Sexual Identity, Sex of Sexual Contacts, and Health-Risk Behaviors Among Students in Grades 9-12: Youth Risk Behavior Surveillance, Selected Sites, United States, 2001-2009

2011·1.8 MB·English

by  Kann, Laura, Chen, David, Harris, William A., Kinchen, Steve, McManus, Tim, Olsen, Emily O'Malley, Wechsler, Howell

Morbidity and Mortality Weekly Report
Early Release / Vol. 60 June 6, 2011
Sexual Identity, Sex of Sexual Contacts,
and Health-Risk Behaviors Among Students
in Grades 9–12 — Youth Risk Behavior
Surveillance, Selected Sites,
United States, 2001–2009
U.S. Department of Health and Human Services
Centers for Disease Control and Prevention
Early Release
CONTENTS
Introduction ............................................................................................................2
Methods ....................................................................................................................2
Results .......................................................................................................................5
Discussion .............................................................................................................43
Conclusion ............................................................................................................49
References .............................................................................................................50
Tables ......................................................................................................................51
The MMWR series of publications is published by the Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC),
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Suggested Citation: Centers for Disease Control and Prevention. [Title]. MMWR Early Release 2011;60[Date]:[inclusive page numbers].
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Early Release
Sexual Identity, Sex of Sexual Contacts, and Health-Risk Behaviors
Among Students in Grades 9–12 — Youth Risk Behavior Surveillance,
Selected Sites, United States, 2001–2009
Laura Kann, PhD
Emily O’Malley Olsen, MSPH
Tim McManus, MS
Steve Kinchen
David Chyen, MS
William A. Harris, MM
Howell Wechsler, EdD
Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
Abstract
Problem: Sexual minority youths are youths who identify themselves as gay or lesbian, bisexual, or unsure of their sexual identity
or youths who have only had sexual contact with persons of the same sex or with both sexes. Population-based data on the health-
risk behaviors practiced by sexual minority youths are needed at the state and local levels to most effectively monitor and ensure
the effectiveness of public health interventions designed to address the needs of this population.
Reporting Period Covered: January 2001–June 2009
Description of the System: The Youth Risk Behavior Surveillance System (YRBSS) monitors priority health-risk behaviors
(behaviors that contribute to unintentional injuries, behaviors that contribute to violence, behaviors related to attempted suicide,
tobacco use, alcohol use, other drug use, sexual behaviors, dietary behaviors, physical activity and sedentary behaviors, and weight
management) and the prevalence of obesity and asthma among youths and young adults. YRBSS includes state and local school-
based Youth Risk Behavior Surveys (YRBSs) conducted by state and local education and health agencies. This report summarizes
results from YRBSs conducted during 2001–2009 in seven states and six large urban school districts that included questions on
sexual identity (i.e., heterosexual, gay or lesbian, bisexual, or unsure), sex of sexual contacts (i.e., same sex only, opposite sex only,
or both sexes), or both of these variables. The surveys were conducted among large population-based samples of public school
students in grades 9–12.
Results: Across the nine sites that assessed sexual identity, the prevalence among gay or lesbian students was higher than the preva-
lence among heterosexual students for a median of 63.8% of all the risk behaviors measured, and the prevalence among bisexual
students was higher than the prevalence among heterosexual students for a median of 76.0% of all the risk behaviors measured.
In addition, the prevalence among gay or lesbian students was more likely to be higher than (rather than equal to or lower than)
the prevalence among heterosexual students for behaviors in seven of the 10 risk behavior categories (behaviors that contribute to
violence, behaviors related to attempted suicide, tobacco use, alcohol use, other drug use, sexual behaviors, and weight manage-
ment). Similarly, the prevalence among bisexual students was more likely to be higher than (rather than equal to or lower than)
the prevalence among heterosexual students for behaviors in eight of the 10 risk behavior categories (behaviors that contribute
to unintentional injuries, behaviors that contribute to violence, behaviors related to attempted suicide, tobacco use, alcohol use,
other drug use, sexual behaviors, and weight management).
Across the 12 sites that assessed sex of sexual contacts, the prevalence among students who had sexual contact with both sexes
was higher than the prevalence among students who only had sexual contact with the opposite sex for a median of 71.1% of all
the risk behaviors measured, and the prevalence among students who only had sexual contact with the same sex was higher than
the prevalence among students who only had sexual contact with the opposite sex for a median of 29.7% of all the risk behaviors
measured. Furthermore, the prevalence among students who had sexual contact with both sexes was more likely to be higher
than (rather than equal to or lower than) the prevalence among
students who only had sexual contact with the opposite sex for
Corresponding author: Laura Kann, PhD, Division of Adolescent
behaviors in six of the 10 risk behavior categories (behaviors
and School Health, National Center for Chronic Disease Prevention
and Health Promotion, MS K-33, 4770 Buford Hwy, NE, Atlanta, that contribute to violence, behaviors related to attempted
GA 30341. Telephone: [phone]; Fax: [phone]; E-mail: suicide, tobacco use, alcohol use, other drug use, and weight
[email protected].
management). The prevalence among students who only had
MMWR / June 6, 2011 / Vol. 60 1
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sexual contact with the same sex was more likely to be higher than (rather than equal to or lower than) the prevalence among
students who only had sexual contact with the opposite sex for behaviors in two risk behavior categories (behaviors related to
attempted suicide and weight management).
Interpretation: Sexual minority students, particularly gay, lesbian, and bisexual students and students who had sexual contact
with both sexes, are more likely to engage in health-risk behaviors than other students.
Public Health Action: Effective state and local public health and school health policies and practices should be developed to help
reduce the prevalence of health-risk behaviors and improve health outcomes among sexual minority youths. In addition, more
state and local surveys designed to monitor health-risk behaviors and selected health outcomes among population-based samples
of students in grades 9–12 should include questions on sexual identity and sex of sexual contacts.
Introduction health outcomes by sexual minority status (defined by sexual
identity or by sex of sexual contacts) as reported by large
Sexual minority youths may be defined in at least two ways:
population-based samples of high school students will provide
by sexual identity or by the sex of their sexual contacts. Sexual
additional information about sexual minority youths and might
minority youths defined by sexual identity include those who
help reduce the health disparities they experience (8,10,11).
identify themselves as gay, lesbian, or bisexual or who are
This report summarizes results from YRBSs conducted
unsure of their sexual identity. Sexual minority youths defined
during 2001–2009 from seven states and six large urban
by the sex of their sexual contacts include those who have only
school districts that included questions on sexual identity,
had sexual contact with persons of the same sex or with both
sex of sexual contacts, or both. The prevalence of health-risk
sexes. Youths who identify themselves as heterosexual, gay,
behaviors and obesity and overweight is compared among
lesbian, or bisexual might not have had any sexual contact.
subgroups of students defined by sexual identity and by sex of
Furthermore, youths who have only had sexual contact with
sexual contacts. All surveys were conducted during the spring
persons of the same sex or with both sexes might identify
semester of each survey year.
themselves as heterosexual, and youths who have only had
sexual contact with persons of the opposite sex might identify
themselves as gay, lesbian, or bisexual. Some youths who Methods
eventually identify themselves as a sexual minority or only
Detailed information about the state and local YRBSs has
have sexual contact with persons of the same sex or both sexes
been published elsewhere (9). Information also is available at
might not identify themselves as a sexual minority and might
http://www.cdc.gov/yrbs.
not have had any sexual contact. This dissonance between
sexual identity and sex of sexual contacts is well documented,
particularly among youths (1–7). Inclusion Criteria
Sexual minority youths have specific health needs and are at
States and cities that included questions on sexual identity,
disproportionate risk for certain health problems. However,
the sex of sexual contacts, or both and had weighted YRBS
as described in a recent Institute of Medicine (IOM) report,
data were eligible for inclusion in this report. To ensure
more data about sexual minority youths are needed (8). CDC
stable estimates, each state and city was required to have ≥75
developed the Youth Risk Behavior Surveillance System
students per subgroup defined by sexual identity and sex of
(YRBSS) to monitor priority health-risk behaviors and selected
sexual contacts. To meet this minimum subgroup sample size
health outcomes among all youths and young adults (9). The
requirement, multiple years of weighted YRBS data collected
YRBSS includes biennial, school-based Youth Risk Behavior
during 2001–2009 were combined by site (Table 1).
Surveys (YRBSs) conducted among population-based samples
Five states (Delaware, Maine, Massachusetts, Rhode Island,
of students in grades 9–12 in participating states and large
and Vermont) and four large urban school districts (Boston,
urban school districts. To address the lack of knowledge about
Massachusetts; Chicago, Illinois; New York City, New York;
the health-risk behaviors and selected health outcomes among
and San Francisco, California) asked a question on sexual
sexual minority students at the state and local levels, state and
identity and met the subgroup sample size requirement. Seven
local agencies participating in YRBSS may add questions to
states (Connecticut, Delaware, Maine, Massachusetts, Rhode
their YRBS questionnaire to measure sexual identity, sex of
Island, Vermont, and Wisconsin) and five large urban school
sexual contacts, or both. Understanding state-level and local-
districts (Boston; Chicago; Milwaukee, Wisconsin; New York
level differences in the prevalence of health-risk behaviors and
2 MMWR / June 6, 2011 / Vol. 60
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City; and San Diego, California) asked a question on the sex of Data Processing Procedures
sexual contacts and met the subgroup sample size requirement. and Response Rates
Five states (Delaware, Maine, Massachusetts, Rhode Island,
Data from each state and local YRBS were cleaned and
and Vermont) and three large urban school districts (Boston,
edited for inconsistencies using standard procedures each
Chicago, and New York City) asked questions on both sexual
survey year. Among the surveys included in this report, the
identity and sex of sexual contacts and met the subgroup sample
number of completed questionnaires that failed quality control
size requirement.
checks and were excluded from analysis ranged from 0 to 249
(median: 12). School response rates ranged from 73% to 100%,
Sampling
student response rates ranged from 63% to 90%, and overall
Each state and local YRBS included in this report used an response rates ranged from 60% to 90%. After the data from
independent, cross-sectional, two-stage cluster sample design multiple survey years were combined by site, the total sample
to produce a representative sample of public school students in sizes used for this report ranged from 3,733 to 36,774 (Table
grades 9–12 in their jurisdiction. In the first sampling stage in 2). Demographic characteristics of the samples varied by site.
Connecticut, Maine, Massachusetts, Rhode Island, Vermont, For most sites in most survey years, the sexual identity of
Wisconsin, Chicago, Milwaukee, and New York City, schools students was based on responses to the optional YRBS question,
with any of the grades 9–12 were sampled with probability “Which of the following best describes you?” and the response
proportional to school enrollment size. In Delaware, Boston, options 1) “heterosexual (straight),” 2) “gay or lesbian,” 3)
San Diego, and San Francisco, all schools with any of the grades “bisexual,” and 4) “not sure.” This optional YRBS question
9–12 were sampled. In the second sampling stage, intact classes was modified by three sites in selected survey years. In 2007
from either a required subject (e.g., English or social studies) and 2009, New York City changed the response options for
or a required period (e.g., homeroom or second period) were this question to “heterosexual or straight,” “gay or lesbian,”
sampled randomly, and all students in the sampled classes were “bisexual,” and “not sure.” In 2003 and 2005, Delaware
eligible to participate. In Vermont, all students in sampled changed the response options for this question to “heterosexual
schools were eligible to participate. (straight),” “homosexual (gay or lesbian),” “bisexual,” “not
sure,” and “none of the above.” The 49 students in 2003 and
Data Collection Procedures 40 students in 2005 who selected “none of the above” were
and Questionnaires excluded from the sexual identity analyses. In 2007, Delaware
changed the response options for this question to “heterosexual
Survey procedures for each state and local YRBS were
(straight),” “homosexual (gay or lesbian),” “bisexual,” and “not
designed to protect student privacy by allowing for anonymous
sure.” In 2001, the San Francisco survey asked “How would
and voluntary participation. Before survey administration,
you describe your sexual orientation/preference?” with response
local parental permission procedures were followed. Students
options “heterosexual, attracted to the opposite sex,” “bisexual,
completed the self-administered questionnaire during one class
attracted to both sexes,” “homosexual, gay or lesbian,” and “not
period and recorded their responses directly on a computer-
sure.” In this report, students who responded to the question
scannable booklet or answer sheet.
on sexual identity were classified as heterosexual, gay or lesbian,
Each survey year, the standard YRBS questionnaire contained
bisexual, or unsure.
approximately 87 questions. Sites could add or delete questions
For most sites in most survey years, the sex of the students’
from the standard questionnaire. A YRBS optional question list
sexual contacts was based on responses to 1) the standard
was provided to all sites and was the source for the questions
YRBS question, “What is your sex?” and the response options
on sexual identity and the sex of sexual contacts for most sites.
“female” and “male” and 2) the optional YRBS question,
To protect student privacy, skip patterns were not included in
“During your life, with whom have you had sexual contact?”
any YRBS questionnaire, which ensured that all students took
and the response options “I have never had sexual contact,”
about the same amount of time to complete the questionnaire.
“females,” “males,” and “females and males.” This optional
Information about the reliability of most of the questions on
YRBS question was modified by seven sites in selected survey
the standard questionnaire has been published elsewhere (12).
years. Maine modified this question in 2001, 2003, and 2005
to “The person(s) with whom you have had sexual contact
during your life is (are),” with the response options “I have
never had sexual contact,” “female,” “male,” and “male and
female.” Massachusetts and Boston in 2001, 2003, and 2005
MMWR / June 6, 2011 / Vol. 60 3
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and Chicago in 2003 asked, “During your life, the person(s) first question and for students who answered “no” to the first
with whom you have had sexual contact is (are),” with the question but did not answer the second question.
response options “I have not had sexual contact with anyone,” Students were classified as obese or overweight based on
“female(s),” “male(s),” and “female(s) and male(s).” Delaware their body mass index (BMI), measured as kilograms/meters2
in 2003 and 2005; Vermont in 2001, 2003, 2005, 2007, and (kg/m2). BMI was calculated from responses to two standard
2009; and San Diego in 2001, 2003, and 2005 asked, “With YRBS questions assessing self-reported height and weight.
whom have you had sexual intercourse?” with the response The BMI values were compared with sex- and age-specific
options “I have never had sexual intercourse,” “females,” reference data from the 2000 CDC growth charts (13).
“males,” and “females and males.” Delaware in 2007 and 2009 Obese was defined as a BMI of ≥95th percentile for age and
asked, “During your life, with whom have you had sexual sex. Overweight was defined as a BMI of ≥85th percentile
intercourse?” with the response options “I have never had sexual and <95th percentile for age and sex. These classifications are
intercourse,” “females,” “males,” and “females and males.” In not intended to diagnose obesity or overweight in individual
this report, students who responded to the question on the students but to provide estimates of obesity and overweight
sex of sexual contacts were classified as students who only had for the populations of students surveyed.
sexual contact with the opposite sex, students who only had
sexual contact with the same sex, or students who had sexual Weighting
contact with both sexes. Students who had never had sexual
For each survey included in this report, a weight was applied
contact were excluded from these analyses.
to each student record to adjust for student nonresponse and
Since 2001, race/ethnicity has been assessed by the standard
the distribution of students by grade, sex, and race/ethnicity
YRBS questionnaire two ways. In 2001, 2003, and 2005,
in each site. Therefore, weighted state and local estimates are
race/ethnicity was based on responses to one standard YRBS
representative of all students in grades 9–12 attending public
question: “How do you describe yourself? (select one or more
schools in each site.
responses),” with response options “American Indian or Alaska
Native,” “Asian,” “black or African American,” “Hispanic or
Analytic Methods
Latino,” “Native Hawaiian or other Pacific Islander,” and
“white.” In this report, students are classified as Hispanic/ Statistical analyses were conducted on weighted data using
Latino and are referred to as Hispanic if they selected Hispanic statistical software (14,15) to account for the complex sample
or Latino only or with any other response option. Students are designs. For every site and each subgroup of students categorized
classified as black or African American and referred to as black by sexual identity (i.e., heterosexual, gay or lesbian, bisexual, or
if they selected black or African American and did not select unsure) and sex of sexual contacts (i.e., opposite sex only, same
Hispanic or Latino. Students who did not select Hispanic or sex only, or both sexes), prevalence estimates and confidence
Latino and selected white are classified as white and referred intervals were computed for 76 behaviors distributed across 10
to as white. categories of health-risk behaviors (behaviors that contribute
In 2007 and 2009, race/ethnicity was based on responses to to unintentional injuries; behaviors that contribute to
two standard YRBS questions: “Are you Hispanic or Latino?” violence; behaviors related to attempted suicide; tobacco use;
with response options “yes” or “no” and “What is your alcohol use; other drug use; sexual behaviors that contribute
race? (select one or more responses),” with response options to unintended pregnancy and sexually transmitted diseases,
“American Indian or Alaska Native,” “Asian,” “black or African including human immunodeficiency virus [HIV] infection;
American,” “Native Hawaiian or other Pacific Islander,” or dietary behaviors; physical activity and sedentary behaviors;
“white.” In this report, students are classified as Hispanic/ and weight management), as well as obesity and overweight.
Latino and referred to as Hispanic if they responded “yes” to Only variables assessed in at least two YRBS cycles during
the first question, regardless of how they answered the second 2001–2009 were included. For condom use, female students
question. Students who responded “no” to the first question who only had sexual contact with females were excluded from
and selected only black or African American for the second the analyses. For birth control pill use, Depo-Provera use, birth
question are classified as black or African American and are control pill use or Depo-Provera use, and condom use and
referred to as black. Students who responded “no” to the first birth control pill or Depo-Provera use, all students who only
question and selected only white for the second question are had sexual contact with the same sex were excluded from the
classified as white and referred to as white. Race/ethnicity analyses. For all variables assessed, percentages for the variables
was classified as missing for students who did not answer the are only reported if the denominator was ≥25 cases.
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Differences in prevalence estimates among subgroups of only had sexual contact with the same sex ranged from 0.7% to
students defined by sexual identity and sex of sexual contacts 3.9% (median: 2.5%), and had sexual contact with both sexes
were identified by t-tests, and differences were considered ranged from 1.9% to 4.9% (median: 3.3%). The percentage
statistically significant if a t-test p value was <0.05. Only of students who had no sexual contact ranged from 30.4% to
statistically significant differences in prevalence estimates 59.3% (median: 40.5%).
are reported for each variable in the results section in the Across the eight sites that assessed both sex of sexual contacts
following order: for sexual identity — heterosexual vs. gay or and sexual identity, the percentage of students who identified
lesbian, heterosexual vs. bisexual, heterosexual vs. unsure, gay themselves as heterosexual ranged from 94.9% to 97.7%
or lesbian vs. bisexual, gay or lesbian vs. unsure, and bisexual (median: 96.3%) among students who only had sexual contact
vs. unsure; for sex of sexual contacts — opposite sex only vs. with the opposite sex, from 17.0% to 77.8% (median: 61.7%)
same sex only, opposite sex only vs. both sexes, and same sex among students who only had sexual contact with the same sex,
only vs. both sexes. and from 17.3% to 63.4% (median: 29.8%) among students
To produce estimates by sex and race/ethnicity and maintain who had sexual contact with both sexes. The percentage of
subgroups of ≥75 students, gay or lesbian and bisexual students students who identified themselves as gay or lesbian ranged
were combined to form a sexual minority subgroup based on from 0.0% to 0.8% (median: 0.4%) among students who only
sexual identity, and students who only had sexual contact with had sexual contact with the opposite sex, from 10.8% to 60.0%
the same sex and students who had sexual contact with both (median: 21.7%) among students who only had sexual contact
sexes were combined to form another sexual minority subgroup with the same sex, and from 2.3% to 14.7% (median: 9.1%)
based on any sexual contact with persons of the same sex. As a among students who had sexual contact with both sexes. The
result, estimates were calculated by 1) sex and sexual identity percentage of students who identified themselves as bisexual
and 2) sex and sex of sexual contacts for all sites, as well as by ranged from 1.2% to 3.3% (median: 2.0%) among students
1) race/ethnicity (i.e., black, Hispanic, and white) and sex of who only had sexual contact with the opposite sex, from 6.6%
sexual contacts for Massachusetts and New York City and 2) to 22.3% (median: 11.3%) among students who only had
race/ethnicity and sexual identity for New York City. sexual contact with the same sex, and from 24.9% to 61.9%
To summarize the variations in prevalence of health-risk (median: 50.9%) among students who had sexual contact
behaviors (overall and for the 10 categories of health-risk with both sexes. The percentage of students who were unsure
behaviors) among subgroups of students (i.e., gay or lesbian of their sexual identity ranged from 0.6% to 2.1% (median:
vs. heterosexual, bisexual vs. heterosexual, same sex only vs. 1.4%) among students who only had sexual contact with the
opposite sex only, and both sexes vs. opposite sex only), the opposite sex, from 0.7% to 6.6% (median: 4.4%) among
percentage of each possible t-test outcome (i.e., higher, lower, or students who only had sexual contact with the same sex, and
equal to [i.e., no statistical difference]) across the total number from 6.1% to 15.9% (median: 10.1%) among students who
of comparisons was calculated by site, and a median and range had sexual contact with both sexes (Table 4).
were calculated for all sites combined. For this analysis, all
behaviors were recalculated in the greater risk direction (e.g., Behaviors that Contribute to
did not use a condom at last sexual intercourse rather than
Unintentional Injuries
used a condom at last sexual intercourse). Furthermore, obesity
and overweight were excluded from these summary analyses. Rarely or Never Wore a Seatbelt
Across the nine sites (Delaware, Maine, Massachusetts,
Results Rhode Island, Vermont, Boston, Chicago, New York City,
and San Francisco) that assessed having never or rarely worn
Across the nine sites that assessed sexual identity, the a seatbelt when riding in a car driven by someone else and
percentage of students who identified themselves as sexual identity, the prevalence of having rarely or never worn
heterosexual ranged from 90.3% to 93.6% (median: 93.0%), a seatbelt ranged from 7.1% to 23.2% (median: 12.3%)
as gay or lesbian ranged from 1.0% to 2.6% (median: 1.3%), among heterosexual students, from 13.1% to 35.8% (median:
and as bisexual ranged from 2.9% to 5.2% (median: 3.7%) 21.0%) among gay or lesbian students, from 11.3% to 28.8%
(Table 3). The percentage of students who were unsure of their (median: 20.4%) among bisexual students, and from 11.5%
sexual identity ranged from 1.3% to 4.7% (median 2.5%). to 23.5% (median: 18.7%) among unsure students (Table 5).
Across the 12 sites that assessed sex of sexual contacts, the The prevalence of having rarely or never worn a seatbelt was
percentage of students who only had sexual contact with the lower among heterosexual than gay or lesbian students in five
opposite sex ranged from 37.2% to 60.9% (median: 53.5%),
MMWR / June 6, 2011 / Vol. 60 5
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sites (Delaware, Massachusetts, Rhode Island, Vermont, and than unsure students in three sites (Vermont, New York City,
Boston), lower among heterosexual than bisexual students in six and San Francisco), and higher among bisexual than unsure
sites (Delaware, Massachusetts, Rhode Island, Vermont, New students in five sites (Massachusetts, Rhode Island, Vermont,
York City, and San Francisco), and lower among heterosexual Boston, and New York City).
than unsure students in four sites (Massachusetts, Vermont, Across the 12 sites (Connecticut, Delaware, Maine,
New York City, and San Francisco). The prevalence of having Massachusetts, Rhode Island, Vermont, Wisconsin, Boston,
rarely or never worn a seatbelt was higher among gay or lesbian Chicago, Milwaukee, New York City, and San Diego) that
than bisexual students in one site (Massachusetts) and higher assessed having rarely or never worn a bicycle helmet and sex
among gay or lesbian than unsure students in three sites of sexual contacts, the prevalence of having rarely or never
(Massachusetts, Rhode Island, and Vermont). worn a bicycle helmet ranged from 74.0% to 96.2% (median:
Across the 12 sites (Connecticut, Delaware, Maine, 89.7%) among students who only had sexual contact with the
Massachusetts, Rhode Island, Vermont, Wisconsin, Boston, opposite sex, from 70.6% to 94.8% (median: 88.3%) among
Chicago, Milwaukee, New York City, and San Diego) that students who only had sexual contact with the same sex, and
assessed having rarely or never worn a seatbelt and sex of from 76.0% to 98.6% (median: 88.5%) among students
sexual contacts, the prevalence of having rarely or never worn a who had sexual contact with both sexes. The prevalence of
seatbelt ranged from 8.5% to 29.7% (median: 15.2%) among having rarely or never worn a bicycle helmet was lower among
students who only had sexual contact with the opposite sex, students who only had sexual contact with the opposite sex
from 14.3% to 29.3% (median: 22.4%) among students who than students who only had sexual contact with the same
only had sexual contact with the same sex, and from 13.4% sex in one site (Maine), lower among students who only had
to 29.8% (median: 20.2%) among students who had sexual sexual contact with the opposite sex than students who had
contact with both sexes. The prevalence of having rarely sexual contact with both sexes in two sites (Massachusetts
or never worn a seatbelt was lower among students who and Wisconsin), higher among students who only had sexual
only had sexual contact with the opposite sex than students contact with the opposite sex than students who had sexual
who only had sexual contact with the same sex in four sites contact with both sexes in one site (New York City), and higher
(Massachusetts, Rhode Island, Vermont, and Wisconsin) and among students who only had sexual contact with the same
lower among students who only had sexual contact with the sex than students who had sexual contact with both sexes in
opposite sex than students who had sexual contact with both one site (Connecticut).
sexes in four sites (Delaware, Massachusetts, Vermont, and
Rode with a Driver Who Had Been
New York City).
Drinking Alcohol
Rarely or Never Wore a Bicycle Helmet
Across the nine sites (Delaware, Maine, Massachusetts,
Across the nine sites (Delaware, Maine, Massachusetts, Rhode Island, Vermont, Boston, Chicago, New York City, and
Rhode Island, Vermont, Boston, Chicago, New York City, San Francisco) that assessed having ridden, one or more times
and San Francisco) that assessed, among students who had during the 30 days before the survey, in a car or other vehicle
ridden a bicycle during the 12 months before the survey, driven by someone who had been drinking alcohol and sexual
having rarely or never worn a bicycle helmet and sexual identity, the prevalence of having ridden with a driver who had
identity, the prevalence of having rarely or never worn a been drinking alcohol ranged from 17.1% to 30.5% (median:
bicycle helmet ranged from 58.6% to 95.3% (median: 81.0%) 22.9%) among heterosexual students, from 16.6% to 46.3%
among heterosexual students, from 64.6% to 88.0% (median: (median: 36.5%) among gay or lesbian students, from 20.1%
78.4%) among gay or lesbian students, from 61.2% to 91.7% to 41.6% (median: 33.6%) among bisexual students, and from
(median: 87.0%) among bisexual students, and from 53.2% 19.0% to 50.1% (median: 32.0%) among unsure students
to 84.6% (median: 67.4%) among unsure students (Table 6). (Table 7). The prevalence of having ridden with a driver who
The prevalence of having rarely or never worn a bicycle helmet had been drinking alcohol was lower among heterosexual than
was lower among heterosexual than bisexual students in four gay or lesbian students in three sites (Massachusetts, Vermont,
sites (Delaware, Massachusetts, Rhode Island, and Vermont) and Chicago), lower among heterosexual than bisexual students
and higher among heterosexual than unsure students in four in six sites (Delaware, Massachusetts, Rhode Island, Vermont,
sites (Boston, Chicago, New York City, and San Francisco). Boston, and San Francisco), and lower among heterosexual
The prevalence of having rarely or never worn a bicycle helmet than unsure students in two sites (Maine and Vermont).
was lower among gay or lesbian than bisexual students in two Across the 12 sites (Connecticut, Delaware, Maine,
sites (Delaware and Vermont), higher among gay or lesbian Massachusetts, Rhode Island, Vermont, Wisconsin, Boston,
6 MMWR / June 6, 2011 / Vol. 60
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Chicago, Milwaukee, New York City, and San Diego) that Chicago, Milwaukee, New York City, and San Diego) that
assessed having ridden with a driver who had been drinking assessed having driven when they had been drinking alcohol
alcohol and sex of sexual contacts, the prevalence of having and sex of sexual contacts, the prevalence of having driven
ridden with a driver who had been drinking alcohol ranged when they had been drinking alcohol ranged from 4.2% to
from 20.3% to 38.5% (median: 33.2%) among students who 17.6% (median: 13.8%) among students who only had sexual
only had sexual contact with the opposite sex, from 31.8% contact with the opposite sex, from 7.2% to 22.5% (median:
to 45.2% (median: 37.8%) among students who only had 16.5%) among students who only had sexual contact with
sexual contact with the same sex, and from 27.9% to 52.6% the same sex, and from 9.3% to 35.0% (median: 19.3%)
(median: 42.1%) among students who had sexual contact with among students who had sexual contact with both sexes. The
both sexes. The prevalence of having ridden with a driver who prevalence of having driven when they had been drinking
had been drinking alcohol was lower among students who alcohol was lower among students who only had sexual contact
only had sexual contact with the opposite sex than students with the opposite sex than students who had sexual contact
who only had sexual contact with the same sex in one site with both sexes in nine sites (Connecticut, Delaware, Maine,
(Wisconsin), lower among students who only had sexual Massachusetts, Rhode Island, Vermont, Boston, Milwaukee,
contact with the opposite sex than students who had sexual and New York City) and lower among students who only had
contact with both sexes in eight sites (Connecticut, Delaware, sexual contact with the same sex than students who had sexual
Maine, Massachusetts, Rhode Island, Vermont, Boston, and contact with both sexes in four sites (Maine, Massachusetts,
San Diego), and lower among students who only had sexual Rhode Island, and Vermont).
contact with the same sex than students who had sexual contact
with both sexes in three sites (Connecticut, Massachusetts, Behaviors that Contribute to Violence
and Vermont).
Carried a Weapon
Drove When Drinking Alcohol
Across the eight sites (Delaware, Maine, Massachusetts,
Across the nine sites (Delaware, Maine, Massachusetts,
Rhode Island, Boston, Chicago, New York City, and San
Rhode Island, Vermont, Boston, Chicago, New York City, and
Francisco) that assessed having carried a weapon (e.g., a gun,
San Francisco) that assessed having driven a car or other vehicle
knife, or club) on at least 1 day during the 30 days before the
one or more times when they had been drinking alcohol during
survey and sexual identity, the prevalence of having carried
the 30 days before the survey and sexual identity, the prevalence
a weapon ranged from 9.8% to 17.6% (median: 13.6%)
of having driven when they had been drinking alcohol ranged
among heterosexual students, from 19.8% to 31.0% (median:
from 2.9% to 10.2% (median: 7.8%) among heterosexual
22.9%) among gay or lesbian students, from 18.9% to 36.5%
students, from 7.0% to 30.2% (median: 15.4%) among gay
(median: 22.5%) among bisexual students, and from 8.1%
or lesbian students, from 6.0% to 18.3% (median: 13.3%)
to 34.5% (median: 20.4%) among unsure students (Table 9).
among bisexual students, and from 2.1% to 19.5% (median:
The prevalence of having carried a weapon was lower among
16.3%) among unsure students (Table 8). The prevalence
heterosexual than gay or lesbian students in five sites (Delaware,
of having driven when they had been drinking alcohol was
Massachusetts, Rhode Island, New York City, and San
lower among heterosexual than gay or lesbian students in five
Francisco), lower among heterosexual than bisexual students
sites (Delaware, Massachusetts, Vermont, Boston, and New
in all eight sites, and lower among heterosexual than unsure
York City), lower among heterosexual than bisexual students
students in two sites (Massachusetts and New York City). The
in seven sites (Delaware, Massachusetts, Vermont, Boston,
prevalence of having carried a weapon was higher among gay
Chicago, New York City, and San Francisco), and lower among
or lesbian than bisexual students in one site (Massachusetts),
heterosexual than unsure students in five sites (Delaware,
higher among gay or lesbian than unsure students in one
Massachusetts, Vermont, Boston, and New York City). The
site (San Francisco), and higher among bisexual than unsure
prevalence of having driven when they had been drinking
students in one site (San Francisco).
alcohol was higher among gay or lesbian than bisexual students
Across the 11 sites (Connecticut, Delaware, Maine,
in two sites (Massachusetts and Vermont), higher among gay
Massachusetts, Rhode Island, Wisconsin, Boston, Chicago,
or lesbian than unsure students in two sites (Massachusetts and
Milwaukee, New York City, and San Diego) that assessed
Vermont), and higher among bisexual than unsure students in
having carried a weapon and sex of sexual contacts, the
one site (San Francisco).
prevalence of having carried a weapon ranged from 13.0% to
Across the 12 sites (Connecticut, Delaware, Maine,
22.9% (median: 18.4%) among students who only had sexual
Massachusetts, Rhode Island, Vermont, Wisconsin, Boston,
MMWR / June 6, 2011 / Vol. 60 7
Early Release
contact with the opposite sex, from 18.4% to 34.3% (median: in three sites (Delaware, Maine, and Massachusetts), lower
25.8%) among students who only had sexual contact with among students who only had sexual contact with the opposite
the same sex, and from 20.0% to 45.0% (median: 25.5%) sex than students who had sexual contact with both sexes in
among students who had sexual contact with both sexes. The four sites (Delaware, Massachusetts, New York City, and San
prevalence of having carried a weapon was lower among Diego), higher among students who only had sexual contact
students who only had sexual contact with the opposite sex with the opposite sex than students who had sexual contact
than students who only had sexual contact with the same sex with both sexes in one site (Milwaukee), and lower among
in four sites (Delaware, Massachusetts, Rhode Island, and students who only had sexual contact with the same sex than
New York City), lower among students who only had sexual students who had sexual contact with both sexes in one site
contact with the opposite sex than students who had sexual (San Diego).
contact with both sexes in seven sites (Connecticut, Delaware,
In a Physical Fight
Massachusetts, Rhode Island, Wisconsin, New York City, and
San Diego), and lower among students who only had sexual Across the nine sites (Delaware, Maine, Massachusetts,
contact with the same sex than students who had sexual contact Rhode Island, Vermont, Boston, Chicago, New York City,
with both sexes in one site (San Diego). and San Francisco) that assessed having been in a physical
fight one or more times during the 12 months before the
Carried a Gun
survey and sexual identity, the prevalence of having been in a
Across the seven sites (Delaware, Maine, Massachusetts, physical fight ranged from 23.5% to 40.4% (median: 29.0%)
Boston, Chicago, New York City, and San Francisco) that among heterosexual students, from 35.7% to 50.5% (median:
assessed having carried a gun on at least 1 day during the 30 41.8%) among gay or lesbian students, from 41.5% to 50.3%
days before the survey and sexual identity, the prevalence of (median: 42.8%) among bisexual students, and from 23.5%
having carried a gun ranged from 2.3% to 5.3% (median: to 51.2% (median: 35.0%) among unsure students (Table 11).
3.8%) among heterosexual students, from 6.7% to 18.2% The prevalence of having been in a physical fight was lower
(median: 12.1%) among gay or lesbian students, from 5.1% among heterosexual than gay or lesbian students in seven sites
to 20.7% (median: 8.4%) among bisexual students, and from (Delaware, Maine, Massachusetts, Rhode Island, Vermont,
2.3% to 23.5% (median: 10.4%) among unsure students Boston, and San Francisco), lower among heterosexual
(Table 10). The prevalence of having carried a gun was lower than bisexual students in eight sites (Delaware, Maine,
among heterosexual than gay or lesbian students in four sites Massachusetts, Rhode Island, Vermont, Boston, New York
(Delaware, Massachusetts, Boston, and New York City), City, and San Francisco), and lower among heterosexual than
lower among heterosexual than bisexual students in three unsure students in five sites (Delaware, Maine, Massachusetts,
sites (Massachusetts, New York City, and San Francisco), and Rhode Island, and Vermont). The prevalence of having been in
lower among heterosexual than unsure students in five sites a physical fight was higher among gay or lesbian than unsure
(Delaware, Maine, Massachusetts, Boston, and New York students in four sites (Massachusetts, Vermont, Boston, and
City). The prevalence of having carried a gun was higher San Francisco) and higher among bisexual than unsure students
among gay or lesbian than bisexual students in one site in six sites (Massachusetts, Rhode Island, Vermont, Boston,
(Massachusetts), lower among bisexual than unsure students New York City, and San Francisco).
in one site (Massachusetts), and higher among bisexual than Across the 12 sites (Connecticut, Delaware, Maine,
unsure students in one site (San Francisco). Massachusetts, Rhode Island, Vermont, Wisconsin, Boston,
Across the nine sites (Delaware, Maine, Massachusetts, Chicago, Milwaukee, New York City, and San Diego) that
Wisconsin, Boston, Chicago, Milwaukee, New York City, assessed having been in a physical fight and sex of sexual
and San Diego) that assessed having carried a gun and sex of contacts, the prevalence of having been in a physical fight
sexual contacts, the prevalence of having carried a gun ranged ranged from 31.5% to 50.0% (median: 38.7%) among
from 4.2% to 10.3% (median: 6.3%) among students who students who only had sexual contact with the opposite sex,
only had sexual contact with the opposite sex, from 6.0% to from 32.2% to 47.9% (median: 42.0%) among students who
20.6% (median: 7.9%) among students who only had sexual only had sexual contact with the same sex, and from 43.3%
contact with the same sex, and from 5.6% to 22.1% (median: to 72.4% (median: 49.8%) among students who had sexual
9.9%) among students who had sexual contact with both contact with both sexes. The prevalence of having been in
sexes. The prevalence of having carried a gun was lower among a physical fight was lower among students who only had
students who only had sexual contact with the opposite sex sexual contact with the opposite sex than students who only
than students who only had sexual contact with the same sex had sexual contact with the same sex in one site (Vermont),
8 MMWR / June 6, 2011 / Vol. 60