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Risky decisions define the American high school experience: Do I trust my driver after a party? If I take this edible during English, will it wear off by the time Physics comes around? As it turns out, the government is following along: The 2011-2021 Youth Risk Behavior Survey, newly published by the CDC, charts trends over the past decade in everything from drug use to sexual activity and mental health. According to the report, which analyzes survey responses from 17,000 high schoolers, young people are experiencing more trauma and violence than in past years. Still, they seem to resort to illegal substances as a coping mechanism less frequently. What's perhaps even more striking is that in 2021, for the first time in the survey's 30-year history, young women reported using marijuana and other illicit drugs at a higher rate than young men.What changed? To learn more, VICE spoke with Kathleen Ethier, the CDC's Director of the Division of Adolescent and School Health (DASH) and one of the people behind the Youth Risk Behavior Survey. She spoke about the challenges young women face in the United States, and why weed may be a coping mechanism more than anything else. VICE: What is the Youth Risk Behavior Survey, and how did you become involved?
Kathleen Ethier: It's pretty much the standard for our understanding of what's happening with young people in the country. I've used it for years. I became the director [of DASH] in 2016, and we released the 2017 report as a way of analyzing the data, particularly the focal points that we in [the DASH] focus on: sexual behavior, substance use, experienced violence, mental health, and suicidal thoughts and behaviors. Rather than taking the full 20- to 30-year look at the data, we focus on these 10-year periods as a way of understanding where young people have been more recently and where we think things are going.What did the latest survey reveal, generally, about teen drug use?
Substance use among young people has been moving in the right direction in the last 10 years. I think what's clear from this data, however, is that those improvements are happening differently across groups of young people. So although overall, we see improvements in the proportion of young people who drink alcohol, we see that for instance, it's improving more for males than it is for females. If you look at 2011, there was really no difference in alcohol use in the past 30 days between males and females. By 2021, they're significantly different from each other. This was the first time the YRBS showed that marijuana use among young women was higher than among men. Could you speak to that specifically and explain why you think that might be the case?
Across most of the data in this report, teenage girls and LGBTQ+ students are experiencing more negative outcomes. I don't know that the marijuana data is any different than that. And that's kind of part of a larger picture.We're really trying to understand how substance use fits in with what we're learning about the mental health crisis among young people. How does it relate to their experience of violence? Are these things interrelated? In terms of prevention, we have to understand those interrelationships when we're seeing the disparities that we're seeing in each of these areas.How would you like to see the insights from this survey applied?
We really focus on what schools can do. And there's a lot that schools can do in terms of prevention. We have a program called What Works in Schools that is currently in 28 large urban school districts. What it's demonstrated is that when you give people quality health education, when you make sure that they can connect to needed health services, and when you create safe and supportive school environments, we see improvements in sexual risk behavior. We also see decreases in marijuana use, specifically. Why specifically marijuana use?
It could be the factors that we included in our program evaluation and the way that we included them. It could be something about the combination of marijuana use being prevalent so that we can actually measure a decrease in it when it happens. For some of the other illicit drugs or injection drug use or something like that, the prevalence is so low that you wouldn't necessarily see a difference if there was one. So it may be that that's a particular substance that for this program was more open to change.What do you think is the most positive optimistic takeaway besides obviously, like, the overall decrease in substance and alcohol use amongst adolescents?
Young people are making better decisions. That is clear. We've spent many years talking to them about the importance of avoiding risky behaviors, and it looks like they're listening to us. At the same time, we have to create environments that support them because the things that they're telling us are that they are not going to school because they don't feel safe, they are experiencing sexual violence, and it's having a deleterious impact on their mental health.
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Kathleen Ethier: It's pretty much the standard for our understanding of what's happening with young people in the country. I've used it for years. I became the director [of DASH] in 2016, and we released the 2017 report as a way of analyzing the data, particularly the focal points that we in [the DASH] focus on: sexual behavior, substance use, experienced violence, mental health, and suicidal thoughts and behaviors. Rather than taking the full 20- to 30-year look at the data, we focus on these 10-year periods as a way of understanding where young people have been more recently and where we think things are going.
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Substance use among young people has been moving in the right direction in the last 10 years. I think what's clear from this data, however, is that those improvements are happening differently across groups of young people. So although overall, we see improvements in the proportion of young people who drink alcohol, we see that for instance, it's improving more for males than it is for females. If you look at 2011, there was really no difference in alcohol use in the past 30 days between males and females. By 2021, they're significantly different from each other. This was the first time the YRBS showed that marijuana use among young women was higher than among men. Could you speak to that specifically and explain why you think that might be the case?
Across most of the data in this report, teenage girls and LGBTQ+ students are experiencing more negative outcomes. I don't know that the marijuana data is any different than that. And that's kind of part of a larger picture.
This is the largest nationally representative survey that we have that looks at this whole range of things. There's the National Survey on Drug Use and Health that's run by SAMHSA, Monitoring the Future that's run by the NIH, and others. I haven't gotten to compare whether what we see in terms of substance use is on par with those. During the pandemic, however, we saw an increase in suicidal ideations and suicide attempts, as well as visits to emergency departments for suicide attempts, so it does fit with the larger picture.“Across most of the data in this report, teenage girls and LGBTQ+ students are experiencing more negative outcomes.” —Kathleen Ethier
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We really focus on what schools can do. And there's a lot that schools can do in terms of prevention. We have a program called What Works in Schools that is currently in 28 large urban school districts. What it's demonstrated is that when you give people quality health education, when you make sure that they can connect to needed health services, and when you create safe and supportive school environments, we see improvements in sexual risk behavior. We also see decreases in marijuana use, specifically. Why specifically marijuana use?
It could be the factors that we included in our program evaluation and the way that we included them. It could be something about the combination of marijuana use being prevalent so that we can actually measure a decrease in it when it happens. For some of the other illicit drugs or injection drug use or something like that, the prevalence is so low that you wouldn't necessarily see a difference if there was one. So it may be that that's a particular substance that for this program was more open to change.What do you think is the most positive optimistic takeaway besides obviously, like, the overall decrease in substance and alcohol use amongst adolescents?
Young people are making better decisions. That is clear. We've spent many years talking to them about the importance of avoiding risky behaviors, and it looks like they're listening to us. At the same time, we have to create environments that support them because the things that they're telling us are that they are not going to school because they don't feel safe, they are experiencing sexual violence, and it's having a deleterious impact on their mental health.