MMWR News Synopsis

Supplement: Overview and Methods for the Youth Risk Behavior Surveillance System — United States, 2019

CDC Media Relations
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Supplement: Condom and Contraceptive Use Among Sexually Active High School Students — Youth Risk Behavior Survey, United States, 2019

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Using a condom with a more effective contraceptive use, the recommended approach for preventing both unintended pregnancy and sexually transmitted infections (STIs) and HIV, was reported by only 9% of sexually active high school students with notable disparities by race/ethnicity, grade, and other sexual risk behaviors. The findings underscore the need for quality sexual and reproductive health education and services for preventing unintended pregnancy and STIs/HIV and addressing disparities among sexually active youth. The 2019 national YRBS provides information on condom use, primary contraceptive method, and condom use with more effective methods of contraception, all at last sexual intercourse among U.S. high school students. Condoms were the most prevalent primary pregnancy prevention method (44%), followed by birth control pills (23%), withdrawal or other method (10%), IUD or implant (5%), and shot, patch, or ring (3%). Approximately 9% had used condoms with an IUD, implant, shot, patch, ring, or birth control pills. Overall, 54% of currently sexually active students had used a condom at last sexual intercourse. Approximately one-fifth (19.8%) of sexually active students reported using withdrawal or some other method only or no condom and no primary contraceptive method. Compared with white students (6.8%), black (23.2%) and Hispanic (12.8%) students had higher prevalence of no pregnancy prevention method use and lower prevalence of highly and moderately effective contraceptive method use – presenting notable disparities in sexual health risk. The national data underscore the importance of health education and services to improve condom and contraceptive use, and achieve unintended pregnancy and STI/HIV prevention goals.

Supplement: Trends in Violence Victimization and Suicide Risk by Sexual Identity Among High School Students — Youth Risk Behavior Survey, United States, 2015–2019

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CDC’s most recent Youth Risk Behavior Surveillance System provides the first opportunity to examine trends of health risks among lesbian, gay, and bisexual (LGB) youth with three cycles of data. Overall LGB youth continue to experience more violence victimization and suicide risk than heterosexual youth – highlighting the continued need for policies and practices within school environments that address these disparities. This analysis uses data from the 2015, 2017, and 2019 cycles of YRBS to assess national trends in violence victimization and suicide risk among high school students by sexual identity and provides the first look at trends for LGB youth. The proportion of LGB youth experiencing both violence victimization and suicide risk remained stable during 2015–2019, except for reports of physical dating violence which decreased for LGB youth from 2015 to 2019. However, overall LGB students had greater odds of violence victimization and suicide risk than heterosexual students in all indicators assessed, including experiencing sexual dating violence, physical dating violence, bullying at school, having felt persistently sad or hopeless, and having attempted suicide. Additionally, trends stratified by sex highlight important differences between male and female experiences, as well as differences across racial/ethnic groups. These findings highlight the continued need for policies and practices within school environments and communities that reduce victimization and bolster the mental health of LGB students.

Supplement: Interpersonal Violence Victimization Among High School Students — Youth Risk Behavior Survey, United States, 2019

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Among U.S. high school students, 1 in 8 experience dating violence, 1 in 9 experience sexual violence, and 1 in 4 experience bullying.  Dating violence, sexual violence, and bullying are adverse childhood experiences (ACEs) and serious public health problems. This study examined these types of violence among U.S. high school students by sex, race/ethnicity, and sexual identity using data from the 2019 Youth Risk Behavior Survey. For this study, sexual identity options included heterosexual; lesbian, gay, or bisexual (LGB); and “not sure”, which includes students not sure of their sexual identity. Findings indicate that students who are female, LGB, and “not sure” experience higher rates of dating violence, sexual violence, and bullying victimization than male students and heterosexual students. White students experience higher rates of bullying than Hispanic and black students. Understanding who is at higher risk for experiencing these types of violence during high school can help guide prevention efforts that address ACEs and the health disparities experienced by specific populations.

Supplement: Prescription Opioid Misuse and Use of Alcohol and Other Substances Among High School Students — Youth Risk Behavior Survey, United States, 2019

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Substance use among high school students remains common despite some recent declines. Students who reported current prescription opioid misuse also commonly reported current use of other substances including marijuana and alcohol, as well as current binge drinking. Scaling up evidence-based policies, programs, and practices are important to reduce risk factors and strengthen protective factors among youth. This report includes data from CDC’s 2009–2019 national Youth Risk Behavior Surveys (YRBSs) and addresses four current substance use behaviors (marijuana use, alcohol use, binge drinking, prescription opioid misuse) and seven substance use behaviors among public and private school students in grades 9–12. Though declining, substance use among high school students remains common — with approximately 1 in 3 students reporting current alcohol use, 1 in 5 reporting current marijuana use, and 1 in 7 reporting current binge drinking. About 7% of U.S. high school students reported current prescription opioid misuse, and over 14% reported misusing prescription opioids at least once. U.S. high school students who reported current prescription opioid misuse also commonly reported current use of other substances like marijuana and alcohol, as well as current binge drinking. This report provides actionable information on prescription opioid misuse among high school students that can be applied to ongoing efforts for preventing substance use and opioid misuse, substance use disorders, and overdoses.

Supplement: Suicidal Ideation and Behaviors Among High School Students —Youth Risk Behavior Survey, United States, 2019

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Many adolescents experience suicidal ideation, make suicide plans, and attempt suicide. During 2019, approximately 1 in 5 youth seriously considered attempting suicide; 1 in 6 made a suicide plan; 1 in 11 made a suicide attempt; and 1 in 40 made a suicide attempt requiring medical treatment. Prevalence of attempting suicide was highest among females; black non-Hispanic students; lesbian, gay, or bisexual students; and students who reported having sex with persons of the same sex or with both sexes. Comprehensive suicide prevention may reduce prevalence of suicidal ideation and behaviors by:

• implementing programs, practices, and policies that prevent suicide (e.g., parenting programs),
• supporting people currently at risk (e.g., treatment/psychotherapy),
• preventing re-attempts (e.g., emergency department follow-up), and
• helping people who have lost a friend or loved one to suicide.

Media can help by following best practice recommendations for reporting on suicide, such as including prevention resources and avoiding sensational headlines that may increase risk.

Supplement: Tobacco Product Use Among High School Students — Youth Risk Behavior Survey, United States, 2019

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Although current use of cigarettes, cigars, and smokeless tobacco among U.S. high school students has decreased, tobacco product usage has evolved, and the increasing prevalence of electronic vapor product use among youths from 2015 to 2019 years is concerning. This report uses data from the 2019 Youth Risk Behavior Survey to assess use of electronic vapor products, cigarettes, cigars, and smokeless tobacco among U.S. high school students, including frequency of use, trends in use over time, and usual source of electronic vapor products. In 2019, current electronic vapor product use was 32.7%, current cigarette smoking was 6.0%, current cigar smoking was 5.7%, and current smokeless tobacco use was 3.8%. Implementing evidence-based tobacco control strategies, combined with FDA’s regulatory efforts, is important for preventing and reducing all forms of tobacco product use among youths. In addition, continued surveillance of all tobacco products is needed to guide and evaluate public health policy at the local, state, tribal, and national levels.

Supplement: Dietary and Physical Activity Behaviors Among U.S. High School Students —Youth Risk Behavior Survey, United States, 2019

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Establishing healthy dietary and physical activity behaviors early in life is a vital public health strategy for promoting lifelong physical health. Given the limited progress in improving dietary and physical activity behaviors based on data from CDC’s 2019 Youth Risk Behavior Surveys, schools, communities, and families can work together to create healthy environments where adolescents thrive. Data from CDC’s 2019 YRBS shows that the dietary and physical activity behaviors of high school students have not improved during the last 10 years, and in some cases have worsened. The only exceptions are decreases in the percentage of students who had consumed soda or sports drinks one or more times per day and those who consumed less than three glasses per day of plain water. These data support the need for multicomponent approaches, including policy and environmental changes, and opportunities for adolescents to learn about and practice making healthy choices.

Supplement: Transportation Risk Behaviors Among High School Students — Youth Risk Behavior Survey, United States, 2019

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Students engaging in one transportation risk behavior—including not always wearing a seat belt when riding in a car driven by someone else, riding with a drinking driver, drinking and driving, and texting while driving—were more likely to engage in other transportation risk behaviors. During 2019, 43.1% of U.S. high school students did not always wear a seat belt when riding in a car driven by someone else, and 16.7% rode with a drinking driver during the past 30 days. Of the approximately 60% of students who drove a car during the past 30 days, 5.4% drove after drinking alcohol and 39.0% texted or e-mailed while driving at least once during the past 30 days. Driver-related transportation risk behaviors (i.e., driving after drinking alcohol and texting while driving) usually increased with age. The association between age and these driver-related transportation risk behaviors demonstrates that it’s important to focus on preventing these behaviors throughout high school among teen drivers. Reducing all risky transportation behaviors among adolescents by using proven strategies (e.g., primary enforcement seat belt laws, publicized sobriety checkpoints, and Parent-Teen Driving Agreements) can help prevent crashes, reduce injuries, and save lives.

National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13-17 Years – United States, 2019

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New data published by CDC reveal continued improvement in HPV and meningococcal vaccination rates among U.S. adolescents in 2019, while also highlighting continued disparities in those rates based on geography. Despite the steady, overall progress in adolescent vaccination rates, the COVID-19 pandemic now threatens to reverse some of these gains. CDC analyzed data from the 2019 National Immunization Survey-Teen (NIS-Teen) to estimate vaccination coverage among adolescents aged 13-17 years in the United States. In 2019, 71.5% of adolescents received  one more doses of HPV vaccine, and 54.2% were up-to-date with the HPV vaccination series. That is an increase from 2018, with 68% of respondents having received one or more doses, and 51% being up-to-date with the HPV vaccination series. Among adolescents living at or above the poverty level, those living in rural areas had lower coverage for HPV and meningococcal vaccines compared to those in urban areas. These two vaccinations, along with Tdap, are routinely recommended for adolescents to prevent diseases including pertussis (or whooping cough), meningococcal disease, and cancers caused by HPV. Despite the steady, overall progress in adolescent vaccination rates, the COVID-19 pandemic now threatens to reverse some of these gains. CDC data show adolescent vaccine orders have slowed in the U.S. this year, with the pandemic causing delays and decreases in the number of adolescents getting their recommended vaccines. Although there have been some recent rebounds in these vaccine ordering rates, everyone must remain vigilant in efforts to ensure that children of all ages get the vaccines they need to protect against serious and sometimes deadly disease.

Overdose Education and Naloxone Distribution within Syringe Service Programs – United States, 2019

Cobey Culton
RTI International
Communications Specialist, External Communications
Office Phone: 919-541-7340
Cell Phone: 919-282-6754
cculton@rti.org

Scaling-up overdose education and naloxone distribution (OEND) programs within syringe service programs (SSPs) could be a critical component of opioid overdose prevention efforts, especially in areas of the country with high rates of death from opioid overdose. OEND programs train laypersons to be responders during overdose events and provide access to naloxone and directions for drug delivery. Ensuring that SSPs have adequate resources and staffing as well as supportive legal environments for OEND programming is a critical component to achieving these goals. A 2019 survey showed that 94% of syringe service programs (SSPs) distribute naloxone. Yet, the scale of naloxone distribution from SSPs varied substantially throughout the United States. SSPs located in some regions with high rates of death from opioid overdose had a low number of naloxone doses distributed and number of people receiving naloxone. Scaling-up SSP-based naloxone distribution is a critical component to prevent opioid overdose deaths, especially in areas of the country with high opioid overdose mortality rates. Ensuring that SSPs have adequate resources and staffing, as well as supportive legal environments, for OEND programming might be a critical component to achieving these goals.

Disparities in Incidence of COVID-19 Among Underrepresented Racial/Ethnic Groups in Counties Identified as Hotspots During June 5–18, 2020 — 22 States, February–June 2020

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Trends in Number and Distribution of COVID-19 Hotspot Counties — United States, March 8–July 15, 2020

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Racial and Ethnic Disparities Among COVID-19 Cases in Workplace Outbreaks by Industry Sector — Utah, March 6–June 5, 2020

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Mass Testing for SARS-CoV-2 in 16 Prisons and Jails — Six Jurisdictions, United States, April–May 2020

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People who are incarcerated/detained are required to live, work, eat, study, and participate in activities within congregate environments, heightening the potential for respiratory diseases like COVID-19 to spread. Data from broad-based/mass testing (offering testing to everyone in at least one housing unit regardless of symptoms) in 16 prisons and jails in six jurisdictions showed that COVID-19 prevalence can be very high in correctional and detention settings. Mass testing of people who are incarcerated or detained identified 12 times more COVID-19 cases compared with earlier symptom-based testing in facilities alone. Median prevalence was three times higher in dorm-based housing than cell-based housing. Jurisdictions were selected for the study based on previous discussions with investigators about mass testing events that had already occurred. Information in this study represents 16 adult prisons and jails that shared data collected during mass testing events from April 11 – May 20, 2020, and symptom-based testing that occurred before this time period.

• COVID-19 Prevention Practices in State Prisons — Puerto Rico, 2020

In mid-March, Puerto Rico began managing all state prisons according to a new protocol based on CDC’s interim guidance on management of COVID-19 in correctional and detention facilities, which aimed to slow the spread of COVID-19 in these high-risk congregate settings. The protocol featured various preventive measures including visitor restrictions, rigorous testing for COVID-19 during intake, grouping asymptomatic prisoners together during intake, and enhanced cleaning, among other measures. During March 16-July 31, 2020, 1,340 people in Puerto Rico entered the state prison system, and two tested positive for COVID-19. Neither individual showed symptoms. According to this report, efforts to slow the spread of COVID-19 through measures like intake screening and cohorting likely helped prevent an outbreak in the Puerto Rican state prison population. Additionally, this is an example of the successful implementation of CDC’s guidelines for correctional facilities.

• Death Rates from Stroke Among Persons Aged ≥65 Years, by Sex and Age Group — National Vital Statistics System, United States, 2018

• Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2020–21 Influenza Season

This report provides updated recommendations for influenza vaccination for the 2020-2021 flu season. Because the viruses that cause flu and COVID-19 might spread at the same time this fall and winter, getting a flu vaccine is particularly important as a way to reduce the amount of flu disease and symptoms that may be confused with COVID-19, and to reduce stress on the U.S. healthcare system. CDC and ACIP recommend yearly flu vaccination for all people 6 months of age and older. This season inactivated influenza vaccines, recombinant influenza vaccines, and live attenuated influenza vaccines are expected to be available. New for the 2020-21 flu season, two new flu vaccines have been licensed for use in people aged 65 years and older: a quadrivalent (4-component) high-dose flu vaccine and a quadrivalent adjuvanted flu vaccine. Both vaccines are intended to produce a better immune response in people 65 years of age and older, and, therefore, better protection. Previously, high-dose and adjuvanted flu vaccines were only available in trivalent formulations. There is no preferential recommendation for one flu vaccine over another for people for whom more than one licensed, recommended and appropriate vaccine is available.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CDC works 24/7 protecting America’s health, safety and security. Whether diseases start at home or abroad, are curable or preventable, chronic or acute, or from human activity or deliberate attack, CDC responds to America’s most pressing health threats. CDC is headquartered in Atlanta and has experts located throughout the United States and the world.