The identification of key health risks among the adolescent population allows Roanoke County to develop and implement a youth risk behavior prevention program that is tailored to the needs of the students. This study provides Roanoke County Schools with a large sample of student survey data regarding youth risk behavior. The final sample includes 6504 student surveys. The research tool that was used for the study is titled the Youth Risk Behavior Survey. The instrument is designed to gather data in six categories: behaviors that contribute to unintentional and intentional injuries; tobacco use; alcohol and other drugs; sexual behavior; dietary behavior; and physical activity. Roanoke County students reported participating in at risk behavior more than their national counterparts in all six categories. Injuries, violence, drugs, and behaviors related to dieting, had the highest number of responses above percents reported in national YRBS data. Additional research is needed to determine the impact of prevention programs designed to deal with these problem behaviors. / Ph. D.

Self-injury is a significant issue with a variety of psychological, social, legal and ethical consequences and implications (Froeschle & Moyer, 2004; McAllister, 2003; Nock & Mendes, 2008; White Kress, Drouhard, & Costin, 2006). Self-injurious behavior is commonly associated with the cutting, bruising or burning of the skin. It also can include trichotillomania, interfering with wound healing and extreme nail biting (Klonsky & Olino, 2008; Zila & Kiselica, 2001). In assessing severity, it is important to note that self-inflicted wounds typically do not require any medical attention, as those who engage in self-injury will usually care for any open wounds in order to prevent infection (Walsh, 2006). The typical duration of a self-injurious act is usually less than 30 minutes, resulting in immediate relief from the emotional turmoil precipitating the behavior (Alderman, 1997; Gratz, 2007). It is difficult to estimate the prevalence of self-injury for many reasons. Nock (2009) noted that reports indicating increased estimates in this behavior derive from “anecdotal reports and estimates from small cross-sectional studies” (p. 81). Given the many ethical and legal ramifications involved in working with clients that self-injure, it is important to understand how self-injury typically manifests itself, how it affects differing populations based on gender and cultural differences, and the level of danger it truly represents to the person choosing to utilize it.

Background: The rate of adolescent overweight and obesity has more than quadrupled over the past few decades, and has become a major public health problem [1]. In 2011, 55% of 12-19 year olds in the United States (U.S.) were overweight or obese [2]. Adolescence is a pivotal time in which many health risk behaviors such as tobacco, alcohol, and drug use are initiated. Such health risk behaviors have been significantly associated with overweight and obesity among adolescents. Objective: The purpose of this study is to evaluate the relationship between obesity and the health risk behaviors most commonly associated with premature morbidity and mortality among adolescents with a novel micro area estimate approach that uses weighted hierarchical logistic regression to nest individuals in classes, classes in schools, and schools in districts. Methods: This study is a secondary analysis of a state-wide representative sample of middle school students that participated in the 2010 Tennessee Middle School Youth Risk Behavior Survey (YRBS). Data was collected from 119 (85.6%) of Tennessee’s local education agencies (LEAs), 456 (95.2%) schools, and 64,790 of 78,441 (82.6%) students. The outcome variable was adolescent obesity (≥ 95th BMI percentile). Explanatory variables were divided into four levels [1] district level: use seatbelt/helmet, asked to show ID for tobacco purchase; [2] school level: ever tried smoking, received HIV education in school; [3] class level: average number of days smoked, having ever exercised to lose weight; [4] individual level: having ever been in fight, early onset of substance use, physical activity, and thought about, planed, or attempted suicide. Weighted hierarchical logistic regression analysis was performed to assess the association between risk factors or protective factors and obesity using effect size (ES) and odds ratio (OR) estimates. Results: The study sample included 64,790 middle school students in the state of Tennessee with a mean age of 12.8 years, of which (49.42%) were females and (50.58%) were males. Nearly one-fourth of the students had a BMI at or above the 95th percentile (22.30%). Weighted hierarchical logistic regression analysis shows that seatbelt and helmet use [ES: -2.161 OR: 0.020, 95% CI: (0.006, 0.070)], and weight misperception [ES: 1.256 OR: 9.720, 95% CI: (9.216, 10.251)], having ever exercised to lose weight [ES: -0.340 OR: 0.540, 95% CI: (0.446, 0.654)], having ever tried smoking [ES: 0.705 OR: 3.581, 95% CI: (2.637, 4.863)] and gender (male vs female) [ES: 0.327 OR: 1.810, 95% CI: (1.740, 1.880)] were strongly associated with adolescent obesity. Results from this study also showed that Black, Hispanic or Latino adolescents were more likely to be obese than Whites, Indian, and Asian adolescent [ES: 0.129 OR: 1.260, 95% CI: (1.200, 1.330)], students with grades of mostly C, D and F were more likely to be obese than those with grades of mostly A and B [ES: 0.189 OR: 1.409, 95% CI: (1.303, 1.523)], and that students having an eating disorder [ES: 0.251 OR: 1.576, 95% CI: (1.508, 1.648)] and/or engagement in sports teams [ES: -0.197 OR: 0.700, 95% CI: (0.674, 0.728)] had small or medium ES association with adolescent obesity. Conclusion:This study uses small area estimates in weighted hierarchical logistic regression models to describe the prevalence and distribution of health risk behaviors associated with adolescent obesity among middle school student subpopulations in Tennessee. The value of small area estimates has been demonstrated previously in a variety of other contexts, and again here offers important insights for intervention design and resource allocation at different micro-levels within small and large areas (i.e., district, school, and class). This work adds to the growing body of research that supports community-driven school-based lifestyle interventions targeting early-onset chronic disease and, more specifically, enhances the geographic resolution with which adolescent obesity can be addressed in middle school populations across Tennessee.

A 4-H impact evaluation study, conducted in Montana, Idaho, Colorado, and Utah, was replicated in the Nevada public schools. The purpose was to measure the impact of the 4-H experience on the lives of Nevada youth, and to provide impact data for accountability and improvement for University of Nevada Cooperative Extension 4- H Programs. The 1,492 respondents were; 47.6% male and 52.4% female; 34.6% 5th grade, 28.1% 7th grade, and 37.3% 9th grade; 63.1% urban and 36.9% rural; and 11.7% 4-H and 88.3% non 4-H youth. Eight youth development constructs were measured including; extracurricular activity involvement; school leadership positions held; close relationship with adults; caring for others; amount of negative behavior; personal identity; positive identity; and self-confidence, character and empowerment. ANOVA for constructs by independent variables, age groups gender, 4-H participation, and population density revealed that 4-H participation significantly contributed to the variance in extracurricular activity involvement (p = .000), school leadership positions held (p = .025), caring for others (p = .000), and self-confidence, character and empowerment (p = .004).

A 4-H impact evaluation study, conducted in Montana, Idaho, Colorado, and Utah, was replicated in the Nevada public schools. The purpose was to measure the impact of the 4-H experience on the lives of Nevada youth, and to provide impact data for accountability and improvement for University of Nevada Cooperative Extension 4- H Programs. The 1,492 respondents were; 47.6% male and 52.4% female; 34.6% 5th grade, 28.1% 7th grade, and 37.3% 9th grade; 63.1% urban and 36.9% rural; and 11.7% 4-H and 88.3% non 4-H youth. Eight youth development constructs were measured including; extracurricular activity involvement; school leadership positions held; close relationship with adults; caring for others; amount of negative behavior; personal identity; positive identity; and self-confidence, character and empowerment. ANOVA for constructs by independent variables, age groups gender, 4-H participation, and population density revealed that 4-H participation significantly contributed to the variance in extracurricular activity involvement (p = .000), school leadership positions held (p = .025), caring for others (p = .000), and self-confidence, character and empowerment (p = .004).

Problem: Prevention Planning Teams are challenged with developing intervention programs designed to decrease youth risk behaviors. Literature indicates that by increasing the number of assets/protective factors within a child's external ecology it decreases the likelihood of the youth participating in risk behaviors. Information which explicitly focuses on the etiology (external ecology) of youth risk behaviors for Southwest Virginia Region (SWVAR) 6th grade youth had not been performed; therefore, this study investigated the reported external ecology present in the SWVAR 6th grade youth, whether there are differences in the reported external ecology by gender, and whether there are differences in the reported external ecology by race/ethnicity. Methods: The SWVAR 2009-2010 6th grade Youth Risk Behavior Surveys were analyzed and items extracted which pertained to the Search Institute Developmental Assets Framework. Twelve survey items were identified which fit into the External Asset Building Block areas of Support, Empowerment, and Boundaries and Expectations. Responses to these items by SWVAR 6th grade youth who participated in the 2009-2010 YRBS (n=2051) were analyzed via descriptive statistics for overall responses and Chi-Square in relation to gender and race/ethnicity. Results: Descriptive statistics and Chi-Square analysis indicated an overall positive external ecology. There were however statistically significant differences by gender and race/ethnicity in each of the represented External Asset Building Blocks. Conclusions: SWVAR 6th grade youth who participated in the 2009-2010 YRBS indicated an overall positive external ecology by overall responses, gender and race/ethnicity. There are however segments by gender and race/ethnicity which indicate a need for intervention and/or further investigation. / Ph. D.

No description available.

Physical fights among middle school students is a problem in our school systems, with 24.7% of students having been in a physical fight one or more times in 2013. The purpose of this study was to estimate the extent to which physical fights among middle school students in Tennessee was associated with demographic factors (age, sex and race) and to identify individual level factors that influence the likelihood of middle school students engaging in a physical fight.The 2013 Tennessee Youth Risk Behavior Survey (YBRS) data was used for this study, which is an annual cross-sectional school data collected by the National Center for Health Statistics of the Center for Disease Control and Prevention. A total of 5589 Tennessee Middle school students were included in the analysis. The outcome variable was physical fighting. Explanatory variables included demographic variables, life styles and health behavior risk factors. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were reported.The analyses indicate that male students were more likely to be involved in a physical fight than the female students (OR 2.89, 95% CI 2.49-3.36) and white students were less likely to be involved in a physical fight than the non-White students (OR 0.50, 95% CI 0.43-0.58). For every one year increase in age, the relative odds of being involved in a physical fight increased by 9.4% (OR 1.09, 95% CI 1.02-1.18). Similarly, students who ever tried to commit suicide (OR 1.89, 95% CI 1.39-2.53), drink alcohol (OR 2.48, 95% CI 2.02-3.05) and smoke cigarettes (OR 1.95, 95% CI 1.56-2.44) were more likely to be involved in a physical fight than those who did not. Students who carried a weapon were more likely to be involved in a physical fight than those students who did not (OR 2.72, 95% CI 2.31-3.20). While Students who watched television for 3 or more hours per day were more likely to engage in physical fights (OR 1.20, 95%CI 1.04-1.39) than students who did not, students with school grades A and B (OR 0.58, 95% CI 0.49-0.68), feeling safe and secure at school (OR 0.73, 95% CI 0.62-0.87), sleeping eight or more hours per day (OR 0.80, 95% CI 0.69-0.92) were less likely to be involved in a fight in school than other students.Age, gender, race, smoking, alcohol, use of marijuana, sleeping time, school performance, school safety environment, suicide attempt and TV time were potential risk factors associated with physical fights among middle school students. Strategies to reduce physical fights among students in Tennessean middle schools are needed.

Adolescent obesity is an area of growing public health concern. The Centers for Disease Control and Prevention conducts surveys through their Youth Risk Behavior Surveillance System (YRBSS) every two years to monitor a variety of health risk factors and behaviors among high school and middle school students. The YRBSS compiles information about obesity and BMI percentile, among many other factors. We accessed a combined dataset available on the YRBSS website which includes all data collected from high school students’ surveys from 1991 to 2013. Due to updating of questionnaires and adding of variables over the years, some variables only appear in the most recent years, limiting trend analysis to the timeframe in which the variable of interest was included. We analyzed the linear and quadratic trends in BMI percentile, obesity, and overweight rates in the national Youth Risk Behavior Survey (YRBS) from 1999 to 2013 and in the Tennessee YRBS from 2003 to 2013. Each variable was stratified by age and race to observe differences among groups. National trends show an increase in average BMI percentiles overall from 1999 to 2007, a decrease between 2007 and 2009, then another increase between 2009 and 2013. Tennessee trends show a dramatic increase in average BMI percentile overall from 2003 to 2007, then a decrease between 2007 and 2013. Since 2005, Tennessee has maintained a higher average BMI percentile (64.23, 66.37, 65.00, 64.96, 64.23) than the national average (63.47, 64.23, 62.81, 63.00, 63.51) for each recorded year, however, the decreasing trends in Tennessee and increasing trends in the nation have brought the average BMI percentiles of each to comparable rates. There is literature to support the variation of BMI among young, middle-aged, and elderly individuals. However, there is currently little evidence of differences in BMI percentiles, obesity, or overweight rates between different age groups of high school students. We expect to see little, if any, differences across different age groups of high school students in this study both nationally and at the state level. Racial and ethnic disparities exist for a variety of health conditions and outcomes. Many conditions, including obesity, disproportionately affect minority populations. We expect to see differences in BMI percentiles, obesity, and overweight rates across different races at both nationally and at the state level.

Introduction. Suicide-related fatalities are the third leading cause of death among adolescents, resulting in approximately 4,600 deaths annually. According to findings from the 2005 National College Health Assessment, engagement in weekly physical activity (PA) reduced the risk of suicidal behaviors. Data from the 2010 middle school Youth Risk Behavior Survey (YRBS) administered by Tennessee Coordinated School Health this study investigates the cross-sectional relationships of PA with suicidal behaviors, while simultaneously considering explanatory variables such as personal characteristics, sedentary behaviors, drug use, extreme weight control behaviors (EWCB), body mass index (BMI) and weight misperception. Methods. This is a secondary analysis of data from the 2010 Tennessee Middle School YRBS conducted among 65,182 middle school students of which 60,715 students were included in the final analysis. Items assessed were PA, sports team engagement, PE class, sedentary behaviors, suicidal behaviors, drug use, EWCB, BMI, weight misperception and selected personal characteristics. A bivariate analysis was used to create simple descriptive statistics, including means, standard deviations and proportions. Overall, approximately 21.15% (N= 13,704) reported suicidal behaviors, specifically, 18.30% reported ever having thoughts of suicide, 11.13% had ever made a suicide plan and 7.02% had one or more suicide attempts in their lifetime. A logistic regression analysis was conducted to compare the odds of experiencing suicidal behaviors in adolescents who engaged in PA, sports teams, and PE class, with students who did not perform these activities. We used odds ratios (OR) to assess effect size (ES), rather than p-values to assess statistical significance due to the study’s large sample size. As general rules of thumb, there is a small effect size when ES=0.20 or OR = 1.44, 0.694, medium effect size when ES=0.50 or OR = 2.47, 0.405 and large effect size when ES=0.80 or OR = 4.25, 0.235. Results. Based on ES, age, race/ethnicity, gender, grade in school, sports team engagement, PE class attendance, sedentary behaviors, drug use and EWCB were associated with suicidal behaviors. Associations were strongest for drug/substance use and EWCB and suicidal behaviors, both with large ESs. Although weakened when controlling for other independent variables, the ES of race/ethnicity (other vs white non-Hispanic), gender, sports team engagement, drug/substance use and EWCB on suicidal behaviors were >0.20. The ES of age, PE class attendance, and sedentary behaviors were <0.20. Conclusion. Findings suggest that sports team engagement is associated with reduced risk for suicidal behaviors; whereas, no effects were found for PA or PE class attendance. Asking adolescents questions about sports team engagement may help screen for risk of suicidal behaviors.