Cleveland Metropolitan School District Youth Risk Behavior Survey (YRBS) High School Report

2009 Cleveland Metropolitan School District Youth Risk Behavior Survey (YRBS) High School Report Center for Health Promotion Research Dept. of Epidemiology and Biostatistics Case Western Reserve University Page 1

CONTENTS Acknowledgements... 3 Introduction... 4 Methods... 5 Instrument... 6 Terms and Conventions... 7 Demographics... 8 RESULTS... 9 Physical Activity, Nutrition, and Obesity... 9 Physical Activity... 9 Nutrition... 12 Obesity, Overweight, and Weight Control... 14 Tobacco, Alcohol, and Other Drug Use... 17 Tobacco Use... 17 Alcohol Use... 20 Marijuana and Other Drug Use... 22 Sexual Behaviors... 25 Safety and Violence... 31 Personal Safety Behaviors... 31 Violent Behaviors... 32 Suicide Related Behaviors... 35 Neighborhood Context... 37 Additional Topics... 38 Other Health Issues... 38 School & Community Involvement... 40 School Performance & Attendance... 41 REFERENCES... 43 Page 2

ACKNOWLEDGEMENTS The Steps to a Healthier Cleveland 2009 Cleveland Metropolitan School District (CMSD) High School Youth Risk Behavior Survey (Steps/YRBS) was successfully completed because of the expertise, cooperation and dedication of influential partners. The Center for Health Promotion Research (CHPR), Department of Epidemiology and Biostatistics at Case Western Reserve University is grateful for the technical assistance provided by the Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (DASH/NCCDPHP/CDC) and the Westat research corporation. These services were available because of the joint cooperative agreement of Steps to a Healthier Cleveland via Steps to a Healthier US with the U.S. Department of Health and Human Services. CHPR wishes to show particular appreciation to members of the Surveillance Partnership: Child and Family Health Services, City of Cleveland Department of Public Health, Cuyahoga County Board of Health, Shaker Prevention Coalition, Social Advocates for Youth Coalition and Steps to a Healthier Cleveland. Through the collaboration of this partnership the adolescent surveillance reach has expanded significantly. We are especially grateful to the students, teachers, principals, superintendents, and all administrative personnel of the Cleveland Metropolitan School District who agreed to participate in the survey. A singular thank you is extended to the CMSD Department of Health and Support Services and the Department of Health and Physical Education, particularly David Harrison. Additionally, the survey could not have been administered without the assistance of our many student employees and volunteers. Report prepared by: Center for Health Promotion Research Department of Epidemiology and Biostatistics Case Western Reserve University 11430 Euclid Avenue Cleveland, OH 44106-4945 http://www.case.edu/affil/healthpromotion Laura Danosky, Data Manager Michelle Del Toro, Graduate Student Research Assistant Jean Frank, Manager of Community Initiatives Edward Hill, Surveillance Coordinator Elizabeth Larkin, Data Manager This publication is supported by the Steps to a Healthier US Cooperative Agreement Program of the U.S. Department of Health and Human Services (HHS). Its contents do not necessarily represent the official view of HHS. Page 3

INTRODUCTION In the spring of 2009, the Center for Health Promotion Research (CHPR) administered the Youth Risk Behavior Survey (YRBS) in Cleveland Metropolitan School District (CMSD) high schools in partnership with Steps to a Healthier Cleveland and the Cleveland Department of Public Health. This report will refer to the Steps YRBS surveyed population as CMSD for ease of reading. The report presents findings from this survey administration addressing 5 key areas: Physical Activity, Nutrition, and Obesity Tobacco, Alcohol, and Other Drug Use Sexual Intercourse and Birth Control Safety and Violence Additional Topics The report includes a section for each of the 5 key areas aforementioned. Findings for each section are organized according to the following format: Summary findings (graphic and written) for each of the sections deemed to be reflective of the main categories of risk behavior known to affect the health and wellness of adolescents. For example, within the key area of Physical Activity, Nutrition and Obesity, separate sections exist for Physical Activity, Nutrition and Obesity. Each of these sections begins with summary findings. Where available, HP2010 goals are included along with CMSD specific prevalence. o Narrative for each questionnaire item is included in the section, with differences of significance noted. Attached at the end of this report are three appendices aimed at supplementing the findings presented herein. In Appendix I, prevalence trends for CMSD High School students are presented. Many risk behaviors have been tracked among 9 th through 12 th grade students in CMSD High Schools since 2004. A version of this survey was also administered among CMSD High School students in the spring of 2007. Comparisons to National and State YRBS data are from the most recent data available from 2007. In Appendix II, data tables are displayed that provide a more in-depth look at the prevalence of a given risk behavior. These tables supplement the results provided in this report and allow for further comparisons between demographic groups (e.g., male vs. female). A simple way to look for significant differences between groups is to check whether the 95% confidence intervals overlap. A statistically significant difference exists if the confidence intervals do not overlap. In Appendix III, a copy of the 2009 CMSD High School YRBS instrument is provided. Page 4

METHODS The YRBS was conducted in 15 public high schools by the Center for Health Promotion Research. Each school that was contacted agreed to participate in survey administration, resulting in a 100% school response rate. Student participation was both anonymous and voluntary. Permission slips were mailed home to all students in selected classrooms, giving parents or guardians the option of excluding their child from participating in the 2009 CMSD High School YRBS. Student nonparticipation was due to absence on the day of survey administration, parental refusal, or student refusal. Additionally, a small number of questionnaires failed minimum quality control standards and were removed from the final data set. Within selected classrooms, a total of 1669 students were eligible to complete the survey. The final sample consisted of 1061 9 th through 12 th grade students in CMSD schools. The student participation rate was 64%, resulting in an overall participation rate of 64%. Once the survey administration was completed, data were analyzed by Westat and the Division of Adolescent and School Health of the Centers for Disease Control and Prevention (CDC). Due to the high overall participation rate (64%), the data were weighted. Data presented in this report are reflective of all students in CMSD high schools. Please note that comparisons of CMSD to the state of Ohio and the nation were taken from most recent YRBS data available from 2007. Statistical analyses were conducted on weighted data by Westat, Survey Technical Assistance Project, through a collaborative agreement between DASH/CDC and Steps to a Healthier US with the U.S. Department of Health and Human Services. Prevalence estimates and 95% confidence intervals were computed for all variables. Differences between prevalence estimates were considered statistically significant if the 95% confidence intervals did not overlap for main effects (gender, race, parental education, and grade), for interactions (gender by race, gender by parental education, gender by grade, race by gender, parental education by gender, and grade by gender), for changes over time within the CMSD schools, and for differences between state of Ohio and nation with respect to their 2007 YRBS results. In the Results section, only statistically significant differences in prevalence estimates are reported in the following order: between state of Ohio and nation, for changes over time within the CMSD schools, and for main effects in the following order: gender, race, parent education and grade. Statistically significant differences among interactions were reported in the results section only when they were counter to the differences noted by main effect. Page 5

INSTRUMENT The Youth Risk Behavior Survey (YRBS) is a national health behavior survey developed by the Centers for Disease Control and Prevention (CDC). It is a collection of questions designed to provide a snapshot of teenage students health risk behaviors. Questions are grouped into several broad categories, which have been identified as leading causes of morbidity and mortality among adolescents. These categories include: Tobacco Use Alcohol and Other Drug Use Sexual Behaviors Dietary Behaviors Physical Activity Due to the goals of Steps to a Healthier US, physical activity and dietary behaviors received extra attention. In addition to the standard YRBS questions, supplemental questions were added to the 2009 Steps to a Healthier Cleveland YRBS in order to meet specific goals and explore research questions. The instrument contained 99 items and took approximately one classroom period, or 50 minutes, to complete. Students received question booklets, answer sheets, and pencils. Page 6

TERMS AND CONVENTIONS Cigar use: Having smoked any of the following products: cigars, cigarillos, or little cigars, such as Black and Milds, Swisher Sweets, or Phillies. Obese/overweight: Classification based on a student s Body Mass Index (BMI) (kg/m2), 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. 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. Previous YRBS reports used the terms overweight to describe youth with a BMI >95th percentile for age and sex and at risk for overweight for those with a BMI >85th percentile and <95th percentile. However, this report uses the terms obese and overweight in accordance with the 2007 recommendations from the Expert Committee on the Assessment, Prevention, and Treatment of Child and Adolescent Overweight and Obesity convened by the American Medical Association (AMA) and co-funded by AMA in collaboration with the Health Resources and Services Administration and CDC. These classifications are not intended to diagnose obesity or overweight in individual students, rather to provide estimates of obesity and overweight for the population of students surveyed. Race/ethnicity: Analysis included this process: 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 analysis, students were classified as Hispanic/Latino if they answered yes to the first question, regardless of how they answered the second question. Students were classified as Black if they answered no to the first question and selected only Black or African American to the second question. Students were classified as White if they answered no to the first question and selected only White to the second question. Students were classified as other if they answered no to the first question and selected American Indian or Alaska Native, Asian, and/or Native Hawaiian or other Pacific Islander or selected more than one response to the second question. 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. For the purposes of this report, students who classified as Black, Hispanic/Latino, and White, are included in the main effect analysis for race. Page 7

DEMOGRAPHICS This table shows the demographic makeup of the 2009 Steps to a Healthier Cleveland (CMSD) sample. Of the total sample, 52.3% of students were female. The remainder of students, or 47.7% of the sample, was male. Over 60% or 598 students identified themselves as Black or African American of non-hispanic decent. Hispanic students made up the second largest group, with 209 students or 19.7% of the sample indicating Hispanic descent. Fewer than 14% or 137 students identified themselves as White. 6.2% of students surveyed were comprised of multiple races or other race categories. Other races include: American Indian or Alaskan Native, Asian, Native Hawaiian or other Pacific Islander Ninth grade students made up the largest proportion of the sample, with 432 or 31.8% of students in the sample indicating they were in 9 th grade. Approximately 26% of the sample or 284 students were 10 th graders. Eleventh and twelfth graders made up the remainder of students, with a little more than 40% of the sample falling into those two grades. 2009 CMSD High School YRBS n % Sex Level * Non-Hispanic Total 1069 100.0% Female 541 52.3% Male 517 47.7% Black * 598 60.7% Hispanic * 209 19.7% White 137 13.4% Multiple Races 54 4.9% All other races 16 1.3% 9th 432 31.8% 10th 284 26.0% 11th 215 23.9% 12th 117 18.1% American Indian or Alaska Native, Asian, Native Hawaiian or other Pacific Islander, and multiple races (non-hispanic). Page 8

RESULTS PHYSICAL ACTIVITY, NUTRITION, AND OBESITY PHYSICAL ACTIVITY 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.,i Over time, regular physical activity decreases the risk of high blood pressure, heart disease, diabetes, some types of cancer, and premature death. 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. The 2009 CMSD YRBS asked students about their computer/video game usage and television watching habits, along with how many days during the 7 days before the survey they had engaged in physical activity. Television (TV) viewing, computer usage, and video/dvd usage are all considered sedentary behaviors. TV viewing, in particular, is associated with childhood and adult obesity. Youth who engage in less than two hours of TV viewing per day tend to be more active. Computer usage and video game playing are associated with physical inactivity among adolescents and young adults. When students are watching television excessively, they are less likely to be spending time doing homework or reading, participating in after school activities, exercising frequently or being engaged in other intellectually stimulating activities. ii 100% Prevalence of Physical Activity Behaviors, by 80% 60% 40% 20% 26.4% 45.0% 30.1% 15.6% 41.6% 57.6% Female Male 0% Met Recommended Levels of Physical Activity No Physical Activity Sports Team Participation In CMSD high schools, males were significantly more likely than females to participate in physical activities. Page 9

Prevalence of Watched Television 3 Hours/Day on an Average School Day, by Black 53.7% Hispanic 39.1% White 35.6% 0% 20% 40% 60% 80% 100% In CMSD high schools, Black students are significantly more likely than White and Hispanic students to have watched television 3 or more hours on average school days. RELEVANT HEALTHY PEOPLE 2010 GOAL: Increase the proportion of adolescents who view television 2 or fewer hours on a school day to 75%. AMONG CMSD STUDENTS: 53.2% viewed television 2 or fewer hours on school days. MET RECOMMENDED LEVELS OF PHYSICAL ACTIVITY In CMSD, 35.7% of students 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 per day on 5 or more days during the 7 days before the survey (i.e., met recommended levels of physical activity) (Table 1). Overall, the prevalence of having met recommended levels of physical activity was lower among CMSD students than students at the state level (44.7%). The prevalence of having met recommended levels of physical activity was lower among female (26.4%) than male (45.0%) students. DID NOT PARTICIPATE IN 60 OR MORE MINUTES OF PHYSICAL ACTIVITY ON ANY DAY In CMSD, 22.9% of students did not participate in 60 or more minutes of any kind of physical activity that increased their heart rate and made them breathe hard some of the time on at least 1 day during the 7 days before the survey (i.e., did not participate in 60 or more minutes of physical activity on any day) (Table 1). Overall, the prevalence of not participating in 60 or more minutes of physical activity on any day was higher among CMSD students than students at the state level (14.4%). The prevalence of not participating in 60 or more minutes of physical activity on any day was higher among female (30.1%) than male (15.6%) students. The prevalence of not participating in 60 or more minutes of physical activity on any day was higher among Black (27.2%) students than Hispanic (14.3%) students. ATTENDED PE CLASSES In CMSD, 32.1% of students went to physical education (PE) classes on one or more days in an average week when they were in school (i.e., attended PE classes) (Table 2). Overall, the prevalence of attending PE classes was lower among CMSD students than students nationwide (53.6%). The prevalence of attending PE classes was lower among 9 th, 10 th and 11 th grade (28.0%, 19.4%, 28.0%) students, respectively, than among 12 th grade (58.9%) students. 10

PLAYED ON AT LEAST ONE SPORTS TEAM In CMSD, 49.5% of students had played on at least one sports team (run by their school or community groups) during the 12 months before the survey (Table 2). Overall, the prevalence of having played on at least one sports team was lower among CMSD students than among students at the state level and nationwide (56.7%, 56.3%), respectively. Overall, the prevalence of having played on at least one sports team was lower among CMSD 04 students (42.5%). The prevalence of having played on at least one sports team was lower among female (41.6%) than male (57.6%) students. The prevalence of having played on at least one sports team was lower among White (39.4%) than Black (53.8%) students. USED COMPUTERS 3 OR MORE HOURS PER DAY In CMSD, 29.9% of students played video or computer games or used a computer for something that was not schoolwork for 3 or more hours per day on an average school day (i.e., used computers 3 or more hours per day), (Table 3). Overall, the prevalence of having used computers 3 or more hours per day was higher among CMSD students than students at the state level (22.7%). The prevalence of having used computers 3 or more hours per day was higher among male (36.2%) than female (23.5%) students. WATCHED TELEVISION 3 OR MORE HOURS PER DAY In CMSD, 46.8% of students watched television 3 or more hours per day on an average school day (Table 3). Overall, the prevalence of having watched television 3 or more hours per day was higher among CMSD students than among students at the state level and nationwide (32.0%, 35.4%), respectively. Overall, the prevalence of having watched television 3 or more hours per day was higher among students in CMSD 04 and 07 (65.0%, 57.2%), respectively. The prevalence of having watched television 3 or more hours per day was higher among Black (53.7%) than White and Hispanic (35.6%, 39.1%) students, respectively. 11

NUTRITION The 2009 CMSD YRBS asked students about their consumption of fruits and vegetables, breakfast, and fast food. Diet and nutrition have important links to adolescent health and well-being, as well as to major causes of morbidity and mortality later in life. 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, iii,iv,v cardiovascular disease, vi and stroke. vii Although data are limited, an increased intake of fruits and vegetables appears to be associated with a decreased risk of being overweight. 100% Prevalence of Dietary Behaviors, by 80% 60% 40% 20% 22.0% 24.1% 11.3% 31.3% 32.0% 46.8% 17.4% 18.1% 16.6% Black Hispanic White 0% Ate Fruits and Vegetables Five or More Times/Day Drank Soda/Pop Everyday Ate Breakfast Everyday The chart above illustrates racial/ethnic differences among CMSD high schools students with respect to dietary behaviors. White students were significantly more likely than Black and Hispanic students to drink soda/pop every day. Rates of eating breakfast daily and consuming 5 or more servings of fruits and vegetables daily, during the 7 days before completing the survey, were similar among the racial/ethnic groups. ATE FRUITS AND VEGETABLES FIVE OR MORE TIMES PER DAY In CMSD, 20.7% of students had eaten fruits and vegetables five or more times per day during the 7 days before the survey (Table 4). DRANK SODA OR POP EVERYDAY In CMSD, 33.3% of 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 (Table 4). The prevalence of having drunk soda or pop at least one time per day was higher among White (46.8%) than Black (31.3%) students. 12

DID NOT EAT BREAKFAST EVERYDAY In CMSD, 82.6% of students had not eaten breakfast everyday during the 7 days before the survey (Table 5). Breakfast Consumption 30.2% 17.4% 24.0% No mornings 1 or 2 mornings 3 to 6 mornings All 7 mornings 28.5% ATE FAST FOOD DURING WEEK In CMSD, 81.5% of students had eaten fast food on at least 1 day during the 7 days before the survey (Table 5). The prevalence of having eaten fast food was higher among 12 th grade (86.1%) than 9 th grade (79.6%) students. Fast Food Consumption 20.0% 18.5% 0 days 1 day 21.7% 2 or 3 days 4 or more days 39.9% ATE BREAKFAST AT SCHOOL In CMSD, 16.1% of students had eaten breakfast at school most of the time or always (Table 6). The prevalence of having eaten breakfast at school most of the time or always was higher among 9 th grade (20.2%) than 12 th grade (9.5%) students. Ate Breakfast at School 9.2% 15.6% 6.9% Never Rarely Sometimes Most of the time Always 19.9% 48.3% 13

OBESITY, OVERWEIGHT, AND WEIGHT CONTROL Obesity has reached epidemic proportions. In the past 20 years, the prevalence of obesity has increased by more than 60% among adults and tripled in children and adolescents. viii Overweight adolescents often become overweight adults with an increased risk for a wide variety of poor health outcomes including diabetes, stroke, heart disease, arthritis and certain cancers. ix,x 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. xi The 2009 CMSD High School YRBS asked students about their height and weight in order to calculate the student s Body Mass Index (BMI). Additionally, students were asked how they describe their own weight and what (if anything) they were currently trying to do about their weight. The chart below depicts the distribution of Body Mass Index (BMI) classifications among CMSD high school students. Obese was defined as a BMI of 95 th percentile for age and sex. Overweight was a BMI of 85 th percentile and <95 th percentile for age and sex. Normal weight was a BMI of 5 th percentile and <85 th percentile for age and sex. Underweight was a BMI of <5 th percentile for age and sex. Body Mass Index (BMI) Classification 17.7% 1.2% 22.7% 58.5% Underweight Normal weight Overweight Obese More than 40% of CMSD students had a BMI for their age and sex that put them into a category of risk (underweight, overweight, or obese). It is important to note that BMI is calculated using self-reported height and weight and, therefore, may underestimate the actual prevalence of overweight and obese. 100% 80% Prevalence of Obese and Overweight, by Region 60% 40% 20% 17.7% 22.7% 12.4% 13.0% 15.0% 15.8% CMSD OH US 0% Obese Overweight CMSD high schools students were significantly more likely to report heights and weights consistent with being obese or overweight than students across the state or nation. 14

Prevalence of Weight Perception and Control, by 100% 80% 60% 49.8% 40% 20% 31.9% 19.1% 30.3% Female Male 0% Described Themselves as Overweight Trying to Lose Weight In CMSD high schools, females were significantly more likely to describe themselves as overweight and to be trying to lose weight than male students. RELEVANT HEALTHY PEOPLE 2010 GOAL: Reduce the proportion of children and adolescents who are overweight or obese to no more than 5 percent. IN CMSD: 17.7% of students were obese. 22.7% of students were overweight. OBESE In CMSD, 17.7% of students were obese (Table 7). Overall, the prevalence of obesity was higher among CMSD students than students statewide or across the nation (12.4%, 13.0%), respectively. OVERWEIGHT In CMSD, 22.7% of students were overweight (Table 7). Overall, the prevalence of overweight was higher among CMSD students than students at the state level and nationally (15.0%, 15.8%), respectively. Overall, the prevalence of overweight was higher among CMSD 09 (22.7%) than CMSD 04 (16.3%) students. DESCRIBED THEMSELVES AS OVERWEIGHT In CMSD, 25.3% of students described themselves as slightly or very overweight (Table 8). The prevalence of describing themselves as overweight was higher among female (31.9%) than male (19.1%) students. The prevalence of describing themselves as overweight was higher among White (38.5%) than Black (19.2%) students. WERE TRYING TO LOSE WEIGHT In CMSD, 39.7% of students were trying to lose weight (Table 8). Overall, the prevalence of trying to lose weight was higher among students across the state and nationally (46.7%, 45.2%). The prevalence of trying to lose weight was higher among female (49.8%) than male (30.3%) students. The prevalence of trying to lose weight was higher among White (53.3%) than Black (35.5%) students. 15

ATE LESS FOOD, FEWER CALORIES, OR LOW-FAT FOODS TO LOSE WEIGHT OR TO KEEP FROM GAINING WEIGHT In CMSD, 32.9% of students ate less food, fewer calories, or low fat foods to lose weight or to keep from gaining weight. EXERCISED TO LOSE WEIGHT OR TO KEEP FROM GAINING WEIGHT In CMSD, 55.0% of students exercised to lose weight or to keep from gaining weight. DID NOT EAT FOR 24 OR MORE HOURS TO LOSE WEIGHT OR TO KEEP FROM GAINING WEIGHT In CMSD, 11.4% of students did not eat for 24 or more hours to lose weight or to keep from gaining weight. TOOK DIET PILLS, POWDERS, OR LIQUIDS TO LOSE WEIGHT OR TO KEEP FROM GAINING WEIGHT In CMSD, 5.3% of students took diet pills, powders, or liquids to lose weight or to keep from gaining weight. TOOK LAXATIVES OR VOMITED TO LOSE WEIGHT OR TO KEEP FROM GAINING WEIGHT In CMSD, 4.2% of students took laxatives or vomited to lose weight or to keep from gaining weight. 16

TOBACCO, ALCOHOL, AND OTHER DRUG USE TOBACCO USE The 2009 CMSD High School YRBS asked students about cigarette, cigar and smokeless tobacco use. Using tobacco can have serious effects on long-term health. The use of cigarettes is the single leading preventable cause of death in the United States. xii Almost 90% of adult smokers initiated use before or at age 18. xiii Tobacco use in adolescence is associated with many other health risk behaviors, including higher-risk sexual behavior and use of alcohol or other drugs. xiii 100% Prevalence of Cigarette Use Behaviors, by 80% 60% 48.1% 62.1% 55.0% Black 40% 20% 26.1% 23.9% 15.7% 14.4% 5.8% 7.9% Hispanic White 0% Lifetime Cigarette Use Current Cigarette Use Smoked Cigarettes before Age 13 In CMSD high schools, White students were significantly more likely than Black students to have ever tried cigarettes, smoked cigarettes in the 30 days before the survey, and to have smoked cigarettes before age 13. 100% Prevalence of Current Cigar Use, by 80% 60% 9th 10th 40% 25.4% 20.9% 30.8% 20.1% 11th 12th 20% 0% In CMSD high schools, the prevalence of current cigar use was similar for students in each of the grades 9-12. RELEVANT HEALTHY PEOPLE 2010 GOAL: Reduce the percentage of adolescents reporting cigarette smoking during the past 30 days to no more than 16%. AMONG CMSD SCHOOLS: 10.6% of CMSD students smoked a cigarette on one or more days in the 30 days before the survey. 17

RELEVANT HEALTHY PEOPLE 2010 GOAL: Reduce the percentage of adolescents reporting cigar smoking during the past 30 days to no more than 8%. AMONG CMSD SCHOOLS: 24.7% of CMSD students smoked a cigar in the 30 days before the survey. RELEVANT HEALTHY PEOPLE 2010 GOAL: Reduce the percentage of adolescents reporting smokeless tobacco use during the past 30 days to no more than 1%. AMONG CMSD SCHOOLS: 4.1% of CMSD students used smokeless tobacco in the 30 days before the survey. LIFETIME CIGARETTE USE In CMSD, 50.6% of students had ever tried cigarette smoking (even one or two puffs) (i.e., lifetime cigarette use) (Table 9). The prevalence of lifetime cigarette use was higher among White (62.1%) than Black (48.1%) students. The prevalence of lifetime cigarette use was higher among 9 th and 11 th grade (55.1%, 58.8%) students, respectively, than among 10 th grade (42.3%) students. LIFETIME DAILY CIGARETTE USE In CMSD, 7.7% of students had ever smoked at least one cigarette every day for 30 days (i.e., lifetime daily cigarette use) (Table 9). The prevalence of lifetime daily cigarette use was higher among White (21.9%) than Black and Hispanic (3.7%, 9.4%) students, respectively. CURRENT CIGARETTE USE In CMSD, 10.6% of students had smoked cigarettes on at least 1 day during the 30 days before the survey (i.e., current cigarette use) (Table 10). Overall, the prevalence of current cigarette use was higher among students across the state and nationally (21.6%, 20.0%), respectively. The prevalence of current cigarette use was higher among White (26.1%) than Black and Hispanic (5.8%, 14.4%) students, respectively. SMOKED A WHOLE CIGARETTE BEFORE AGE 13 YEARS In CMSD, 12.2% of students had smoked a whole cigarette for the first time before age 13 years (Table 10). Overall, the prevalence of having smoked a whole cigarette for the first time before age 13 years was higher among CMSD 04 (19.6%) students. The prevalence of having smoked a whole cigarette for the first time before age 13 years was higher among White (23.9%) than Black (7.9%) students. SMOKED CIGARETTES ON SCHOOL PROPERTY In CMSD, 4.2% of students had smoked cigarettes on school property on at least 1 day during the 30 days before the survey (Table 11). The prevalence of having smoked cigarettes on school property was higher among White (10.4%) than Black (2.0%) students. TRIED TO QUIT SMOKING CIGARETTES In CMSD, among the 10.6% of students who currently smoked cigarettes, 50.1% had tried to quit smoking cigarettes during the 12 months before the survey (Table 11). 18

SMOKED MORE THAN 10 CIGARETTES PER DAY In CMSD, among the 10.6% of students who currently smoked cigarettes, 6.2% of students had smoked more than 10 cigarettes per day on the days they smoked during the 30 days before the survey (Table 12). The prevalence of having smoked more than 10 cigarettes per day was higher among White (11.1%) than Black (0.0%) students. BOUGHT CIGARETTES IN A STORE OR GAS STATION In CMSD, 31.8% of the 10.6% of students who currently smoked cigarettes and were less than 18 years usually obtained their own cigarettes by buying them in a store (i.e., convenience store, supermarket, or discount store) or gas station during the 30 days before the survey (Table 12). The prevalence of having bought their own cigarettes in a store or gas station was higher among 10 th and 12 th grade (40.0%, 57.4%) students, respectively, than 9 th grade (17.7%) students. CURRENT CIGAR USE In CMSD, 24.7% of students had smoked cigars, cigarillos, or little cigars (e.g., Black & Milds, Phillies, or Swisher Sweets) on at least 1 day during the 30 days before the survey (current cigar use) (Table 13). Overall, the prevalence of current cigar use was higher among CMSD students than students across the state and nationally (19.6%, 13.6%), respectively. CURRENT SMOKELESS TOBACCO USE In CMSD, 4.1% 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 13). Overall, the prevalence of current smokeless tobacco use was higher among students across the state and nationally (9.8%, 7.9%), respectively. The prevalence of current smokeless tobacco use was higher among male (6.7%) than female (0.8%) students. 19

ALCOHOL USE The 2009 YRBS asked students about drinking alcohol. Alcohol use among youth has been linked to unintentional injuries, physical fights, academic problems, job problems and illegal behavior. xiv Alcohol use has been identified as a major contributing factor in approximately one-third of all unintentional injury deaths, homicides and suicides, which are the leading causes of death and disability among young people. xv More young people use alcohol than tobacco or illicit drugs in the United States. Teens that begin drinking before age 15 are five times more likely to develop alcohol dependence than those who begin drinking at age 21. xvi 100% Prevalence of Alcohol Use Behaviors, by 80% 60% 40% 20% 31.5% 41.2% 41.7% 9.6% 18.9% 21.1% 19.8% 27.7% 34.5% Black Hispanic White 0% Current Alcohol Use Binge Drinking Drank Alcohol before Age 13 In CMSD high schools, White students were significantly more likely to report binge drinking or to have drunk alcohol before age 13, than Black students. The prevalence of current alcohol use was similar across race/ethnic groups. 100% Prevalence of Alcohol Use Beahviors, by Region 80% 60% 40% 34.5% 45.7% 44.7% 28.8% 26.0% CMSD OH US 20% 12.8% 0% Current Alcohol Use Binge Drinking The prevalence of current alcohol use and binge drinking were higher among CMSD students in 09 than among students at the state and national level in 07. 20

LIFETIME ALCOHOL USE In CMSD, 69.7% of students had had at least one drink of alcohol on at least 1 day during their life (i.e., lifetime alcohol use) (Table 14). CURRENT ALCOHOL USE In CMSD, 34.5% 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 14). Overall, the prevalence of current alcohol use was higher among students across the state and nation (45.7%, 44.7%), respectively. EPISODIC HEAVY DRINKING (BINGE DRINKING) In CMSD, 12.8% 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., episodic heavy drinking) (Table 15). Overall, the prevalence of episodic heavy drinking was higher among students at the state level and nationally (28.8%, 26.0%), respectively. The prevalence of episodic heavy drinking was higher among White and Hispanic (21.1%, 18.9%), students, respectively, than among Black (9.6%) students. DRANK ALCOHOL BEFORE AGE 13 YEARS In CMSD, 23.6% of students had drunk alcohol (other than a few sips) for the first time before age 13 years (Table 15). The prevalence of having drunk alcohol before age 13 years was higher among White (34.5%) than Black (19.8%) students. The prevalence of having drunk alcohol before age 13 years was higher among 9 th grade (32.1%) than 11 th and 12 th grade (18.6%, 15.5%) students, respectively. DRANK ALCOHOL ON SCHOOL PROPERTY In CMSD, 3.9% 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 16). 21

MARIJUANA AND OTHER DRUG USE The 2009 CMSD High School YRBS asked students about marijuana use, other drug use and whether they had been offered, sold, or given drugs on school property. Illegal drug use can lead to unhealthy behaviors and negative consequences. Drug abuse may contribute to depression and suicide, unintended pregnancy, school failure, violent behavior, delinquency, and transmission of sexually transmitted diseases, including HIV. xvii Marijuana is used for the intoxication or high that it gives most users. For most youth, marijuana is not difficult to obtain. xviii Many think marijuana is not as harmful as other illicit drugs; however, it has both short- and longterm health effects. The short-term effects include memory problems, loss of coordination, anxiety attacks, and increased heart rate. xix Possible long-term effects include respiratory problems, a weakened immune system, and cognitive deficits. xx While causation is complex, teens who use marijuana are also more likely to have lower achievement, more delinquent behavior and aggression, and weaker relationships with parents than non-users. xix 100% Prevalence of Marijuana Use Behaviors, CMSD 2004 2009 80% 60% 40% 20% 45.2% 46.6% 42.7% 22.1% 24.0% 24.5% 12.3% 12.4% 11.6% 2004 2007 2009 0% Lifetime Marijuana Use Current Marijuana Use Smoked Marijuana before Age 13 From 2004 to 2009, the prevalence of lifetime marijuana use, current marijuana use, and smoking marijuana before the age of 13, among CMSD high school students have remained similar. Prevalence of Illegal Drug Use Marijuana 46.6% Inhalant Steroid Ecstasy Cocaine Heroin Methamphetamine 7.7% 5.6% 5.2% 4.3% 3.5% 3.5% 0% 20% 40% 60% 80% 100% The chart above depicts the prevalence of lifetime illegal drug use among CMSD students. The prevalence of lifetime marijuana use was highest with the prevalence of inhalant use ranking second. 22

RELEVANT HEALTHY PEOPLE 2010 GOAL: Reduce the proportion of adolescents reporting use of marijuana during the past 30 days to no more than 0.7 percent. IN CMSD: 24.5% of students used marijuana during the 30 days before the survey. LIFETIME MARIJUANA USE In CMSD, 46.6% of students had used marijuana one or more times during their life (i.e., lifetime marijuana use) (Table 17). Overall, the prevalence of lifetime marijuana use was higher among CMSD students than among students across the state and nation (33.8%, 38.1%), respectively. The prevalence of lifetime marijuana use was higher among 11 th (57.2%) than 10 th (38.4%) grade students. CURRENT MARIJUANA USE In CMSD, 24.5% of students had used marijuana one or more times during the 30 days before the survey (i.e., current marijuana use) (Table 17). TRIED MARIJUANA BEFORE AGE 13 YEARS In CMSD, 11.6% of students had tried marijuana for the first time before age 13 years (Table 18). The prevalence of having tried marijuana for the first time before age 13 years was higher among male (15.8%) than female (7.1%) students. The prevalence of having tried marijuana for the first time before age 13 years was higher among 9 th (16.5%) than 10 th grade (8.2%) students. LIFETIME COCAINE USE In CMSD, 4.3% of students had used any form of cocaine (e.g., powder, crack, or freebase) one or more times during their life (i.e., lifetime cocaine use) (Table 18). Overall, the prevalence of lifetime cocaine use was higher among students across the state (8.3%). LIFETIME INHALANT USE In CMSD, 7.7% of students had sniffed glue, breathed the contents of aerosol spray cans, or inhaled any paints or sprays to get high one or more times during their life (i.e., lifetime inhalant use) (Table 19). Overall, the prevalence of lifetime inhalant use was higher among students nationwide (13.3%). The prevalence of lifetime inhalant use was higher among 9 th (10.5%) than 12 th (4.8%) grade students. LIFETIME HEROIN USE In CMSD, 3.5% of students had used heroin (also called smack, junk, or China White ) one or more times during their life (i.e., lifetime heroin use) (Table 19). The prevalence of lifetime heroin use was higher among male (6.1%) than female (0.6%) students. LIFETIME METHAMPHETAMINE USE In CMSD, 3.5% of students had used methamphetamines (also called speed, crystal, crank, or ice ) one or more times during their life (i.e., lifetime methamphetamine use) (Table 20). The prevalence of lifetime methamphetamine use was higher among male (5.7%) than female (1.2%) students. LIFETIME ECSTASY USE In CMSD, 5.2% of students had used ecstasy (also called MDMA ) one or more times during their life (i.e., lifetime ecstasy use) (Table 20). The prevalence of lifetime ecstasy use was higher among Hispanic (9.2%) than Black (3.1%) students. 23

LIFETIME ILLEGAL STEROID USE In CMSD, 5.6% of students had taken steroid pills or shots without a doctor s prescription one or more times during their life (i.e., lifetime illegal steroid use) (Table 21). OFFERED, SOLD, OR GIVEN DRUGS ON SCHOOL PROPERTY In CMSD, 27.0% of students had been offered, sold, or given an illegal drug by someone on school property during the 12 months before the survey (Table 21). The prevalence of having been offered, sold, or given illegal drugs on school property was higher among male (32.8%) than female (21.0%) students. 24

SEXUAL BEHAVIORS The 2009 CMSD High School YRBS asked students a number of questions about sexual behavior, sexually transmitted diseases (infections), and feelings. Early sexual activity is associated with a high number of sexual partners, xxi,xxii STI contraction, teenage pregnancy, xxi and greater risk for unwanted sex. xxiii Since 1990, teen pregnancy and birth rates in the United States have declined significantly. Researchers cite two main factors: fewer teens are having sex, and among those who are, more are using contraceptives. xxiv While this is a positive trend, there are still risks for those teens who are entering into sexual relationships during their adolescent years. xxiv 100% Prevalence of Sexual Behaviors, CMSD 2004 2009 80% 70.7% 68.0% 67.9% 60% 44.6% 50.1% 47.1% 2004 40% 2007 20% 14.7% 17.0% 15.4% 2009 0% Ever Had Sexual Intercourse Current Sexual Intercourse Had Sexual Intercourse before Age 13 From 2004 to 2009, the prevalence of ever having had sexual intercourse, current sexual intercourse, and having sexual intercourse before the age of 13, among CMSD high school students have remained similar. 100% Prevalence of Sexual Behaviors, by Region 80% 67.9% 60% 40% 44.5% 47.8% 47.1% 35.1% 35.0% CMSD Ohio 20% 15.4% 6.3% 7.1% US 0% Ever Had Sexual Intercourse Current Sexual Intercourse Had Sexual Intercourse before Age 13 25

Among CMSD high school students the prevalence of ever having had sexual intercourse, current sexual intercourse and having sexual intercourse before the age of 13 years were higher than among students at the state and national level. Prevalence of Lifetime Sexual Intercourse, by 100% 81.1% 76.3% 80% 60% 56.5% 61.5% 9th 10th 40% 11th 12th 20% 0% Among CMSD students, the prevalence of having ever had sexual intercourse was lower among ninth and tenth grade students than among eleventh and twelfth grade students. 100% Prevalence of Current Sexual Activity, by 80% 60% 40% 37.6% 37.9% 61.5% 55.1% 9th 10th 11th 12th 20% 0% Among CMSD students, the prevalence of being currently sexually active was lower among ninth and tenth grade students than among eleventh and twelfth grade students. 26

Prevalence of Condom Use, by 100% 80% 77.7% 79.6% 72.1% 71.5% 67.4% 7th 60% 55.0% 8th 9th 40% 10th 11th 20% 12th 0% Among CMSD students 7 th through 12 th grades, condom use shows a downward pattern. Middle school students (7 th, 8 th grades) wear condoms at rates significantly higher than 12 th grade students. **Middle school data taken from YRBS survey of 2007-2008 school year.** EVER HAD SEXUAL INTERCOURSE In CMSD, 67.9% of students had ever had sexual intercourse (Table 22). Overall, the prevalence of having had sexual intercourse was higher among CMSD students than among students across the state and nation (44.5%, 47.8%), respectively. The prevalence of having had sexual intercourse was higher among male (74.8%) than female (60.8%) students. The prevalence of having had sexual intercourse was higher among 11 th and 12 th grade (81.1%, 76.3%) students, respectively than among 9 th and 10 th grade (56.5%, 61.5%) students, respectively. HAD SEXUAL INTERCOURSE WITH FOUR OR MORE PERSONS DURING THEIR LIFE In CMSD, 28.7% of students had had sexual intercourse with four or more persons during their life (Table 22). Overall, the prevalence of having had sexual intercourse with four or more persons was higher among CMSD students than among students across the state and nation (14.1%, 14.9%), respectively. The prevalence of having had sexual intercourse with four or more persons was higher among male (39.2%) than female (18.4%) students. The prevalence of having had sexual intercourse with four or more persons was higher among Black (34.6%) than White and Hispanic (17.1%, 18.9%) students, respectively. The prevalence of having had sexual intercourse with four or more persons was higher among 11 th and 12 th (36.9%, 38.5%) grade students, respectively than among 9 th grade (21.3%) students. The prevalence of having had sexual intercourse with four or more persons was higher among 12 th (38.5%) than 10 th (22.8%) grade students. CURRENTLY SEXUALLY ACTIVE In CMSD, 47.1% of students had had sexual intercourse with at least one person during the 3 months before the survey (i.e., currently sexually active) (Table 23). Overall, the prevalence of being currently sexually active was higher among CMSD students than among students across the state and nation (35.1%, 35.0%), respectively. The prevalence of being currently sexually active was higher among 11 th and 12 th grade (61.5%, 55.1%) students, respectively, than among 9 th and 10 th grade (37.6%, 37.9%) students, respectively. 27

HAD FIRST SEXUAL INTERCOURSE BEFORE AGE 13 YEARS In CMSD, 15.4% of students had first sexual intercourse before age 13 years (Table 23). Overall, the prevalence of having had sexual intercourse before age 13 years was higher among CMSD students than among students across the state and nation (6.3%, 7.1%), respectively. The prevalence of having had sexual intercourse before age 13 years was higher among male (24.5%) than female (6.3%) students. The prevalence of having had sexual intercourse before age 13 years was higher among Black (16.9%) than White (6.6%) students. The prevalence of having had sexual intercourse before age 13 years was higher among 9 th and 11 th (20.2%, 18.4%) grade students, respectively, than among 12 th (6.1%) grade students. CONDOM USE In CMSD, among the 47.1% of currently sexually active students, 67.0% reported that either they or their partner had used a condom during last sexual intercourse (Table 24). The prevalence of having used a condom during last sexual intercourse was higher among male (75.5%) than female (56.5%) students. The prevalence of having used a condom during last sexual intercourse was higher among 9 th and 10 th (72.1%, 71.5%) grade students, respectively, than among 12 th (55.0%) grade students. USED BIRTH CONTROLS PILLS OR INJECTABLE PREGNANCY PREVENTION In CMSD, among the 47.1% of currently sexually active students, 18.4% reported that either they or their partner had used birth control pills or injectable birth control to prevent pregnancy before last sexual intercourse (Table 24). The prevalence of having used birth control pills or injectable birth control was higher among female (27.4%) than male (11.4%) students. The prevalence of having used birth control pills or injectable birth control was higher among 12 th grade (25.5%) than 9 th grade (15.3%) students. Pregnancy Prevention Method 7.0% 6.4% 19.1% 2.1% Condoms Birth control pills None or not sure Withdrawal Depo-Provera 11.4% 54.0% Some other method HAVE BEEN OR GOTTEN SOMEONE PREGNANT In CMSD, 13.0% of students had been pregnant or gotten someone pregnant one or more times in their life (Table 25). 28

SEXUAL CONTACT In CMSD, 25.7% of students reported never having sexual contact in their lifetime. Of those who had sexual contact, 41.1% had sexual contact with females, 29.1% had sexual contact with males, and 4.0% had sexual contact with both males and females. The following pie chart depicts the breakdown of sexual contact reported by students in CMSD high schools. With Whom, Sexual Contact 4.0% 25.7% 29.1% Never Females Males Both 41.1% SEXUAL ORIENTATION In CMSD, 89.8% described themselves as heterosexual while 2.3% described themselves as gay or lesbian. 5.6% described themselves as bisexual. 2.3% described themselves as not sure. TAUGHT ABOUT AIDS OR HIV INFECTION IN SCHOOL In CMSD, 88.2% were taught about Acquired Immune Deficiency Syndrome (AIDS) or Human Immunodeficiency Virus (HIV) infection in school (Table 26). TAUGHT ABOUT OTHER SEXUALLY TRANSMITTED DISEASES IN SCHOOL In CMSD, 87.5% had been taught in school about other sexually transmitted diseases (STDs) (e.g., genital herpes, genital warts, chlamydia, syphilis, gonorrhea, or human papillomavirus) (Table 26). TESTED FOR HIV In CMSD, 26.2% had been tested for HIV (Table 27). Overall, the prevalence of having been tested for HIV was higher among CMSD than students nationwide (12.9%). The prevalence of having been tested for HIV was higher among black (28.9%) than white (14.2%) students. The prevalence of having been tested for HIV was higher among 12 th grade (35.7%) than 9 th grade (20.0%) and 10 th grade (21.9%) students. STD DIAGNOSIS In CMSD, 7.5% had been diagnosed by a doctor or nurse with a sexually transmitted disease (STD) (Table 27). The prevalence of having been diagnosed with an STD was higher among 11 th grade (12.0%) than 9 th (5.8%), 10 th (6.6%), and 12 th grade (4.9%) students. 29

WORRIED ABOUT STD EXPOSURE In CMSD, 10.3% were very worried, 8.0% were worried, 19.2% were a little bit worried, and 62.5% were not worried at all about being exposed to a sexually transmitted disease. The following pie chart depicts the level of worry about STD exposure by students in CMSD high schools. Worried about STD Exposure 8.0% 19.2% 10.3% 62.5% Not worried at all A little bit worried Worried Very worried 30

SAFETY AND VIOLENCE PERSONAL SAFETY BEHAVIORS The 2009 YRBS asked students how often they wore a bicycle helmet when riding a bicycle, wore a seat belt when riding in a car driven by someone else, rode in a car driven by someone who had been drinking alcohol, and drove a car when drinking alcohol. Head injury is the leading cause of death in bicycle crashes and use of bicycle helmets is the single most effective way of reducing head injuries and fatalities. xxv,xxvi Motor vehicle accidents are the leading cause of death for children and youth ages 5 to 24. xxvii The use of seat belts and child safety restraints greatly reduces the chance of fatalities and serious injuries in motor vehicle crashes. The pie chart below depicts the frequency of seat belt use among CMSD students. Seat Belt Use 25.1% 9.8% 16.6% Never Rarely Sometimes Most of the time Always 25.8% 22.7% RELEVANT HEALTHY PEOPLE 2010 GOAL: Increase use of seat belts to 92%. AMONG CMSD SCHOOLS: 73.6% of students had worn a seat belt sometimes, most of the time, or always. RELEVANT HEALTHY PEOPLE 2010 GOAL: Reduce the percentage of students who rode in a car by driven someone who had been drinking alcohol to 30%. AMONG SAY SCHOOLS: 25.1% of students rode in a car driven by someone who had been drinking alcohol in the 30 days before the survey. SEAT BELT USE In CMSD, 26.4% of students had rarely or never worn a seat belt when riding in a car driven by someone else (Table 32). Overall, the prevalence of having rarely or never worn a seat belt was higher among CMSD students than students statewide (14.3%) and nationwide (11.1%). The prevalence of having rarely or never worn a seat belt was higher among male (32.4%) than female (19.8%) students. RODE WITH A DRIVER WHO HAD BEEN DRINKING ALCOHOL In CMSD, 25.1% of students had ridden in a car driven by someone who had been drinking alcohol one or more times in the 30 days before the survey (Table 32). DROVE WHEN DRINKING ALCOHOL In CMSD, 5.9% of students had driven a car when they had been drinking alcohol one or more times in the 30 days before the survey (Table 33). Overall, the prevalence of having driven when they had been drinking alcohol was higher among students nationwide (10.5%). Page 31

VIOLENT BEHAVIORS The 2009 YRBS asked students about violent behaviors, such as physical fighting, weapon carrying, bullying, and suicide. Adolescents can experience violence along a continuum that may begin with verbal harassment and advance into physical acts of violence. xxviii Violence affects the quality of life of those who experience it and those who witness the acts. xxviii Bullying and being bullied at school are associated with key violence-related behaviors including carrying weapons, fighting and sustaining injuries from fighting. xxix Bullying is no longer limited to school an estimated 9% of youth online are targets of harassment. xxx 100% Prevalence of Violence Related Behaviors, by Region 80% 60% 40% 20% 0% 49.4% 35.5% 30.4% 19.3% 9.4% 12.4% 10.8% 3.8% 5.5% In a Physical Fight Fighting at School Felt Unsafe at or Going to School CMSD OH US CMSD high school students reported rates of being in a physical fight, fighting at school and feeing unsafe at or going to school, at rates significantly higher than the state and nation. 100% Prevalence of Violence Related Behaviors, by 80% 60% 40% 20% 42.7% 55.6% 15.3% 22.7% 10.0% 17.6% Female Male 0% In a Physical Fight In a Physical Fight on School Property Carried a Weapon In CMSD high schools, male students were significantly more likely to be in a physical fight, to be in a physical fight on school property, or to carry a weapon, than female students. 32

Prevalence of Violence Related Behaviors, CMSD 2004 2009 100% 80% 60% 2004 40% 20% 17.1% 21.7% 14.1% 8.0% 7.7% 2.6% 2007 2009 0% Carried a Weapon Carried a Weapon on School Property From 2007 to 2009 in CMSD high schools rates of carrying a weapon and carrying a weapon on school property have declined significantly. RELEVANT HEALTHY PEOPLE 2010 GOAL: Reduce physical fighting among adolescents to no more than 32%. AMONG CMSD SCHOOLS: 49.4% of students were in a physical fight in the 12 months before the survey. RELEVANT HEALTHY PEOPLE 2010 GOAL: Reduce weapon carrying by adolescents on school property to 4.9%. AMONG CMSD SCHOOLS: 2.6% of students carried a weapon such as a gun, knife, or club on school property in the 30 days before the survey. IN A PHYSICAL FIGHT In CMSD, 49.4% of students were in a physical fight one or more times in the 12 months before the survey (Table 28). Overall, the prevalence of having been in a physical fight was higher among CMSD students (49.4%) than among students at the state level (30.4%) and nationwide (35.5%). The prevalence of having been in a physical fight was higher among male (55.6%) than female (42.7%) students. The prevalence of having been in a physical fight was higher among 9 th grade (55.4%) than 12 th grade (36.1%) students. IN A PHYSICAL FIGHT ON SCHOOL PROPERTY In CMSD, 19.3% of students were in a physical fight on school property one or more times in the 12 months before the survey (Table 28). Overall, the prevalence of having been in a physical fight on school property was higher among students across the state and nation (9.4%, 12.4%), respectively. The prevalence of having been in a physical fight on school property was higher among 9 th grade (23.3%) than 12 th grade (10.6%) students. 33

CARRIED A WEAPON In CMSD, 14.1% of students carried a weapon (e.g., gun, knife, or club) one or more times in the 30 days before the survey (Table 29). Overall, the prevalence of weapon carrying was higher among CMSD students in 07 (21.7%). The prevalence of weapon carrying was higher among male (17.6%) than female (10.0%) students. The prevalence of weapon carrying was higher among 9 th grade (15.6%) than 12 th grade (7.3%) students. CARRIED A WEAPON ON SCHOOL PROPERTY In CMSD, 2.6% of students carried a weapon (e.g., gun, knife, or club) one or more times on school property in the 30 days before the survey (Table 29). Overall, the prevalence of weapon carrying on school property was higher among students nationally (5.9%). Overall, the prevalence of weapon carrying on school property was higher among CMSD students in 04 and 07 (7.7%, 8.0%), respectively. DID NOT GO TO SCHOOL BECAUSE FELT UNSAFE In CMSD, 10.8% of students did not go to school because they felt unsafe at or on the way to or from school one or more times in the 30 days before the survey (Table 30). Overall, the prevalence of not going to school because they felt unsafe was higher among CMSD than students statewide (3.8%) and nationwide (5.5%). The prevalence of not going to school because they felt unsafe was higher among 9 th grade (15.0%) than 12 th grade (6.1%) students. DATING VIOLENCE In CMSD, 14.6% were hit, slapped, or physically hurt by their girlfriend or boyfriend on purpose one or more times in the 12 months before the survey (Table 30). FORCED TO HAVE SEXUAL INTERCOURSE In CMSD, 11.4% of students had been physically forced to have sexual intercourse when they did not want to (Table 31). 34

SUICIDE RELATED BEHAVIORS Suicide is the third leading cause of death among teenagers aged 15-19. Females are at a particular risk for suicidal thoughts and present higher rates of suicide attempts than males. In 2001, 4,234 youth between the ages of 10 and 24 took their own lives, accounting for nearly 12 percent of all deaths for this age group. xxxi Prevalence of Suicide Attempts, CMSD 2004 2009 2004 7.9% 2007 9.2% 2009 14.4% 0% 20% 40% 60% 80% 100% From 2007 to 2009, the prevalence of suicide attempts has increased significantly among CMSD high school students. 100% Prevalence of Suicide Related Behaviors, by 80% 60% 40% 20% 22.7% 11.0% 36.2% 24.1% Female Male 0% Seriously Considered Suicide Felt Sad or Hopeless The prevalence of having seriously considered suicide and having felt sad or hopeless, were significantly higher among female students than male students. RELEVANT HEALTHY PEOPLE 2010 GOAL: Reduce the rate of suicide attempts by adolescents to 1%. AMONG CMSD SCHOOLS: 14.4% of students had attempted suicide one or more times in the 12 months before the survey. 35

ATTEMPTED SUICIDE In CMSD, 14.4% of students had attempted suicide one or more times during the 12 months before the survey (Table 34). The prevalence of having attempted suicide was higher among CMSD than students statewide (7.2%) and nationwide (6.9%). SERIOUSLY CONSIDERED ATTEMPTING SUICIDE In CMSD, 16.4% of students had seriously considered attempting suicide one or more times in the 12 months before the survey (Table 34). Overall, the prevalence of having seriously considered attempting suicide was higher among female (22.7%) than male (11.0%) students. Overall, the prevalence of having seriously considered attempting suicide was higher among 9 th (22.0%) than 10 th grade (11.9%) students. FELT SAD OR HOPELESS In CMSD, 30.0% of students had felt so sad and hopeless almost every day for two weeks or more in a row that they stopped doing some usual activities one or more times in the 12 months before the survey (Table 35). The prevalence of having felt sad or hopeless was higher among female (36.2%) than male (24.1%) students. The prevalence of having felt sad or hopeless was higher among 9 th grade (34.7%) than 10 th grade (22.1%) students. 36

NEIGHBORHOOD CONTEXT The 2009 Steps to a Healthier Cleveland YRBS also included several items measuring attitudes and behaviors associated with students environment. Included in this survey were several items measuring students views of their local neighborhoods. NEIGHBORHOOD IS HEALTHY PLACE TO LIVE In CMSD, 13.2% of students strongly agree, 31.5% agree, 27.0% are not sure, 19.3% disagree, and 8.9% strongly disagree that their neighborhood is a healthy place to live. (Table 36) NEIGHBORHOOD IS SAFE PLACE TO LIVE In CMSD, 14.3% of students strongly agree, 31.3% agree, 25.3% are not sure, 19.1% disagree, and 10.0% strongly disagree that their neighborhood is a safe place to live. (Table 36) PHYSICAL ACTIVITY OPPORTUNITIES IN NEIGHBORHOOD In CMSD, 28.7% of students strongly agree, 39.0% agree, 17.1% are not sure, 9.7% disagree, and 5.5% strongly disagree that outside of school activities, there are plenty of things to do around their neighborhood to be physically active, such as going for a walk, going to the park or recreation center, riding a bike, or playing basketball. (Table 37) FEEL SAFE BEING PHYSICALLY ACTIVE IN NEIGHBORHOOD In CMSD, 20.6% of students strongly agree, 35.6% agree, 28.6% are not sure, 9.5% disagree, and 5.6% strongly disagree that they feel safe being physically active in their neighborhood. (Table 37) 37

ADDITIONAL TOPICS OTHER HEALTH ISSUES The 2009 YRBS asked students about other health-related issues, including seeing a doctor for a check-up, general health, and asthma. Nationwide, adolescents have the lowest utilization rate of health care services of any age group. Barriers to care include cost of care; low family income; stigma; distrust; confidentiality and parental consent; lack of medical insurance; embarrassment about and lack of transportation to reproductive health services; lack of knowledge about where or how to access care; and lack of adolescent-friendly services. xxxii Last Time Seeing a Doctor or Nurse for Check-Up 11.4% 4.3% 4.4% 14.3% During the past 12 months Between 12 and 24 months ago More than 24 months ago Never 65.6% Not sure The preceding pie chart describes student responses to a question about the last time they had seen a doctor or nurse for a check-up when they were not injured or sick. Nearly 66% of CMSD high school students had seen a doctor or nurse for a check-up or physical exam during the 12 months before the survey. 21.2% General Health - Female 2.1% 12.7% General Health - Male 0.5% 8.1% Poor 32.8% Poor Fair 24.7% Fair Good Good Very good Very good 26.2% 37.8% Excellent Excellent 33.9% The pie charts above depict how female and male students described their health in general. Male students more often described their health, in general, as excellent. 38