reporting System (WISQARS) [database 
online]. Atlanta, GA: National Center for Injury Prevention and Control, Centers 
for Disease Control and Prevention; 2008. Accessed June 5, 2008.
6. 	Substance Abuse and Mental Health Services Administration. Alcohol 
dependence or abuse and age at first use. The NSDUH Report October 22, 2004. 
Available at: http://oas.samhsa.gov/youth.htm. Accessed June 5, 2008.
7.	Klepp KI, Schmid LA, Murray DM.  Effects of the increased minimum drinking 
age law on drinking and driving behavior among adolescents. Addiction Research 
1996;4:237-244.
8.	Everett Jones S, Fisher CJ, Greene BZ, Hertz MF, Pritzl J. Healthy and safe 
school environment, Part I: Results from the School Health Policies and Programs 
Study 2006. Journal of School Health 2007;77(8):522-543. 
9. 	Eaton DK, Kann L, Kinchen S, et al. Youth Risk Behavior Surveillance -- United 
States, 2007.  Morbidity and Mortality Weekly Report 2008:57(SS-4):1-131.
QUESTION(S):
45.	During your life, how many times have you used marijuana?
46.	How old were you when you tried marijuana for the first time?
47.	During the past 30 days, how many times did you use marijuana?
48.	During the past 30 days, how many times did you use marijuana on school 
property?
49.	During your life, how many times have you used any form of cocaine, including 
powder, crack, or freebase?
50.	During the past 30 days, how many times did you use any form of cocaine, 
including powder, crack, or freebase?
51.	During your life, how many times have you sniffed glue, breathed the contents of 
aerosol spray cans, or inhaled any paints or sprays to get high?
52.	During your life, how many times have you used heroin (also called smack, junk, 
or China White)?
53.	During you life, how many times have you used methamphetamines (also called 
speed, crystal, crank, or ice)?
54.	During your life, how many times have you used ecstasy (also called MDMA)?
55.	During your life, how many times have you taken steroid pills or shots without a 
doctors prescription?
56.	During your life, how many times have you used a needle to inject any illegal drug 
into your body?
57.	During the past 12 months, has anyone offered, sold, or given you an illegal drug on 
school property?
RATIONALE:
These questions measure lifetime and current use of marijuana and cocaine, and lifetime 
use of inhalants, heroin, methamphetamines, ecstasy, steroids, and injected drugs.  
Among youth, illicit drug use is associated with heavy alcohol and tobacco use,(1) 
violence and delinquency,(2-4) and suicide.(5)  All school districts prohibit illegal drug 
possession or use by students on school property.(6) Among high school students 
nationwide in 2007, 38% had used marijuana, 7% had used any form of cocaine, 4% had 
taken steroid pills or shots without a doctors prescription, 8% had used hallucinogenic 
drugs, 2% had used heroin, 4% had used methamphetamines, and 6% had used ecstasy 
one or more times during their life.(7)  In addition, 13% of high school students had 
sniffed glue, breathed the contents of aerosol spray cans, or inhaled any paints or sprays 
to get high and 2% had used a needle to inject any illegal drug into their body one or 
more times during their life.  The percentage of high school students who had used 
marijuana one or more times during their life increased during 19911999 (31%47%) 
and then decreased during 19992007 (47%38%).(7)
REFERENCES:
1.  	Substance Abuse and Mental Health Services Administration. Results from the
	2006 National Survey on Drug Use and Health: National Findings. (Office of 
Applied Studies, NSDUH Series H-32, DHHS Publication No. SMA 07-4293). 
Rockville, MD, 2007.
2.  	Substance Abuse and Mental Health Services Administration. Youth violence and 
illicit drug use. The NSDUH Report 2006;5:1-4. Available at: 
http://oas.samhsa.gov/youth.htm. Accessed June 5, 2008.
3.  	Substance Abuse and Mental Health Services Administration.  Marijuana use and 
delinquent behaviors among youths.  The NSDUH Report January 9, 2004. 
Available at: http://oas.samhsa.gov/youth.htm. Accessed June 5, 2008.
4.  	Substance Abuse and Mental Health Services Administration.  Inhalant use and 
delinquent behaviors among young adolescents.  The NSDUH Report March 17, 
2005. Available at: http://oas.samhsa.gov/youth.htm. Accessed June 5, 2008.
5. 	Substance Abuse and Mental Health Services Administration.  Substance use and 
the risk of suicide among youths.  The NHSDA Report July 12, 2002. Available 
at: http://oas.samhsa.gov/youth.htm. Accessed June 5, 2008.
6.	Everett Jones S, Fisher CJ, Greene BZ, Hertz MF, Pritzl J. Healthy and safe 
school environment, Part I: Results from the School Health Policies and Programs 
Study 2006. Journal of School Health 2007;77(8):522-543. 
7. 	Eaton DK, Kann L, Kinchen S, et al. Youth Risk Behavior Surveillance -- United 
States, 2007. Morbidity and Mortality Weekly Report 2008:57(SS-4):1-131.
Sexual Behaviors That Contribute to Unintended Pregnancy and Sexually Transmitted 
Diseases, Including HIV Infection
QUESTION(S):
58.	Have you ever had sexual intercourse?
59.	How old were you when you had sexual intercourse for the first time?
60.	During your life, with how many people have you had sexual intercourse?
61.	During the past 3 months, with how many people did you have sexual intercourse?
62.	Did you drink alcohol or use drugs before you had sexual intercourse the last time?
63.	The last time you had sexual intercourse, did you or your partner use a condom?
64.	The last time you had sexual intercourse, what one method did you or your 
partner use to prevent pregnancy?
85.	Have you ever been taught about AIDS or HIV infection in school?
RATIONALE:
These questions measure the prevalence of sexual activity, number of sexual partners, age 
at first intercourse, alcohol and other drug use related to sexual activity, condom use, 
contraceptive use, and whether high school students received HIV prevention education. 
Early initiation of sexual intercourse is associated with having a greater number of 
lifetime sexual partners.(1,2,3)  In addition, adolescents who initiate sexual intercourse 
early are less likely to use contraception(3,4) and are at higher risk for pregnancy.(5,6)  
Recent estimates suggest that while representing 25% of the ever sexually active 
population, persons aged 15 to 24 years acquire nearly half of all new STDs.(7)  
Gonorrhea rates are highest among females between the ages of 15 and 19 years (647.9 
cases per 100,000 females) and males between the ages of 20 and 24 years (454.1 cases 
per 100,000 males).(8)  In 2006, there were an estimated 5,218 cases of HIV/AIDS among 
persons aged 1524 years.(9) Among high school students nationwide, 48% had ever had 
sexual intercourse, 15% had had sexual intercourse with 4 or more persons during their 
life, and 35% had had sexual intercourse with at least 1 person during the 3 months 
before the survey.  The percentage of students who ever had sexual intercourse decreased 
during 19912007 (54%48%).(10)  In 2006, 88% of high schools taught HIV prevention 
education in a required health education course.(11) 
RELATED NATIONAL HEALTH OBJECTIVES FOR THE YEAR 2010
25-11	Increase the proportion of adolescents who abstain from sexual intercourse 
or use condoms if currently sexually active to 95%.(12) 
RELATED LEADING HEALTH INDICATOR
Responsible Sexual Behaviors
REFERENCES:
1. 	Shrier LA, Emans SJ, Woods ER, DuRant RH. The association of sexual risk 
behaviors and problem drug behaviors in high school students. Journal of 
Adolescent Health 1996;20:377383.
 
2.	Santelli JS, Brener ND, Lowry R, et al. Multiple sexual partners among U.S. 
	adolescents and young adults. Family Planning Perspectives 1998;30:2715.
 
3.	Santelli JS, Kaiser J, Hirsch L, Radosh A, Simkin L, Middlestadt S. Initiation of 
sexual intercourse among middle school adolescents: the influence of 
psychosocial factors. Journal of Adolescent Health 2004;34(3): 200-208.
4.	Manning WD, Longmore MA, Giordano PC. The relationship context of 
contraceptive use at first intercourse. Family Planning Perspectives 
2000;32(3):104110.
 5. 	Manlove J, Terry E, Gitelson L, Papillo AR, Russell S. Explaining demographic 
trends in teenage fertility, 19801995. Family Planning Perspectives 
2000;32(4):166175.
 
6. 	Thornberry TP, Smith CA, Howard GJ. Risk factors for teenage fatherhood. 
Journal of Marriage & the Family 1997;59:505522.
7.	Weinstock H, Berman S, Cates W.  Sexually transmitted disease among American 
youth: Incidence and prevalence estimates, 2000. Perspectives on Sexual and 
Reproductive Health 2004;36(1):610.
8. 			Centers for Disease Control and Prevention. Sexually Transmitted Disease 
Surveillance, 2006.  November 2007; Atlanta, GA: U.S. Department of Health 
and Human Services. Available at: http://www.cdc.gov/std/stats/default.htm. 
Accessed May 7, 2008.
9.  	CDC. HIV/AIDS Surveillance Report, 2006.  Vol. 18.  Atlanta: US Department of 
Health and Human Services, Centers for Disease Control and Prevention; 2008.  
Available at: http://www.cdc.gov/hiv/stats/hasrlink.htm.  Accessed June 5, 2008.
10. 	Eaton DK, Kann L, Kinchen S, et al. Youth Risk Behavior SurveillanceUnited 
States, 2007. Morbidity and Mortality Weekly Report 2008;57(SS-4):1-131.
11. 	Kann L, Telljohann SK, Wooley SF. Health education: Results from the
School Health Policies and Programs Study 2006. Journal of School Health 2007; 
77: 408-434.
12.  		U.S. Department of Health and Human Services. Healthy People 2010. 2nd ed. 
With understanding and improving health and objectives for improving health. 
Washington D.C., Government Printing Office, 2004.
Obesity, Overweight, and Weight Control
QUESTION(S):
  6.	How tall are you without your shoes on?
  7.	How much do you weigh without your shoes on?
65.	How do you describe your weight?
RATIONALE:
These questions measure self-reported height and weight and perceived body weight.  
Data on self-reported height and weight is used to calculate body mass index (BMI) and 
determine the corresponding BMI-for-age percentile for adolescents.  BMI-for-age 
percentile is a proxy measure of weight status, correlates with body fat,(1) and is 
recommended for assessing weight status in youth ages 2-20.(2)   Although obesity 
prevalence estimates derived from self-report data are likely to be low,(3) they are useful 
for tracking trends over time.  In addition, obesity prevalence trends from national 
surveys of adults using self-reported height and weight(4) have been consistent with trend 
data from national surveys using measured height and weight.(5)  It is critical to continue 
monitoring these data because the prevalence of obesity among adolescents has tripled 
since 1980.(6)  Obesity during adolescence is associated with negative psychological and 
social consequences and health problems such as type 2 diabetes, obstructive sleep apnea, 
hypertension, dyslipidemia, and metabolic syndrome.(7) Further, obese adolescents are 
more likely to become obese adults.(8,9) Nationwide in 2007, 13% of high school students 
were obese and 16% were overweight.(10)  During 19992007, significant increases 
occurred in the percentage of students who were obese (11%13%) and who were 
overweight (14%16%).(10)
REFERENCES:
1. 	Mei Z, Grummer-Strawn LM, Pietrobelli A, Goulding A, Goran MI, Dietz WH. 
Validity of body mass index compared with other body-composition screening 
indexes for assessment of body fatness in children and adolescents. American 
Journal of Clinical Nutrition 2002;75(6):978-985.
2.	Krebs NF, Himes JH, Jacobson D, Nicklas TA, Guilday P, Styne D. Assessment 
of child and adolescent overweight and obesity. Pediatrics 2007;120:S193-S228.
3. 	Sherry B, Jefferds ME, Grummer-Strawn LM. Accuracy of adolescent self-report 
of height and weight in assessing overweight status: a literature review. Archives 
of Pediatric and Adolescent Medicine 2007; 161(12):1154-1161.
.
4. 	Galuska DA, Serdula M, Pamuk E, Siegel PZ, Byers T. Trends in overweight 
among US adults from 1987 to 1993: a multistate telephone survey. American 
Journal of Public Health 1996;86:1729-1735.
5.	CDC. Update: Prevalence of overweight among children, adolescents, and adults 
 United States, 1988-1994. Morbidity and Mortality Weekly Report 
1997;46(9):199-202.
6.	National Center for Health Statistics. Prevalence of overweight and obesity 
among children and adolescents: United States, 2003-2004.  NCHS Health E-
Stats.Available at: 
http://www.cdc.gov/nchs/products/pubs/pubd/hestats/overweight/overwght_child
_03.htm. Accessed May 23, 2008.
7.	Freedman DS, Khan, LK, Serdula MK, Dietz WH, Srinivasan SR, Berenson GS. 
The relation of childhood BMI to adult adiposity: The Bogalusa Heart Study. 
Pediatrics 2005;115(1):22-27.
8.	Guo SS, Wu W, Cameron W, Roche AF. Predicting overweight and obesity in 
adulthood from body mass index values in childhood and adolescence. American 
Journal of Clinical Nutrition 2002;76:653-658.
9.	Daniels SR, Arnett DK, Eckel RH, et. al. Overweight in children and adolescents: 
Pathophysiology, consequences, prevention, and treatment. Circulation 
2005;111:1999-2012.
10. 	Eaton DK, Kann L, Kinchen S, et al. Youth Risk Behavior Surveillance -- United 
States, 2007. Morbidity and Mortality Weekly Report 2008:57(SS-4):1-131.
QUESTION(S):
66.	Which of the following are you trying to do about your weight?
67.	During the past 30 days, did you exercise to lose weight or to keep from gaining 
weight?
68.	During the past 30 days, did you eat less food, fewer calories, or foods low in fat 
to lose weight or to keep from gaining weight?
69.	During the past 30 days, did you go without eating for 24 hours or more (also 
called fasting) to lose weight or to keep from gaining weight?
70.	During the past 30 days, did you take any diet pills, powders, or liquids without a 
doctors advice to lose weight or to keep from gaining weight? (Do not include 
meal replacement products such as Slim Fast.)
71.	During the past 30 days, did you vomit or take laxatives to lose weight or to keep 
from gaining weight?
RATIONALE:
Unhealthy weight control behaviors include fasting, taking diet pills or laxatives, or 
inducing vomiting. Engaging in unhealthy weight control behaviors may result in health 
and psychological problems such as obesity, eating disorders such as anorexia and 
bulimia,(1) and stunted growth.(2)  Disordered eating behaviors are correlated with 
inadequate nutrient intake,(3) low self-esteem, high levels of depression, suicidal ideation, 
high levels of stress, and alcohol and drug use.(4)  Nationwide in 2007, 45% of high 
school students were trying to lose weight.  In 2007, 12% of high school students did not 
eat for 24 or more hours to lose weight or to keep from gaining weight, 6% of high 
school students had taken diet pills, powders, or liquids without a doctors advice, and 
4% had vomited or taken laxatives to lose weight or to keep from gaining weight during 
the 30 days before the survey.(5) During 19952007, the percentage of students who 
exercised to lose weight or to keep from gaining weight during the 30 days before the 
survey increased (51%61%).(5)  The percentage of students who ate less food, fewer 
calories, or low-fat foods to lose weight or to keep from gaining weight during the 30 
days before the survey increased during 19992001 (40%-44%) and then decreased 
during 20012007 (44%41%).(5) 
REFERENCES:
1.			Neumark-Sztainer D, Wall M, Guo J, Story M, Haines J, Eisenberg M. Obesity, 
disordered eating, and eating disorders in a longitudinal study of adolescents: 
How do dieters fare 5 years later? Journal of the American Dietetic Association 
2006;106: 559  568.
2.			Golden NH, Katzman DK, Kreipe RE, Stevens SL, Sawyer SM, Rees J, Nicholls 
D, Rome ES. Eating disorders in adolescents: Position paper of the Society for 
Adolescent Medicine. Journal of  Adolescent Health. 2003;33:496-503. 
3.			Neumark-Sztainer D, Hannan PJ, Story M, Perry CL. Weight-control behaviors 
among adolescent girls and boys: Implications for dietary intake. Journal of the 
American Dietetic Association 2004;104:913-920.
4.		Neumark-Sztainer D, Hannan PJ. Weight-related behaviors among adolescent 
girls and boys. Archives of Pediatric and Adolescent Medicine 2000;154:569-577.
5. 	Eaton DK, Kann L, Kinchen S, et al. Youth Risk Behavior Surveillance -- United 
States, 2007. Morbidity and Mortality Weekly Report 2008:57(SS-4):1-131.
Dietary Behaviors
QUESTION(S):
72.	During the past 7 days, how many times did you drink 100% fruit juices such as 
orange juice, apple juice, or grape juice? (Do not count punch, Kool-Aid, sports 
drinks, or other fruit-flavored drinks.)
73.	During the past 7 days, how many times did you eat fruit? (Do not count fruit 
juice.)
74.	During the past 7 days, how many times did you eat green salad?
75.	During the past 7 days, how many times did you eat potatoes? (Do not count 
french fries, fried potatoes, or potato chips.)
76.	During the past 7 days, how many times did you eat carrots?
77.	During the past 7 days, how many times did you eat other vegetables? (Do not 
count green salad, potatoes, or carrots.)
78.	During the past 7 days, how many times per day did you usually drink a can, 
bottle, or glass of soda or pop, such as Coke, Pepsi, or Sprite? (Do not include diet 
soda or diet pop.)
79.	During the past 7 days, how many glasses of milk did you drink? (Include the 
milk you drank in a glass or cup, from a carton, or with cereal.  Count the half 
pint of milk served at school as equal to one glass.)
RATIONALE:
These questions measure dietary behaviors, including consumption of fruits and 
vegetables, soda or pop, and milk. The fruit and vegetable questions are similar to 
questions asked of adults on CDCs Behavioral Risk Factor Survey.(1)  Fruits and 
vegetables are good sources of complex carbohydrates, vitamins, minerals, and other 
substances that are important for good health.  There is probable evidence to suggest that 
dietary patterns with higher intakes of fruits and vegetables are associated with a 
decreased risk for some types of cancer,(2-4) cardiovascular disease,(5) and stroke.(6)  
Although data are limited, an increased intake of fruits and vegetables appears to be 
associated with a decreased risk of being overweight.(7-9)  In 2007, 21% of high school 
students nationwide ate fruits and vegetables five or more times per day during the 7 days 
before the survey.(10)  During 19992007, a significant linear decrease occurred in the 
percentage of students who ate fruits and vegetables 5 or more times per day (24%
21%).(10)    Milk is an important source of calcium for adolescents.(11,12)  Calcium is 
essential for forming and maintaining healthy bones and low calcium intake during the 
first two to three decades of life is an important risk factor in developing osteoporosis.(13)  
Although the recommended intake of calcium is 1,300 mg/day,(14) most adolescents 
consume far less. National data indicate that the average calcium intake per day among 
persons aged 12 to 19 years was 1125 mg/day (among males) and 814 mg/day (among 
females).(12)  In 2007, 14% of high school students nationwide had drunk three or more 
glasses per day of milk during the 7 days before the survey.(10)   In recent years, soft drink 
consumption has significantly increased among children and adolescents.  Among 
persons aged 2 to 18 years, soft drinks comprised 3% of the total daily calories consumed 
in 19771978 compared to 7% in 19992001.(15)  Consumption of sugar-sweetened 
drinks, including soft drinks, appears to be associated with being at increased risk for 
overweight in children.(16)  Nationwide in 2007, 34% of high school students had drunk a 
can, bottle, or glass of soda or pop (not including diet soda or diet pop) at least one time 
per day during the 7 days before the survey. (10)
REFERENCES:
1. 	Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance 
System Survey Questionnaire. 2005. Atlanta, GA, U.S. Department of Health and 
Human Services; Centers for Disease Control and Prevention. Available at: 
http://www.cdc.gov/brfss/questionnaires/english.htm. 
2. 	Key T, Schatzkin A, Willet WC, Allen NE, Spencer EA, Travis RC. Diet, 
nutrition, and the prevention of cancer. Public Health Nutrition 2004;7(1A):187-
200.
3. 	Kushi LH, Byers T, Doyle C, Bandera EV, McCullough M, McTiernan A, 
Gansler T, Andrews KS, Thun MJ; American Cancer Society 2006 Nutrition and 
Physical Activity Guidelines Advisory Committee. American Cancer Society 
Guidelines on Nutrition and Physical Activity for cancer prevention: reducing the 
risk of cancer with healthy food choices and physical activity. CA: A Cancer 
Journal for Clinicians 2006; 56:254-281.
4. 	Vainio H, Weiderpass E. Fruit and vegetables in cancer prevention. Nutrition and 
Cancer. 2006;54(1):111-42.
5.  	Bazzano LA, He J, Ogden LG, Loria CM, Vupputuri S, Myers L, Whelton PK.  
Fruit and vegetable intake and risk of cardiovascular disease in US adults: the first 
National Health and Nutrition Examination Survey Epidemiologic Follow-up 
Study. American Journal of Clinical Nutrition 2002;76(1):93-99.
6.  	He FJ, Nowson CA, MacGregor GA. Fruit and vegetable consumption and stroke: 
meta-analysis of cohort studies. Lancet 2006;367(9507):320-326.
7. 	Rolls BJ, Ello-Martin JA, Tohill BC. What can intervention studies tell us about 
the relationship between fruit and vegetable consumption and weight 
management. Nutrition Reviews 2004;62(1):1-17.
8.	He K, Hu FB, Colditz GA, Manson JE, Willett WC, Liu S. Changes in intake of 
fruits and vegetables in relation to risk of obesity and weight gain among middle-
aged women. International Journal of Obesity 2004;28:1569-1574.
9.	Goss J, Grubbs L. Comparative analysis of body mass index, consumption of 
fruits and vegetables, smoking, and physical activity among Florida residents. 
Journal of Community Health Nursing 2005;22(1):37-46.
10.	Eaton DK, Kann L, Kinchen S, et al. Youth Risk Behavior Surveillance -- United 
States, 2007.  Morbidity and Mortality Weekly Report 2008:57(SS-4):1-131.
11.	US Department of Health and Human Services and US Department of 
Agriculture: Dietary Guidelines for Americans 2005. Washington, DC, 2005. 
Available at http://www.healthierus.gov/dietaryguidelines/.  Accessed June 5, 
2008.
12.	Forshee RA, Anderson PA, Storey ML. Changes in calcium intake and 
association with beverage consumption and demographics: Comparing data form 
CSFII 1994-1996, 1998 and NHANES 1999-2002.  Journal of the American 
College of Nutrition 2006;25(20):108-116.
13.  	NIH Consensus Development on Optimal Calcium Intake. Optimal calcium 
intake. Journal of the American Medical Association 1994;272:1942-1948.
14.	Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes for 
Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, DC: 
National Academy Press; 1997
15.  	Nielsen SJ, Popkin BS. Changes in beverage intake between 1977 and 2001. 
American Journal of Preventive Medicine 2004;27(3):205-210.
16.  	Vartanian LR, Schwartz MB, Brownell KD. Effects of Soft Drink Consumption 
on Nutrition and Health: A Systematic Review and Meta-Analysis. American 
Journal of Public Health, 2007;97(4):667 - 675.
Physical Activity
QUESTION(S):
80.	During the past 7 days, on how many days were you physically active for a total 
of at least 60 minutes per day? (Add up all the time you spend in any kind of 
physical activity that increases your heart rate and makes you breathe hard some 
of the time.)
81.	On an average school day, how many hours do you watch TV?
82.  	On an average school day, how many hours do you play video or computer games 
or use a computer for something that is not school work? (Include activities such 
as Nintendo, Game Boy, PlayStation, Xbox, computer games, and the Internet.)
83.	In an average week when you are in school, on how many days do you go to 
physical education (PE) classes?
84.	During the past 12 months, on how many sports teams did you play? (Include any 
teams run by your school or community groups.)
RATIONALE:
	
These questions measure participation in physical activity, physical education classes, 
sports teams, television watching, and video game/computer use.  Participation in regular 
physical activity among young people can help build and maintain healthy bones and 
muscles, maintain body weight and reduce body fat, reduce feelings of depression and 
anxiety, and promote psychological well-being.(1,2)  Over time, regular physical activity 
decreases the risk of high blood pressure, heart disease, diabetes, some types of cancer, 
and premature death.(1)  The 2005 Dietary Guidelines for Americans recommends that 
youth engage in at least 60 minutes of physical activity on most, preferably all, days of 
the week.(3)  In 2007, 35% of high school students nationwide had been physically active 
doing any kind of physical activity that increased their heart rate and made them breathe 
hard some of the time for a total of at least 60 minutes/day on 5 or more days during the 7 
days before the survey. (4)  School physical education classes can increase adolescent 
participation in physical activity(5-7) and help high school students develop the 
knowledge, attitudes, and skills they need to engage in lifelong physical activity.(5,8,9) In 
2007, 54% of high school students nationwide went to physical education classes on 1 or 
more days in an average week when they were in school.(4)  Television (TV) viewing, 
computer usage, and video/DVD usage are all considered sedentary behaviors.  Child and 
adolescent TV viewing, in particular, is associated with childhood and adult obesity (10-14) 
and youth who engage in less than two hours of TV viewing per day tend to be more 
active.(15)  Computer usage and video game playing are associated with physical inactivity 
among adolescents(16) and young adults.(17)  Among high school students nationwide in 
2007, 35% watched television 3 or more hours per day on an average school day.  During 
19992007, a significant linear decrease occurred in the percentage of high school 
students who watched television 3 or more hours per day (43%35%).(4)   
RELATED NATIONAL HEALTH OBJECTIVES FOR THE YEAR 2010
22-09	Increase the proportion of adolescents who participate in daily school 
physical education to 50%.(18) 
22-10	Increase the proportion of adolescents who spend at least 50% of school 
physical education class time being physically active to 50%.(18) 
22-11	Increase the proportion of adolescents who view television 2 or fewer 
hours on a school day to 75%.(18)
RELATED LEADING HEALTH INDICATOR
Physical Activity
REFERENCES:
1.	U.S. Department of Health and Human Services. Physical Activity and Health: A 
Report of the Surgeon General. Atlanta, GA, Centers for Disease Control and 
Prevention; National Center for Chronic Disease Prevention and Health 
Promotion, 1996. 
2. 	Strong WB, Malina RM, Blimke CJR, et al.. Evidence based physical activity for 
school-age youth. Journal of Pediatrics 2005;146:732-737. 
3.	US Department of Health and Human Services and US Department of 
Agriculture: Dietary Guidelines for Americans 2005. Washington, DC, 2005. 
Available at http://www.healthierus.gov/dietaryguidelines/.  Accessed June 5, 
2008.
4. 	Eaton DK, Kann L, Kinchen S, et al. Youth Risk Behavior SurveillanceUnited 
States, 2007. Morbidity and Mortality Weekly Report 2008;57(SS-4):1-131.
5. 	Trudeau F, Shephard RJ. Contribution of school programmes to physical activity 
levels and attitudes in children and adults. Sports Medicine 2005;35(2):89-105. 
6. 	McKenzie TL, Li DL, Derby CA, Webber LS, Luepker RV, Cribb P. 
Maintenance of effects of the CATCH Physical Education Program: Results from 
the CATCH-ON Study. Health Education & Behavior 2003;30:447-462.
7. 		McKenzie TL, Sallis JF, Prochaska JJ, Conway TL, Marshall SJ, Rosengard P. 
Evaluation of a two-year middle-school physical education intervention: M-
SPAN. Medicine & Science in Sports & Exercise 2004;36:1382-1388.
8. 	Dishman RK, Motl RW, Saunders R, et al. Enjoyment mediates effects of a 
school-based physical-activity intervention. Medicine & Science in Sports & 
Exercise 2005;37(3):478-487. 
9. 	Centers for Disease Control and Prevention. Guidelines for school and 
community programs to promote lifelong physical activity among young people. 
Morbidity and Mortality Weekly Report 1997;46(RR-6):1-36.
10.	Crespo CJ, Smith E, Troian RP, Bartlett SJ, Macera CA, Anderson RE. Television 
watching, energy intake, and obesity in US children. Archives of Pediatric and 
Adolescent Medicine 2001;155:360-365.
11.	Hancox RJ, Poulton R. Watching television is associated with childhood obesity: 
but is it clinically important? International Journal of Obesity 2006;30(1):171-
175. 
12.	Kaur H, Choi WS, Mayo MS, Harris KJ. Duration of television watching is 
associated with increased body mass index. Journal of Pediatrics 
2003;143(4):506-511.
13. 			Lowry R, Wechsler H, Galuska D, Fulton J, Kann L. Television viewing and its 
associations with overweight, sedentary lifestyle, and insufficient consumption of 
fruits and vegetables among US high school students: differences by race, 
ethnicity, and gender. Journal of School Health 2002; 72(10):413-421. 
14. 			Utter J, Neumark-Sztainer D, Jeffery R, Story M. Couch potatoes or french fries: 
are sedentary behaviors associated with body mass index, physical activity, and
			dietary behaviors among adolescents? Journal of the  American Dietetic 
Association 2003;103(10):1298-1305. 
15. 			The Henry J. Kaiser Foundation. Generation M: media in the lives of 8-18 year-
olds. The Henry J. Kaiser Foundation, Washington D.C., 2005. 
16. 				Gordon-Larson P, Adair LS, Popkin BM. Ethnic differences in physical activity 
and inactivity patterns and overweight status. Obesity Research  2002;10(3):141-
149.
17.	Fotheringham MJ, Wonnacott RL, Owen N.  Computer use and physical 
inactivity in young adults: public health perils and potentials of new information 
technologies.  Annals of Behavioral Medicine 2000;22:269-275.
18.  		U.S. Department of Health and Human Services. Healthy People 2010. 2nd ed. 
With understanding and improving health and objectives for improving health. 
Washington D.C., Government Printing Office, 2004.
Asthma
QUESTION(S):
86. 	Has a doctor or nurse ever told you that you have asthma?
87. 	Do you still have asthma?
RATIONALE:
Approximately 9.9 million (14%) U.S. children <18 years have been diagnosed with 
asthma at some time in their lives, and 6.8 million (9%) currently have asthma.(1)  In 
2004, children made 7 million visits to doctors offices and hospital outpatient 
departments, 754,000 visits to hospital emergency departments, and had 198,000 
hospitalizations due to asthma.(2)  In 2003, an estimated 12.8 million school days were 
lost due to asthma among school-aged children.(2)  Among high school students 
nationwide, 20% had ever been told by a doctor or nurse that they had asthma.(3)
REFERENCES:
1.	Bloom B, Cohen RA. Summary Health Statistics for U.S. Children: National 
Health Interview Survey, 2006. National Center for Health Statistics. Vital Health 
Statistics 2007;10(234):4. 
2.	Akinbami, Lara. Asthma prevalence, health care use, and mortality, 2003-2005.  
Hyattsville, MD: US Department of Health and Human Services, CDC, National 
Center for Health Statistics; 2007.  Available at: 
http://www.cdc.gov/nchs/products/pubs/pubd/hestats/ashtma03-05/asthma03-
05.htm.  Accessed May 5, 2008.
3. 	Eaton DK, Kann L, Kinchen S, et al. Youth Risk Behavior SurveillanceUnited 
States, 2007. Morbidity and Mortality Weekly Report 2008;57(SS-4):1-131.
Youth Risk Behavior Survey (YRBS)
Item rationale 
for the 2009 core questionnaire
Page 2 of 28
YRBS Item rationale for the 2009 core questionnaire