Community Assessment and Health Promotion
    Risk Behaviors of Nashville's Youth - 1999 Summary Report

Dear Parents, Students, and Adults Concerned About Nashville's Youth

Our children and youth are Nashville's most important resource. As a community, it is our responsibility to create and foster environments at home, at school, and in the neighborhood that promote their growth and development.

Today, the health of young people - and the adults they will become - is critically linked to the health-related behavior choices they make as young adolescents and teens. A limited number of behaviors contribute markedly to today's major killers. These behaviors are most often established during youth. They include the following:

Tobacco use Alcohol and other drug use       Unhealthy dietary behaviors
Sexual behaviors      Inadequate physical activity Behaviors that result in injuries

What our children and youth decide about these behaviors will determine to a large degree whether they will enjoy good health now and in the future. Thus, it is imperative that we promote positive choices before damaging behaviors are initiated or become ingrained among our youth.

This report shows how a segment of the youth in Nashville are doing in regard to these choices. As you will see in the pages that follow, Nashville's youth are, for the most part, comparable to those in Tennessee and the nation. However, far too many of our youth are making poor choices. Improving the picture of our teenagers requires the commitment of the entire community.

Dr. Stephanie B.C. Bailey             Dr. Bill Wise
Director of Health Director of Schools



About the Survey

In the early spring of 1999, the Metropolitan Health Department and the Metropolitan Nashville Public Schools surveyed a sample of adolescent students (grades 7 through 12) about their behaviors relating to their health and safety. All questionnaire responses were anonymous and participation was voluntary. Parents were notified about the time and nature of the survey.

The survey instrument, the Youth Risk Behavior Survey, and the standardized survey administration protocol were developed by the Centers for Disease Control and Prevention. The survey is updated and given nationally every two years to public school students. Thirteen high schools and 22 of the 23 middle schools participated in the survey that resulted in a total of 1,266 surveys completed by high school students and 744 by 7th and 8th grade middle school students. Sixty-eight percent of students in high school classes and 51% of students in middle school classes selected for the sample completed the questionnaire. Most of the students not responding were absent the day the survey was administered. The confidence intervals range from ± 3 to ±5% margin of error. For instance a 67% response from 850 students has an "accuracy range" of 64% to 70%; for 350 students the range is 62% to 72%.

The sample of high school respondents consisted of 53% females and 47% males, 35% African American, 53% White, 7% Asian, 3% Latino, and 2% of other race or ethnic origin. The high school grades represented included 24% ninth grade, 26% tenth grade, 27% eleventh grade, and 22% twelfth grade. One percent could not be assigned a grade. The middle school respondents consisted of 48% females and 52% males; 43% African American, 47% White, 5% Asian, 3% Hispanic, 2% of other race or ethnic origin; 44% 7th graders and 56% 8th graders.

The results reported here are for high school students unless otherwise noted. The data on high school students involved a more representative sample and have higher reliability. Also, national and state normative data for high school students are available for comparative purposes.



Major Findings

Risk-taking behaviors of the Nashville students surveyed are comparable to those of students in Tennessee and the United States with a few notable exceptions.

1. Nashville has lower percentages of students who smoke compared to Tennessee, but has a higher percentage of students who have attempted suicide.

 Nashville   Tennessee 
Smoke 33% 37%
Attempted Suicide 15% 8%

2. Compared to the United States, Nashville has lower percentages of students who drink, who engage in binge drinking, and who had ridden one or more times with a driver who had been drinking.

 Nashville   United States 
Drink 43% 51%
Binge Drink 26% 33%
Rode W/Drinking Driver 33% 37%

3. Nashville has higher percentages of students who attempt suicide, do not wear seatbelts, smoke marijuana, and who engage in sexual intercourse compared to the United States.

 Nashville   United States 
Attempted Suicide 15% 8%
No/Rarely Use Seatbelt 25% 19%
Smoke Marijuana 30% 26%
Sexual Intercourse 40% 35%



High School Students Engaged in Positive Behaviors

The following chart depicts the percentage of students in the survey who were engaged in positive health behaviors.

yrbs_final1.gif


Extreme, Multiple, and Minimal Risk Takers

The chart below describes four distinct groups of students: those who are extreme risk takers, those who are multiple risk takers, those who engage in one risk behavior, and those who do not engage in risk behaviors. The extreme risk takers (11%) are heavily involved in unhealthy behaviors: smoking cigarettes, using marijuana, drinking alcohol, and sexual intercourse. The multiple risk takers (31%) engage in two to three of the risks listed above. Also shown are those who engage in one (25%) or none (33%) of the risks listed above. The types of risky behaviors that students engage in vary by race and gender.

yrbs_final1.gif


Risk Behavior Highlights

Unintentional Injuries
One quarter (25%) of high school students surveyed in Nashville rarely or never wear a seatbelt.

· Twenty-nine percent of Nashville's middle school students reported rarely or never wearing a seatbelt. These percentages are substantially higher than the Health People 2000 goal for the nation (15%).

· Females (79%) use seatbelts more frequently than males (70%). White students (79%) use seatbelts more frequently than Black students (70%).

Rarely or Never Wore a Seatbelt
yrbs_final3.gif

· Fewer Nashville students (33%) have ridden one or more times with a driver who had been drinking alcohol than reported nationally (37%) in 1997.

· When riding a bicycle during the past 12 months, 89% of high school students reported rarely or never using a helmet while 84% of middle school students reported never or rarely wearing a helmet.


Tobacco Use

A third (33%) of high school students surveyed in Nashville currently smokes cigarettes (smoking on one or more days during the 30 days prior to the survey).

· Nashville's percentage was less than the 1999 results for Tennessee (37%) and about the same for the U.S. (36%).

· Black students (15%) were three times less likely to smoke than White students (45%); the percent for males (34%) is slightly higher than for females (31%).

Current Cigarette Use
yrbs_final4.gif

· Sixteen percent reported having smoked cigarettes on school property during the 30 days prior to the survey; 4% reported having chewed tobacco or snuff on school property.

· Twenty percent of Nashville middle school students smoked one or more cigarettes a day during the past 30 days.


Intentional Injuries

Thirty-five percent of high school students surveyed in Nashville were in a physical fight during the past twelve months.

· Seven percent reported carrying a weapon on school property (compared to 9% reported nationally in 1997).

· Ninth and 10th graders reported fighting more frequently (40%) than 11th and 12th graders (29%) during the 30 days prior to the survey.

Fighting
yrbs_final5.gif

· Twenty percent reported being threatened, injured with a weapon, or fighting during the past 12 months on school property.

· Fourteen percent reported being forced to have sexual intercourse.

· Seventy-one percent of middle school students reported ever having been in a physical fight.


Marijuana Use

Thirty percent of high school students surveyed in Nashville used marijuana during the 30 days prior to the survey.

· Nashville's percentage is higher than the 1997 results for the U.S. (26%).

· The higher percent in the 1999 Nashville survey may reflect the national trend of increasing marijuana use among high school students.

Marijuana Use
yrbs_final6.gif

· A higher percentage (16%) in the 1999 survey reported smoking marijuana before age 13 than students in the 1997 national (10%) and Tennessee (10%) surveys.

· Thirty-five percent reported being offered, sold, or given illegal drugs on school property in the past 12 months (compared to 25% in Tennessee in 1999 and 32% nationally in 1997).


Weight, Dietary, and Physical Activity

One quarter (25%) of high school students surveyed in Nashville are at risk of obesity.

· Twenty-one percent of high school and 27% of middle school students reported using unhealthy methods (e.g. fasting, diet pills, purging) to control weight.

Obesity
yrbs_final7.gif

· Twenty-eight percent of Nashville's middle school students are at risk for obesity. These percentages are substantially higher than the Healthy People 2000 goal for the nation (15%).

· Nashville's high school students (58%) and middle school students (71%) fell short of the nation's Healthy People 2000 goal for engaging in vigorous physical activity (75%).

· Thirty-two percent of high school students and 40% of middle school students reported watching TV for four or more hours on an average school day.


Alcohol Use

Twenty-six percent of high school students surveyed in Nashville have engaged in heavy drinking (5 or more drinks in a row) during the 30 days prior to the survey.

· Nashville's percentage was less than the 1999 results for Tennessee (28%) and the 1997 results for the nation (33%).

· Fewer Black students (12%) than White (35%) reported binge drinking.

· Nationally, there was little change from 1991 (31.3%) to 1997 (33.4%) in reported heavy drinking among high school students.

Binge Drinking
yrbs_final8.gif

· Thirty-one percent of high school students and 38% of middle school students reported drinking their first alcohol (not for religious purposes) before age 13. The Healthy People 2000 goal for the nation is to delay the average age for first alcohol use to age 14.


Sexual Behavior

Forty percent of high school students surveyed in Nashville are sexually active (sexual intercourse in the past three months).

· Nashville's percentage is about the same as the 1999 results for Tennessee (38%) and is higher than the 1997 U.S. rate (35%).

· The percentage for females (41%) is higher than males (37%): the percentage is significantly higher for grades 11 and 12 (48%) than for grades 9 and 10 (30%) and for Black students (47%) as compared to White students (36%).

Sexually Active
yrbs_final9.gif

· A larger percent of students (12%) reported having sexual intercourse for the first time before age 13 than did students in the U.S. (7%) in 1997. Nashville's percentage is comparable to Tennessee (10%).

· More than half (58%) of the sexually active high school students used a condom during the last sexual intercourse.


Suicide

Fifteen percent of high school students surveyed in Nashville attempted suicide within the past 12 months.

· Nashville's percentage is significantly higher than the 1999 results for Tennessee (8%) and the 1997 U.S. results (8%). The national trend has remained constant at 7% - 8% since 1991.

· One in five high school females (19%) reported attempting suicide.

· The percentage for White students (16%) is higher than for Black students (12%).

Attempted Suicide
yrbs_final10.gif

· Nine percent of middle school students reported attempting suicide.

· Fifteen percent of middle and high school students reported planning to commit suicide.


Results of 1999 High School Youth Risk Behavior Survey1

Unintentional Injuries Total Male Female White Black 9-10 11-12 TN '99 US '97
1. Rarely or never wore motorcycle helmet 39% 48% 25% 37% 40% 47% 30% 35% 36%
2. Rarely or never wore bicycle helmet 89% 92% 87% 88% 93% 91% 88% 91% 88%
3. Rarely or never wore a seat belt 25% 30% 21% 21% 30% 25% 26% 21% 19%
4. Rode one or more times with a driver who had been drinking alcohol 33% 33% 32% 36% 28% 32% 33% 32% 37%
5. Had driven a vehicle one or more times after drinking alcohol 13% 16% 10% 16% 7% 10% 16% 13% 17%

Intentional Injuries Total Male Female White Black 9-10 11-12 TN '99 US '97
6. Carried weapon (gun, knife, club) on one or more days (past 30 days) 20% 33% 8% 22% 16% 24% 15% 21% 18%
7. Carried gun on one or more days (past 30 days) 9% 14% 4% 9% 7% 10% 7% 6% 6%
8. Carried weapon on school property on one or more days (past 30 days) 7% 10% 5% 8% 5% 7% 7% 8% 9%
9. Felt too unsafe to go to school on one or more days (past 30 days) 6% 7% 5% 4% 7% 7% 5% 4% 4%
10. Threatened or injured with a weapon on school property (past 12 months) 9% 12% 7% 8% 10% 11% 7% 8% 7%
11. In a physical fight in past twelve months 35% 43% 27% 35% 34% 40% 29% 31% 37%
12. Injured in a physical fight & needed medical treatment (past 12 months) 4% 5% 3% 3% 3% 4% 4% 3% 4%
13. Was in a physical fight on school property (past 12 months) 14% 19% 10% 13% 16% 18% 10% 14% 15%
14. Hit, slapped, or physically hurt by boy/girlfriend (past 12 months) 16% 15% 17% 15% 16% 15% 16% 10% -%
15. Ever forced to have sexual intercourse when they did not want 14% 9% 20% 13% 14% 13% 16% 8% -%

Suicidal Ideation (during past twelve months) Total Male Female White Black 9-10 11-12 TN '99 US '97
16. Seriously considered suicide 20% 16% 23% 21% 16% 23% 17% 18% 21%
17. Made a specific plan to attempt suicide 15% 12% 19% 15% 12% 17% 14% 13% 16%
18. Attempted suicide one or more times 15% 11% 19% 16% 12% 16% 14% 8% 8%
19. Suicide attempt resulted in a condition that had to be treated by doctor 6% 6% 6% 4% 7% 6% 7% 3% 3%

Tobacco Use Total Male Female White Black 9-10 11-12 TN '99 US '97
20. Ever tried cigarette smoking, even one or two puffs 67% 67% 67% 73% 60% 66% 69% 73% 70%
21. Smoked a whole cigarette for first time before age 13 23% 26% 21% 33% 9% 27% 19% 30% 25%
22. Smoked cigarettes one or more days (past 30 days) 33% 34% 31% 45% 15% 33% 32% 37% 36%
23. (Of smokers) Smoked one or more cigarettes per day (past 30 days) 83% 82% 84% 89% 50% 82% 83% 85% -%
24. Bought cigarettes in a store or gas station during (past 30 days and under age 18) 25% 27% 23% 26% 18% 20% 32% 20% 30%
25. Not asked for proof of age when buying cigarettes (past 30 days and under age 18) 69% 70% 67% 72% 59% 72% 66% 71% 68%
26. Smoked cigarettes on school property on one or more days (past 30 days) 16% 18% 15% 25% 3% 19% 13% 14% 15%
27. 1. Smoked cigarettes regularly (at least one cigarette every day for 30 days) 28% 26% 29% 41% 10% 28% 28% 28% -%
28. Ever tried to quit smoking cigarettes (of those responding to question 22) 75% 73% 77% 77% 68% 74% 78% -% -%
29. Used chewing tobacco or snuff (1 or more days during the past 30 days) 6% 11% 1% 8% 1% 6% 5% 13 9%
30. Used chewing tobacco or snuff on school property (1 or more of past 30 days) 4% 8% 1% 6% 1% 4% 3% 8% 9%
31. Smoked cigars, cigarillos, or little cigars (1 or more days of past 30) 22% 31% 14% 25% 15% 24% 19% 21% -%

Alcohol Use Total Male Female White Black 9-10 11-12 TN '99 US '97
32. Had at least 1 drink of alcohol on one or more days of their life 76% 74% 77% 81% 73% 72% 80% 76% 79%
33. Had first drink of alcohol before age 13 31% 38% 24% 31% 30% 37% 25% 29% 31%
34. Had at least 1 drink of alcohol (one or more days of past 30 days) 43% 43% 42% 49% 33% 40% 44% 45% 51%
35. Had five or more drinks of alcohol in a row (one or more of past 30 days) 26% 28% 25% 35% 12% 25% 28% 28% 33%
36. Had at least 1 drink of alcohol on school property (1 or more of past 30 days) 6% 8% 5% 6% 6% 7% 5% 4% 6%

Marijuana, Cocaine, and Other Drug Use Total Male Female White Black 9-10 11-12 TN '99 US '97
37. Used marijuana one or more times during their life 52% 54% 50% 56% 48% 47% 57% 46% 47%
38. Tried marijuana for the first time before age 13 16% 20% 13% 18% 14% 19% 13% 10% 10%
39. Used marijuana one or more times (past 30 days) 30% 34% 26% 35% 24% 30% 29% 26% 26%
40. Used marijuana on school property one or more times (past 30 days) 9% 12% 6% 10% 7% 11% 6% 4% 7%

Marijuana, Cocaine, and Other Drug Use Continued Total Male Female White Black 9-10 11-12 TN '99 US '97
41. Used any form of cocaine one or more times during their life 10% 11% 9% 14% 2% 10% 9% 9% 8%
42. Used any form of cocaine one or more times (past 30 days) 5% 6% 4% 6% 2% 6% 4% 4% 3%
43. Ever sniffed glue, breathed aerosol cans, inhaled paint/spray to get high 15% 15% 14% 20% 7% 17% 11% 19% 16%
44. Sniffed glue, breathed aerosol cans, inhaled paint/spray to get high (past 30 days) 5% 6% 3% 6% 2% 6% 3% 5% -%
45. Used heroin during their life 4% 6% 3% 5% 1% 5% 3% 2% -%
46. Used met amphetamines during their life 10% 10% 10% 13% 3% 12% 7% 10% -%
47. Took steroid pills or shots without a prescription 6% 8% 4% 7% 3% 6% 5% 5% 3%
48. Ever used needle to inject any illegal drug into their body 4% 5% 3% 5% 2% 5% 3% 2% 2%
49. Had someone offer, sell, or give them illegal drugs on school property (past 12 months) 35% 41% 30% 43% 25% 40% 30% 25% 32%

Sexual Behavior Total Male Female White Black 9-10 11-12 TN '99 US '97
50. Ever had sexual intercourse 59% 61% 58% 53% 73% 50% 68% 50% 48%
51. Had sexual intercourse for the first time before age 13 12% 17% 8% 8% 19% 15% 9% 10% 7%
52. Had sexual intercourse with 4 or more people during their life 21% 26% 16% 16% 30% 17% 25% 18% 16%
53. Had sexual intercourse during the past three months 40% 37% 41% 36% 47% 30% 48% 38% 35%
54. Drank alcohol or used drugs before last sexual intercourse 24% 31% 17% 30% 18% 30% 19% 23% 25%
55. Used condom or partner used condom during last sexual intercourse 58% 64% 53% 53% 65% 58% 59% 57% 57%
56. Used birth control pills or partner used during last sexual intercourse 12% 11% 13% 17% 8% 8% 15% 14% 17%
57. Had been pregnant or gotten someone pregnant one or more times 11% 11% 10% 9% 12% 9% 11% 7% 7%

Weight and Dietary Behaviors Total Male Female White Black 9-10 11-12 TN '99 US '97
58. Perceive themselves to be overweight 28% 23% 33% 32% 24% 25% 31% 33% 27%
59. Are trying to lose weight 41% 27% 54% 46% 37% 39% 44% 45% 40%
60. Exercised to lose weight or keep from gaining weight (past 30 days) 54% 51% 57% 59% 48% 56% 53% 59% 52%
61. Ate less food, fewer calories, or low fat foods to lose weight (past 30 days) 38% 26% 48% 44% 29% 38% 38% 42% -%
62. Went without eating for 24 hours or more to lose weight (past 30 days) 14% 7% 20% 16% 12% 16% 11% 14% -%
63. Took diet pills, powders, or liquids to lose weight (past 30 days) 9% 8% 11% 10% 8% 8% 10% 10% 5%
64. Vomited or took laxatives to lose weight (past 30 days) 7% 5% 8% 8% 5% 7% 6% 5% 5%
65. Drank 100% fruit juices at least once (past 30 days) 80% 80% 79% 79% 80% 77% 83% 79% -%
66. Ate fruit at least once during the past seven days 76% 75% 76% 78% 68% 75% 77% 81% -%
67. Ate green salad at least once during the past seven days 60% 56% 64% 64% 50% 57% 63% 62% -%
68. Ate potatoes at least once during the past seven days 69% 72% 67% 75% 62% 68% 70% 77% -%
69. Ate carrots at least once during the past seven days 47% 46% 49% 52% 36% 48% 47% 42% -%
70. Ate other vegetables at least once during past seven days 84% 81% 86% 87% 79% 82% 85% 87% -%
71. Drank one or more glasses of milk at least once during past seven days 77% 81% 73% 83% 66% 81% 73% 83% -%

Physical Activity Total Male Female White Black 9-10 11-12 TN '99 US '97
72. Exercised or physical activity that made them sweat on 3 or more of past 7 days 58% 68% 49% 61% 56% 62% 54% 64% 64%
73. Had physical activity that did not make them sweat on 5 of past 7 days 27% 29% 24% 28% 26% 29% 24% 22% 20%
74. Did exercise to strengthen or tone muscles on 3 or more of past 7 days 47% 58% 36% 53% 40% 52% 40% 50% 51%
75. Watch TV for 4 or more hours on an average school day 32% 31% 32% 23% 50% 33% 30% 24% -%
76. Attend PE classes daily 35% 38% 33% 33% 34% 52% 18% 23% 27%
77. Exercise 20 or more minutes in an average PE class 71% 76% 66% 67% 78% 71% 71% 77% 74%
78. Played on one or more sports teams during past 12 months 49% 58% 41% 53% 47% 52% 46% 51% -%
79. Injured while exercising and had to be treated by doctor (past 12 months) 32% 39% 25% 34% 27% 36% 27% 33% -%

HIV Education Total Male Female White Black 9-10 11-12 TN '99 US '97
80. Have been taught about AIDS or HIV infection in school                                83% 81% 85% 86% 84% 82% 86% 91% 92%
1Metro Nashville Public High School students.      21997 survey data.



Acknowledgements

The 1999 Youth Risk Behavior Survey was a joint undertaking by Metropolitan Health Department and Metropolitan Nashville Public Schools. The Youth Risk Behavior Survey Advisory Committee composed of the following persons guided the project:

Metropolitan Health Department
Mary Kay Hamel, Director's Office
Jeri Ajayi, Director's Office
Celia Larson, Ph.D., Division of Research and Evaluation
Bart Perkey, Bureau of Health Assessment and Evaluation

Metropolitan Nashville Public Schools
Robert Blankenship, Principal, Two Rivers Middle School
Sammy Swor, Ed.D., Principal, Glencliff High School
Jack Willis, Department of Research and Evaluation
Pat McDonald, Ph.D., Department of Research and Evaluation

Appreciation is expressed to Jennifer Kosinski, Rebecca Wiser, Donna Kenerson, Lynn Harbison, and Gay Nell Lane of Metro Health Department and to Julius Witherspoon and the Americorp staff for their work in administering the surveys. Appreciation is also expressed to Nancy Horner of Metro Health Department for assistance in report layout and preparation for printing.

Questions about the report may be addressed to Gay Nell Lane at the Metro Health Department Division of Research and Evaluation, Lentz Public Health Center, 311 23rd Avenue, North, Nashville, TN, 37203. Phone number 340-2149.
 
Home  |  Metro Nashville Home Page  |  Privacy/Security Statement
Comments, suggestions, or error reports
© 1998-2008, Metropolitan Public Health Department
of Nashville and Davidson County