Student Health

Students in grades 9–12

Students in grades 9–12 who reported consumption of ≥ 1 drink of alcohol during the past 30 days

Students in grades 9–12 who reported having a specific number of drinks of alcohol, including zero, during the past 30 days

Prevalence (crude)

Past 30 days

In 2021, 23% of high school students reported drinking alcohol on at least one day during the past 30 days.¹ The prevalence of current drinking is greater for girls than boys, and increases by grade. On average, excessive alcohol use is responsible for the deaths of approximately 4,000 people under the age of 21 each year in the United States.² Underage drinking cost the U.S. $24 billion in 2010.³ Delaying the age when drinking is initiated until age 21 years or later substantially reduces the risk of experiencing alcohol-related problems.⁴ Youth who drink alcohol are more likely to experience increased risk of injuries, violence, other substance use, other acute and chronic health effects, and reduced academic performance.⁵

The indicator does not convey the frequency of drinking or the specific amount of alcohol consumed.

Healthy People 2030 objective: SU-04. Reduce the proportion of adolescents who drank alcohol in the past month

Healthy People 2030 objective: SU-04. Reduce the proportion of adolescents who drank alcohol in the past month

Alcohol

National Center for Chronic Disease Prevention and Health Promotion. 1991-2021 High School Youth Risk Behavior Survey Data. Centers for Disease Control and Prevention. Accessed May 1, 2023. https://nccd.cdc.gov/Youthonline

National Center for Chronic Disease Prevention and Health Promotion. Alcohol-Related Disease Impact (ARDI) application. Centers for Disease Control and Prevention. Accessed April 3, 2023. www.cdc.gov/ARDI

Sacks JJ, Gonzales KR, Bouchery EE, Tomedi LE, Brewer RD. 2010 national and state costs of excessive alcohol consumption. Am J Prev Med. 2015;49(5):E73–E79. doi:10.1016/j.amepre.2015.05.031

National Center for Chronic Disease Prevention and Health Promotion. Age 21 Minimum Legal Drinking Age. Centers for Disease Control and Prevention. Updated December 7, 2022. Accessed April 3, 2023. https://www.cdc.gov/alcohol/fact-sheets/minimum-legal-drinking-age.htm

National Center for Chronic Disease Prevention and Health Promotion. Underage Drinking. Centers for Disease Control and Prevention. Updated November 14, 2022. Accessed April 3, 2023. https://www.cdc.gov/alcohol/fact-sheets/underage-drinking.htm

Students in grades 9–12

Students in grades 9–12 who report having ≥ 5 drinks (male) students or ≥ 4 drinks (female students) of alcohol within a couple of hours on ≥ 1 day during the past 30 days

Students in grades 9–12 who report having a specific number, including zero, of drinks of alcohol within a couple of hours on ≥ 1 day during the past 30 days

Prevalence (crude)

Past 30 days

In 2021, 10.5% of high school students reported binge drinking on at least one day during the past 30 days.¹ The prevalence of current binge drinking is greater for female students than male students , and increases by grade. It is most common among high school students who are White.¹ On average, excessive alcohol use is responsible for the deaths of approximately 4,000 people under the age of 21 each year in the United States.² Underage drinking cost the U.S. $24 billion in 2010.³ Delaying the age when drinking is initiated until age 21 years or later substantially reduces the risk of experiencing alcohol-related problems.⁴ Youth who drink alcohol are more likely to experience increased risk of injuries, violence, other substance use, other acute and chronic health effects, and reduced academic performance.⁵

The indicator does not convey the frequency of binge drinking or the specific amount of alcohol consumed. This indicator is available every other year.

Youth Risk Behavior Surveillance System (YRBSS)

Healthy People 2030 objective: SU-09. Reduce the proportion of people under 21 years who engaged in binge drinking in the past month

Alcohol

National Center for Chronic Disease Prevention and Health Promotion. 1991-2021 High School Youth Risk Behavior Survey Data. Centers for Disease Control and Prevention. Accessed April 3, 2023. https://nccd.cdc.gov/Youthonline

National Center for Chronic Disease Prevention and Health Promotion. Alcohol-Related Disease Impact (ARDI) application. Centers for Disease Control and Prevention. Accessed April 3, 2023. www.cdc.gov/ARDI

Sacks JJ, Gonzales KR, Bouchery EE, Tomedi LE, Brewer RD. 2010 national and state costs of excessive alcohol consumption. Am J Prev Med. 2015;49(5):E73–E79. doi:10.1016/j.amepre.2015.05.031

National Center for Chronic Disease Prevention and Health Promotion. Age 21 Minimum Legal Drinking Age. Centers for Disease Control and Prevention. Updated December 7, 2022. Accessed April 3, 2023. https://www.cdc.gov/alcohol/fact-sheets/minimum-legal-drinking-age.htm

National Center for Chronic Disease Prevention and Health Promotion. Underage Drinking. Centers for Disease Control and Prevention. Updated December 7, 2022. Accessed April 3, 2023. https://www.cdc.gov/alcohol/fact-sheets/underage-drinking.htm

Students in grades 9–12

Number of students in grades 9 through 12 who reported poor mental health during the past 30 days

Number of students in grades 9 through 12

Prevalence (crude)

Past 30 days

In 2021, 29% of high school students experienced poor mental health (most of the time or always) during the past 30 days.¹ While mental health affects children and adolescents of all ages, ethnic/racial backgrounds, and regions, the magnitude of health issues vary across subpopulations.^1,2 For example, female students were more likely than male students and Asian and Black students were less likely than Hispanic and multiracial students.¹ Children and adolescents growing up in poverty are two to three times more likely to develop mental health issues than peers who are not living in poverty.^2,3 Although mental health issues in children and adolescents are widespread, they are treatable, and often preventable. In 2021, the Surgeon General issued an advisory that provides actionable recommendations for various audiences and sectors to support the mental health of children and adolescents.¹

Students might have a biased response because of the topic of the question.

Youth Risk Behavior Surveillance System (YRBSS)

None

School Health

National Center for HIV, Viral Hepatitis, STD, and TB Prevention. Youth Risk Behavior Survey Data Summary & Trends Report: 2011-2021. Centers for Disease Control and Prevention. Accessed May 5, 2023. https://www.cdc.gov/healthyyouth/data/yrbs/pdf/YRBS_Data-Summary-Trends_Report2023_508.pdf

Office of the Surgeon General (OSG). Protecting Youth Mental Health: The U.S. Surgeon General’s Advisory. US Dept of Health and Human Services; 2021. https://www.hhs.gov/sites/default/files/surgeon-general-youth-mental-health-advisory.pdf

National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. What Is Children’s Mental Health? Centers for Disease Control and Prevention, US Dept of Health and Human Services. https://www.cdc.gov/mentalhealth/tools-resources/children/index.htm

Reiss F. Socioeconomic inequalities and mental health problems in children and adolescents: a systematic review. Soc Sci Med (1967). 2013;90:24–31. doi:10.1016/j.socscimed.2013.04.026

Students in grades 9–12

Number of students who reported consuming fruit (100% fruit juice and fruit – fresh, frozen, or canned) less than one time a day.

Number of students.

Prevalence (crude)

Past 7 days

Fruits and vegetables are good sources of complex carbohydrates, fiber, vitamins, minerals, and other substances that are important for good health.¹ Dietary patterns with higher intakes of fruits and vegetables are associated with a decreased risk for some types of cancer, cardiovascular disease, and stroke and can help with weight management.¹ However, in 2019 around 40% of high school students nationwide had eaten fruit or drunk 100% fruit juice less than one time per day.² Strategies to help achieve this shift include choosing more whole fruits as snacks and including them in meals.

This indicator does not convey the cup equivalents of fruits consumed so these data cannot be directly compared to Healthy People 2030 targets; does not capture dietary intake of elementary and middle school students

Youth Risk Behavior Surveillance System (YRBSS)

Dietary Guidelines for Americans 2020-2025; Healthy People 2030 objective NWS-06. Increase fruit consumption by people aged 2 years and over

Nutrition, Physical Activity, and Weight Status

U.S. Department of Agriculture, U.S. Department of Health and Human Services. Dietary Guidelines for Americans 2020–2025. U.S. Department of Agriculture. U.S. Government Printing Office; 2020. https://www.dietaryguidelines.gov/.

Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion, Division of Nutrition, Physical Activity, and Obesity. Data, Trend and Maps. Centers for Disease Control and Prevention; 2022. https://www.cdc.gov/nccdphp/dnpao/data-trends-maps/index.html.

Students in grades 9–12

Number of respondents who reported consuming green salad, fried potatoes, other potatoes, and other vegetables less than one time a day.

Number of students.

Prevalence (crude)

Past 7 days

Fruits and vegetables are good sources of complex carbohydrates, fiber, vitamins, minerals, and other substances that are important for good health.¹ Dietary patterns with higher intakes of fruits and vegetables are associated with a decreased risk for some types of cancer, cardiovascular disease, and stroke and can help with weight management.¹ However, in 2019 around 40% of high school students nationwide had eaten vegetables less than one time per day.²

This indicator does not convey the cup equivalents of vegetables consumed so these data cannot be directly compared to Healthy People 2030 targets. This indicator does not capture dietary intake of elementary and middle school students

Youth Risk Behavior Surveillance System (YRBSS)

Dietary Guidelines for Americans 2020-2025;Healthy People 2030 objectives: NWS-07. Increase vegetable consumption by people aged 2 years and older; NWS-08. Increase consumption of dark green vegetables, red and orange vegetables, and beans and peas by people aged 2 years and over

Nutrition, Physical Activity, and Weight Status

U.S. Department of Agriculture, U.S. Department of Health and Human Services. Dietary Guidelines for Americans 2020–2025. U.S. Department of Agriculture. U.S. Government Printing Office; 2020. https://www.dietaryguidelines.gov/.

Division of Nutrition, Physical Activity, and Obesity. Data, Trend and Maps. Centers for Disease Control and Prevention; 2022. https://www.cdc.gov/nccdphp/dnpao/data-trends-maps/index.html.

Students in grades 9–12

Students in grades 9–12 who report consuming 1 or more cans, bottles, or glasses of soda per day.

Students in grades 9–12 who report consuming any cans, bottles, or glasses of soda, including zero, per day.

Prevalence (crude)

Past 7 days

Nationwide in 2019, 15% of high school students had drunk a can, bottle, or glass of soda or pop (not counting diet soda or diet pop) one or more times per day during the 7 days before the survey.¹ Although total sugar-sweetened beverage consumption has significantly decreased during 2003–2014, mainly due to the decrease in regular soda intake, the calorie intake from sugar-sweetened beverages remains high.² Furthermore, sugar-sweetened beverages were a primary source of added sugars in the diet of U.S. children during 2003–2014.³ Consumption of sugar-sweetened beverages is associated with a less healthy diet,⁴ increased risk of dental decay⁵ and obesity among children,⁶ and the development of metabolic syndrome and type 2 diabetes.⁷ Limiting sugary drink intake can help individuals maintain a healthy weight and have healthy dietary patterns.

Indicator does not include all sources of sugar-sweetened beverages.

Youth Risk Behavior Surveillance System (YRBSS)

Healthy People 2030 objective: NWS-10. Reduce consumption of added sugars by people aged 2 years and over

Nutrition, Physical Activity, and Weight Status

Merlo CL, Jones SE, Michael SL, et al. Dietary and physical activity behaviors among high school students—Youth Risk Behavior Survey, United States, 2019. MMWR Suppl. 2020;69(No. Suppl 1).

Bleich SN, Vercammen KA, Koma JW, Li Z. Trends in beverage consumption among children and adults, 2003‒2014. Obesity. 2018;26(2):432-441.

Drewnowski A, Rehm CD. Consumption of added sugars among US children and adults by food purchase location and food source. Am J Clin Nutr. 2014;100(3):901–907.

Leung CW, DiMatteo SG, Gosliner WA, Ritchie LD. Sugar-sweetened beverage and water intake in relation to diet quality in U.S. children. Am J Prev Med. 2018;54(3):394-402.

Bleich, S.N., Vercammen, K.A. The negative impact of sugar-sweetened beverages on children’s health: an update of the literature. BMC Obes 5, 6 (2018). https://doi.org/10.1186/s40608-017-0178-9

Luger M, Lafontan M, Bes-Rastrollo M, Winzer E, Yumuk V, Farpour-Lambert N. Sugar-sweetened beverages and weight gain in children and adults: A systematic review from 2013 to 2015 and a comparison with previous studies. Obesity Facts. 2017;10(6):674-693.

Malik VS, Hu FB. Sugar-sweetened beverages and cardiometabolic health: An update of the evidence. Nutrients. 2019;11(8):1840.

Children and adolescents aged 6-13 years

Number of children aged 6 to 13 years who exercised, played a sport, or participated in physical activity for at least 60 minutes every day during the past week.

Number of children aged 6 to 13 years.

Prevalence (crude) from a 2-year cycle

Past week

Children need at least 60 minutes of physical activity a day. Physical activity improves heart, muscle, bone, and mental health in children ¹, however, less than 1 in 4 (23.6%) children ages 6 to 13 years met the current aerobic physical activity guideline in 2020–2021.² Strategies at the community and family level — and in schools and childcare centers — can promote physical activity in children. For example, CDC and many other federal and national partners are promoting Comprehensive School Physical Activity Programs (CSPAP) to create school environments that offer many opportunities for students to be physically active throughout the school day.³

None

National Survey of Children’s Health (NSCH)

Healthy People 2030 objective: PA-09. Increase the proportion of children who do enough physical activity

Nutrition, Physical Activity, and Weight Status

2018 Physical Activity Guidelines Advisory Committee. 2018 Physical Activity Guidelines Advisory Committee Scientific Report. U.S. Department of Health and Human Services; 2018. https://health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf

Centers for Disease Control and Prevention, Office of Disease Prevention and Health Promotion. Physical Activity. Healthy People 2030. U.S. Department of Health and Human Services. https://health.gov/healthypeople/objectives-and-data/browse-objectives/physical-activity

Centers for Disease Control and Prevention. Comprehensive School Physical Activity Programs: A Guide for Schools. US Department of Health and Human Services; 2013. https://www.cdc.gov/healthyschools/physicalactivity/pdf/13_242620-A_CSPAP_SchoolPhysActivityPrograms_Final_508_12192013.pdf

Students in grades 9–12

Number of students in grades 9 through 12 who were physically active for at least 60 minutes on all 7 days of the past week.

Number of students in grades 9 through 12.

Prevalence (crude)

Past 7 days

The second edition of the Physical Activity Guidelines for Americans states that children and adolescents ages 6–17 years of age should do 60 minutes or more of moderate-to-vigorous intensity physical activity each day.¹ Among children and adolescents, physical activity can improve bone health, improve cardiorespiratory and muscular fitness, decrease levels of body fat, and reduce symptoms of depression.¹ Despite the benefits, only 1 in 4 (23.2%) of students in grades 9 through 12 were physically active for at least 60 minutes on all 7 days in 2019.²

There may be error associated with determining each day’s activities and then considering this across the week. The indicator also does not capture the full physical activity guideline for children and adolescents.

Youth Risk Behavior Surveillance System (YRBSS)

Healthy People 2030 objective: PA-06. Increase the proportion of adolescents who do enough aerobic physical activity

Nutrition, Physical Activity, and Weight Status

U.S. Department of Health and Human Services. Physical Activity Guidelines for Americans, 2nd edition. U.S. Department of Health and Human Services; 2018. https://health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf

Centers for Disease Control and Prevention, Office of Disease Prevention and Health Promotion. Physical Activity. Healthy People 2030. U.S. Department of Health and Human Services. https://health.gov/healthypeople/objectives-and-data/browse-objectives/physical-activity

Students in grades 9–12

Students in grades 9–12 with a body mass index (BMI) at or above the sex- and age-specific 95th percentile from CDC Growth Charts: United States.

Students in grades 9–12 who answer height, weight, sex and age questions.

Prevalence (crude)

Current

Many children and adolescents in the United States have obesity.¹ Obesity is linked to a higher risk for diseases and conditions like high blood pressure, high cholesterol, diabetes, asthma, anxiety, and depression.^2-5 In addition, children with obesity are more likely to be bullied and to have obesity as adults.^4,5 Evidence suggests that intensive behavioral programs that use more than 1 strategy are an effective way to reduce childhood obesity. Policy and school curriculum changes that make it easier for children and adolescents to eat healthy and get physical activity can also help reduce obesity.

Self-reported data underestimate obesity prevalence among adolescents.⁶

Youth Risk Behavior Surveillance System (YRBSS)

Healthy People 2030 objective: NWS-04. Reduce the proportion of children and adolescents with obesity

Nutrition, Physical Activity, and Weight Status

Centers for Disease Control and Prevention, Office of Disease Prevention and Health Promotion. Physical Activity. Healthy People 2030. U.S. Department of Health and Human Services; 2022. https://health.gov/healthypeople/objectives-and-data/browse-objectives/overweight-and-obesity

Barlow SE, Dietz WH. Obesity evaluation and treatment: Expert Committee recommendations. The Maternal and Child Health Bureau, Health Resources and Services Administration and the Department of Health and Human Services. Pediatrics. 1998; 102: E29.

Morrison KM, Shin S, Tarnopolsky M, et al. Association of depression and health related quality of life with body composition in children and youth with obesity. J Affect Disord. 2015;172:18–23.

Overweight & Obesity. Why It Matters. Centers for Disease Control and Prevention. Updated July 14, 2022. Accessed April 26, 2023. https://www.cdc.gov/obesity/about-obesity/why-it-matters.html

Beck AR. Psychosocial aspects of obesity. NASN Sch Nurse. 2016;31(1):23–27.

Allison C, Colby S, Opoku-Acheampong A, et al. Accuracy of self-reported BMI using objective measurement in high school students. J Nutr Sci. 2020 Aug 12; 9:e35. doi: 10.1017/jns.2020.28.

Children and adolescents aged 1–17 years

Children and adolescents aged 1–17 years with parent-reported dental visit to a dentist or other oral health care provider for any kind of dental or oral health care in the past year.

Children and adolescents aged 1–17 years.

Prevalence (crude) from a 2-year cycle

In the past 12 months

Estimates from the 2020–2021 National Survey of Children’s Health indicated 75.1% of children aged 1–17 years had a past-year dental visit.¹ Routine dental visits allow for oral health education, preventive services (e.g., sealants, fluoride varnish), and early detection and treatment of oral diseases such as dental caries (cavities).^2-4 Untreated cavities can lead to pain, infection, and costly treatment. Approximately 34 million school hours were lost annually due to unplanned and acute dental treatment in 2008.⁵ The American Academy of Pediatric Dentistry recommends children have their first dental visit at the time the first tooth erupts, and at least by age one.⁶ Lack of dental use and poor oral health disproportionately affect low socioeconomic status and racial or ethnic minority populations.^2,7 Increasing use of oral health care is a Healthy People 2030 Leading Health Indicator, representing a high-priority objective to reduce health disparities and improve oral health of the nation.⁸

Oral health literacy, social determinants of health, and access to care may affect dental visits.³ The indicator does not validate types of dental care children actually received.

National Survey of Children’s Health (NSCH)

Healthy People 2030 objective(s): OH-08. Increase use of oral health care system; OH-09. Increase the proportion of low-income youth who have a preventive dental visit

Oral Health

Child and Adolescent Health Measurement Initiative. 2020–2021 National Survey of Children’s Health (NSCH) Data Query. Data Resource Center for Child and Adolescent Health supported by the Health Resources and Services Administration (HRSA). https://www.childhealthdata.org/browse/survey

National Institutes of Health. Oral Health in America: Advances and Challenges. US Department of Health and Human Services, National Institutes of Health, National Institute of Dental and Craniofacial Research; 2021. https://www.ncbi.nlm.nih.gov/pubmed/35020293

Institute of Medicine and National Research Council. Improving Access to Oral Health Care for Vulnerable and Underserved Populations. Institute of Medicine and National Research Council; 2011. https://www.hrsa.gov/sites/default/files/publichealth/clinical/oralhealth/improvingaccess.pdf

American Academy of Pediatric Dentistry. Periodicity of Examination, Preventive Dental Services, Anticipatory Guidance/Counseling, and Oral Treatment for Infants, Children, and Adolescents. Pediatr Dent. 2017;39(6):188-196.

Naavaal S, Kelekar U. School hours lost due to acute/unplanned dental care. Health Behav Policy Rev. 2018;5(2):66-73.

American Academy of Pediatric Dentistry. Periodicity of Examination, Preventive Dental Services, Anticipatory Guidance/Counseling, and Oral Treatment for Infants, Children, and Adolescents. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 2022:253-65 https://www.aapd.org/globalassets/media/policies_guidelines/bp_periodicity.pdf

Centers for Disease Control and Prevention, Division of Oral Health. Oral Health Surveillance Report: Trends in Dental Caries and Sealants, Tooth Retention, and Edentulism, United States, 1999–2004 to 2011–2016. Centers for Disease Control and Prevention; 2019. https://www.cdc.gov/oralhealth/publications/OHSR-2019-index.html

US Department of Health and Human Services. Healthy People 2030, Leading Health Indicators 2020. US Department of Health and Human Services; 2020. https://health.gov/healthypeople/objectives-and-data/leading-health-indicators

Children and adolescents aged 1–17 years

Children and adolescents aged 1–17 years with parent-reported preventive dental visit, including receipt of dental sealants or fluoride treatment, in the past year.

Children and adolescents aged 1–17 years.

Prevalence (crude) from a 2-year cycle

In the past 12 months

Tooth decay is among the greatest unmet treatment needs in US youth.¹ During 2011–2016, more than half of US youth experienced caries.² Untreated caries can lead to severe pain, infections, costly treatment, and problems with eating, speaking, and learning.¹ Dental sealants and topical fluoride (e.g., fluoride varnish)—evidence-based caries preventive measures—are recommended and supported by major clinical and public health organizations and agencies to improve oral health and health equity among children.^{1, 3-6} Estimates from the National Survey of Children’s Health (NSCH) 2020–2021 indicated receipt of sealants (14.0%) and fluoride treatment (42.4%) among US youth was much lower than receipt of any preventive dental services (75.1%), and presented pronounced disparities by sociodemographic characteristics (e.g., race and ethnicity, family income, health insurance status).⁷

Oral health literacy, social determinants of health, and access to care may affect dental visits.8 The indicator is based on parent report and does not validate types of dental care children actually received.

National Survey of Children’s Health (NSCH)

Healthy People 2030 objective: OH-09. Increase the proportion of low-income youth who have a preventive dental visit

Oral Health

Griffin SO, Wei L, Gooch BF, Weno K, Espinoza L. Vital Signs: dental sealant use and untreated tooth decay among U.S. school-aged children. MMWR Morb Mortal Wkly Rep. 2016;65(41):1141-5.

Centers for Disease Control and Prevention, Division of Oral Health. Oral Health Surveillance Report: Trends in Dental Caries and Sealants, Tooth Retention, and Edentulism, United States, 1999–2004 to 2011–2016. Centers for Disease Control and Prevention; 2019. https://www.cdc.gov/oralhealth/publications/OHSR-2019-index.html

Weyant RJ, Tracy SL, Anselmo TT, et al. Topical fluoride for caries prevention: executive summary of the updated clinical recommendations and supporting systematic review. J Am Dent Assoc. 2013;144(11):1279-91.

US Preventive Services Task Force. Prevention of Dental Caries in Children Younger Than 5 Years: Screening and Interventions 2021. USPSTF; 2021. https://uspreventiveservicestaskforce.org/uspstf/recommendation/prevention-of-dental-caries-in-children-younger-than-age-5-years-screening-and-interventions1

Community Preventive Services Task Force, The Community Guide. Dental Caries (Cavities): School-Based Dental Sealant Delivery Programs 2013. Community Preventive Services Task Force; 2021. https://www.thecommunityguide.org/findings/dental-caries-cavities-school-based-dental-sealant-delivery-programs

Centers for Medicare and Medicaid Services. Core Set of Children’s Health Care Quality Measures 2022. Centers for Medicare and Medicaid Services; 2023.https://www.medicaid.gov/medicaid/quality-of-care/performance-measurement/adult-and-child-health-care-quality-measures/childrens-health-care-quality-measures/index.html

Children aged 4 months to 14 years old

Children aged 4 months to 14 years whose parents report they usually get insufficient sleep duration (<12 hours for children aged 4–12 months, <11 hours for children aged 1–2 years, <10 hours for children aged 3–5 years, <9 hours for children aged 6–12 years, and <8 hours for children aged 13–14 years), on average day (for children aged 0–5 years) or average weeknight (for children aged 6–14 years).¹

Children aged 4 months to 14 years whose parents reported child’s hours of sleep on average day (for children aged 0–5 years) or average weeknight (for children aged 6–14 years).

Prevalence (crude) from a 2-year cycle

Average day (for children aged 0–5 years) or average weeknight (for children aged 6–14 years)

During 2020–2021, insufficient sleep duration (<12 hours for children aged 4–12 months, <11 hours for children aged 1–2 years, <10 hours for children aged 3–5 years, <9 hours for children aged 6–12 years, and <8 hours for children aged 13–14 years, on average) was reported for 35.0% of children aged 4 months to 14 years.² Insufficient sleep duration among children is associated with an increased risk of a number of conditions—such as obesity, diabetes, poor mental health, attention and behavior problems, and poor cognitive development.^1,3 Parents can support the practice of good sleep habits to improve sleep duration in their children by setting appropriate regular bedtimes and limiting screentime use.^4,5

Indicator does not convey variation in sleep duration (for instance, weekday vs. weekend sleep) or quality of sleep. Both might affect the risk for chronic disease. Indicator does not identify specific sleep problems, such as sleep disordered breathing and insomnia, which are associated with different chronic conditions.

Youth Risk Behavior Surveillance System (YRBSS)

Healthy People 2030 objective: EMC-03. Increase the proportion of children who get sufficient sleep

Sleep

Paruthi S, Brooks LJ, D’Ambrosio C, et al. Recommended amount of sleep for pediatric populations: a consensus statement of the American Academy of Sleep Medicine. J Clin Sleep Med. 2016;12(6):785–786. doi: 10.5664/jcsm.5866.

Increase the proportion of children who get sufficient sleep — EMC‑03: data. U.S. Department of Health and Human Services. Healthy People 2030. Accessed October 26, 2022. https://health.gov/healthypeople/objectives-and-data/browse-objectives/children/increase-proportion-children-who-get-sufficient-sleep-emc-03

Wheaton AG, Claussen AH. Short sleep duration among infants, children, and adolescents aged 4 months–17 years — United States, 2016–2018. MMWR Morb Mortal Wkly Rep. 2021;70:1315–1321. doi: 10.15585/mmwr.mm7038a1

Pyper E, Harrington D, Manson H. Do parents’ support behaviours predict whether or not their children get sufficient sleep? A cross-sectional study. BMC Public Health. 2017;17:432. doi: 10.1186/s12889-017-4334-4.

Hale L, Guan S. Screen time and sleep among school-aged children and adolescents: a systematic literature review. Sleep Med Rev. 2015;21:50-58. doi:10.1016/j.smrv.2014.07.007

Students in grades 9–12

Students in grades 9–12 who report usually getting insufficient sleep duration (<8 hours for those aged 13–18 years, on average school night).¹

Students in grades 9–12 who report hours of sleep on average school night.

Prevalence (crude)

Average school night

In 2019, 77.9% of United States high school students reported insufficient sleep duration (<8 hours for those aged 13–18 years on average school night).² Insufficient sleep duration among high school students is associated with an increased risk of a number of conditions—such as obesity, diabetes, injuries, poor mental health, attention and behavior problems, and poor academic performance.¹ Parents can support the practice of good sleep habits to improve sleep duration in their children by setting appropriate regular bedtimes and limiting evening light exposure and technology use.^3,4

Indicator does not convey variation in sleep duration (for instance, weekday vs. weekend sleep) or quality of sleep. Both might affect the risk for chronic disease. Indicator does not identify specific sleep problems, such as sleep disordered breathing and insomnia, which are associated with different chronic conditions.

Youth Risk Behavior Surveillance System (YRBSS)

Healthy People 2030 objective: EMC-03. Increase the proportion of children who get sufficient sleep

Sleep

Paruthi S, Brooks LJ, D’Ambrosio C, et al. Recommended amount of sleep for pediatric populations: a consensus statement of the American Academy of Sleep Medicine. J Clin Sleep Med. 2016;12(6):785–786. doi: 10.5664/jcsm.5866

U.S. Department of Health and Human Services. Healthy People 2030. Increase the proportion of high school students who get enough sleep — SH‑04: data. Accessed October 26, 2022. https://health.gov/healthypeople/objectives-and-data/browse-objectives/sleep/increase-proportion-high-school-students-who-get-enough-sleep-sh-04/data

Pyper E, Harrington D, Manson H. Do parents’ support behaviours predict whether or not their children get sufficient sleep? A cross-sectional study. BMC Public Health. 2017;17:432. doi: 10.1186/s12889-017-4334-4

Bartel KA, Gradisar M, Williamson P. Protective and risk factors for adolescent sleep: a meta-analytic review. Sleep Med Rev. 2015;21:72–85. doi: 10.1016/j.sleep.2016.07.007

Students in grades 9–12

Students in grades 9–12 who report having used at least one of the following: 1) cigarettes; 2) cigars, cigarillos, or little cigars; 3) smokeless tobacco; 4) electronic vapor products during the previous 30 days.

Students in grades 9–12 who reported information about cigarette, cigar, smokeless tobacco, and electronic vapor product use.

Prevalence (crude)

Previous 30 days

Tobacco product use is started and established primarily during adolescence.^1,2 The use of tobacco products containing nicotine in any form among youth is unsafe, and can harm the developing adolescent brain.³ In 2019, current use of any tobacco product among high school students was 36.5%.⁴ Tobacco product use is started and established primarily during adolescence.^1,2 Flavorings in tobacco products can make them more appealing to youth.⁵ The effects of nicotine exposure during adolescence can include developing nicotine addiction and addition to tobacco products, mood disorders, lower impulse control, and priming the brain for addiction to other drugs.³ National, state, and local program activities have reduced and prevented youth tobacco use when implemented together.² Some of these activities include higher costs for tobacco products, prohibiting smoking and electronic vapor product use in indoor areas, and community programs and school policies that encourage tobacco-free places and lifestyles.^2,3,6

None

Youth Risk Behavior Surveillance System (YRBSS)

Healthy People 2030 objective: TU-04. Reduce current tobacco use in adolescents

Tobacco

National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2014. https://www.ncbi.nlm.nih.gov/books/NBK179276/pdf/Bookshelf_NBK179276.pdf

Office of the Surgeon General. 2012 Surgeon General’s Report: Preventing Tobacco Use Among Youth and Young Adults. US Dept of Health and Human Services; 2012. Accessed April 5, 2023. https://www.ncbi.nlm.nih.gov/books/NBK99237/pdf/Bookshelf_NBK99237.pdf

Office of the Surgeon General. E-cigarette use among youth and young adults: a report of the Surgeon General. US Department of Health and Human Services; 2016. https://www.cdc.gov/tobacco/data_statistics/sgr/e-cigarettes/pdfs/2016_sgr_entire_report_508.pdf

Creamer MR, Jones SE, Gentzke AS, Jamal A, King BA. Youth risk behavior surveillance — United States, 2019. MMWR Morb Mortal Wkly Rep. 2020;69(1):56–63. https://www.cdc.gov/healthyyouth/data/yrbs/pdf/2019/su6901-H.pdf

Corey CG, Ambrose BK, Apelberg BJ, King BA. Flavored tobacco product use among middle and high school students–United States, 2014. MMWR Morb Mortal Wkly Rep. 2015;64(38):1066–1070. doi:10.15585/mmwr.mm6438a2

Centers for Disease Control and Prevention. Best Practices for Comprehensive Tobacco Control Programs—2014. Centers for Disease Control and Prevention, 2014. https://www.cdc.gov/tobacco/stateandcommunity/guides/pdfs/2014/comprehensive.pdf

Students in grades 9–12

Students in grades 9–12 who report having used electronic vapor products on 1 or more of the previous 30 days

Students in grades 9–12 who reported information about electronic vapor product use in the previous 30 days.

Prevalence (crude)

Previous 30 days

The use of tobacco products containing nicotine in any form among youth is unsafe and can harm the developing adolescent brain.¹ Since their introduction in the US marketplace in 2007, electronic vapor product use is now prolific among adolescents, with 32.7% of high school students currently using these products in 2019, more than 5 times higher than current cigarette smoking.² Most e-cigarettes contain nicotine which is highly addictive and can harm adolescent brain development.³ Additionally, besides nicotine, e-cigarette aerosol can contain other harmful and potentially harmful substances including heavy metals, volatile organic compounds and other cancer causing agents.¹ The effects of nicotine exposure during adolescence can include developing nicotine addiction, mood disorders, lower impulse control, and priming the brain for addiction to other drugs.¹ Adolescents who use e-cigarettes may be more likely to smoke cigarettes in the future.^4,5 Adolescents may be particularly vulnerable to the risks of e-cigarettes as they are targeted at new consumers with advertisements and flavors.

None

Youth Risk Behavior Surveillance System (YRBSS)

Healthy People 2030 objective: TU-05. Reduce current use of e-cigarettes among adolescents

Tobacco

Office of the Surgeon General. 2016 Surgeon General’s Report: E-Cigarette Use Among Youth and Young Adults. US Dept of Health and Human Services; 2016. https://www.cdc.gov/tobacco/sgr/e-cigarettes/pdfs/2016_sgr_entire_report_508.pdf

Creamer MR, Jones SE, Gentzke AS, Jamal A, King BA. Youth risk behavior surveillance — United States, 2019. MMWR Morb Mortal Wkly Rep. 2020;69(1):56–63. https://www.cdc.gov/healthyyouth/data/yrbs/pdf/2019/su6901-H.pdf

Marynak KL, Gammon DG, Rogers T, Coats EM, Singh T, King BA. Sales of nicotine-containing electronic cigarette products: United States, 2015. Am J Public Health. 2017;107(5):702–705. doi:10.2105/AJPH.2017.303660

Miech R, Patrick ME, O’Malley PM, Johnston LD. E-cigarette use as a predictor of cigarette smoking: results from a 1-year follow-up of a national sample of 12th grade students. Tob Control. 2017;26(e2):e106–e111. doi:10.1136/tobaccocontrol-2016-053291

Bold KW, Kong G, Camenga DR, et al. Trajectories of e-cigarette and conventional cigarette use among youth. Pediatrics. 2018;141(1):e20171832. doi:10.1542/peds.2017-1832

Students in grades 9–12

Students in grades 9–12 who report having used smokeless tobacco on 1 or more of the previous 30 days

Students in grades 9–12 who reported information about smokeless tobacco use in the previous 30 days.

Prevalence (crude)

Previous 30 days

Tobacco product use is started and established primarily during adolescence.^1,2 Smokeless tobacco is associated with many health problems, and in 2019, 3.8% of high school students reported currently using this product. ³ Using smokeless tobacco may: increase the risk for death from heart disease and stroke;^34,5 can cause nicotine poisoning in youth;⁶ can lead to nicotine addiction;^1,4 and is associated with disease of the mouth.² Because young people who use smokeless tobacco can become addicted to nicotine, they may be more likely to also become cigarette smokers.⁷

None

Youth Risk Behavior Surveillance System (YRBSS)

Healthy People 2030 objective: TU-08. Reduce current use of smokeless tobacco products among adolescents

Tobacco

Office of the Surgeon General. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. US Dept of Health and Human Services; 2014. https://www.ncbi.nlm.nih.gov/books/NBK179276/pdf/Bookshelf_NBK179276.pdf

Office of the Surgeon General. 2012 Surgeon General’s Report: Preventing Tobacco Use Among Youth and Young Adults. US Dept of Health and Human Services; 2012. https://www.cdc.gov/tobacco/data_statistics/sgr/2012/index.htm

Creamer MR, Jones SE, Gentzke AS, Jamal A, King BA. Youth risk behavior surveillance — United States, 2019. MMWR Morb Mortal Wkly Rep. 2020;69(1):56–63. https://www.cdc.gov/healthyyouth/data/yrbs/pdf/2019/su6901-H.pdf

Smokeless Tobacco and Some Tobacco-specific N-Nitrosamines: IARC Monographs on the Evaluation of Carcinogenic Risks to Humans Volume 89. World Health Organization, International Agency for Research on Cancer; 2007.

Piano MR, Benowitz NL, Fitzgerald GA, et al. Impact of smokeless tobacco products on cardiovascular disease: implications for policy, prevention, and treatment: a policy statement from the American Heart Association. Circulation. 2010;122(15):1520–1544. doi:10.1161/CIR.0b013e3181f432c3

Connolly GN, Richter P, Aleguas A Jr, Pechacek TF, Stanfill SB, Alpert HR. Unintentional child poisonings through ingestion of conventional and novel tobacco products. Pediatrics. 2010;125(5):896–899. doi:10.1542/peds.2009-2835

Lund I, Scheffels J. Smoking and Snus Use Onset: Exploring the Influence of Snus Debut Age on the Risk for Smoking Uptake With Cross-Sectional Survey Data. Nicotine Tob Res. 2014;16(6):815–9 .