This story was originally published by Jennifer Fernandez, North Carolina Health News

CONTENT WARNING: This article references suicide. Please take caution when reading. If you need mental health support, please consult this page for resources. 

Like their peers across the country, North Carolina’s teen girls weather an increasing amount of violence, trauma and feelings of hopelessness.

And the state’s lesbian, gay, bisexual and queer or questioning students say they feel less safe at school, get bullied more and face sexual violence more than their peers, according to data collected for the national Youth Risk Behavior Survey.

North Carolina’s data mirrors what is happening across the country.

“These data show a distressing picture. America’s teen girls are engulfed in a growing wave of sadness, violence and trauma,” Debra Houry, chief medical officer for the Centers for Disease Control and Prevention, said in a media briefing on Monday, Feb. 13.

And the findings confirm “ongoing trauma” among the nation’s lesbian, gay, bisexual and queer or questioning students, she said.

“These data are hard to hear and should result in action,” Houry said. 

Key findings

The national Youth Risk Behavior Survey — performed every two years — compiled the responses of more than 17,000 students from 152 schools in the country who filled out the survey in fall 2021.

The survey touches on such topics as violence, personal safety, physical activity, sexual behavior, nutrition, mental health and use of tobacco, drugs and alcohol. 

While the data summary and trends report, which looked at national trends from 2011 to 2021, shows improvement in some areas, others have gotten worse: 

  • Risky sexual behaviors are decreasing, but so are important protective behaviors like condom use, HIV testing and testing for diseases spread through sex.
  • Substance use is generally decreasing, but the authors said it is too high. Marijuana use, for example, dropped from 23 percent to 16 percent in the latest survey. The percentage of high school students using certain illicit drugs (such as cocaine, heroin or Ecstasy) fell from 19 percent to 13 percent.
  • Experiences of violence, including sexual violence, are not declining and in some cases are increasing.
  • Poor mental health and suicidal thoughts and behaviors are increasing for nearly all groups of youth.

In 2021 the survey asked for the first time questions to measure social determinants of health (unstable housing) and protective factors (school connectedness and parental monitoring).

‘Shocked’ and ‘worried’

The CDC report released in February does not include state-level data. However, individual states such as North Carolina have their results already. In December, state officials shared some of that data at a meeting of the Child Fatality Task Force.

The physical dating violence nearly doubled from about 7 percent in 2019 to just over 13 percent in 2021, according to the N.C. Youth Risk Behavior Survey for 2021.

Those numbers stood out for Ellen Essick, section chief of NC Healthy Schools and Specialized Instructional Support at the Department of Public Instruction.

“This really shocked us, and it has us worried,” she told the task force, EducationNC reported. “We’re scrambling to figure out where we need to change our intervention and prevention efforts, at least in public schools, from our perspective, and we’ll work with all of you on how to do that.”

The national data showed several areas of adolescent health and well-being, such as risky sexual behavior and drug use, are continuing to improve overall.

However, the data also showed female students reporting they are faring more poorly than male students in almost all measures of substance use, experiences of violence, mental health and suicidal thoughts and behaviors.

“These differences, and the rates at which female students are reporting such negative experiences, are stark,” the authors wrote.

Mental health

Similar to national rates, North Carolina data show the percentage of students in the state who reported feeling sad or hopeless rose from 28 percent to 43 percent over the past decade. 

During the 10-year time period, the percentage of North Carolina students who said they skipped school because they did not feel safe jumped from 7 percent to 17 percent.

More female and LGBQ+ students reported being affected than students were overall in the state. 

The survey did not have a question assessing gender identity, which is why when referring to data, the report’s authors do not use the acronym LGBTQ, which stands for lesbian, gay, bisexual, transgender and queer and/or questioning.

Graphic showing percentage of teen girls feeling sad or hopeless is higher than their peers.

Suicide risks

LGBQ+ students in North Carolina schools were about three times as likely as their heterosexual peers to report seriously considering suicide, making a suicide plan or attempting suicide, the data show.

That mirrored the national trend in the 2021 survey.

The authors of the national report noted that although Black students were less likely to report poor mental health and persistent feelings of sadness or hopelessness than some other groups of students, they were significantly more likely than Asian, Hispanic and white students to have attempted suicide.

The levels of poor mental health and suicide ideation are the highest they’ve ever seen, Kathleen Ethier, a psychologist and director of the CDC’s Division of Adolescent and School Health, said at last week’s briefing. The numbers for LGBQ+ students are alarming, she said.

“Tragically, almost half seriously considered suicide, and nearly 1 in 4 attempted suicide,” she said. “This is devastating.” 

“These data are clear,” Ethier said. “Our young people are in crisis.”

Sexual violence

In North Carolina, the survey showed 9 percent of high school students reported being forced to have sex. More teen girls in the state reported being raped — 15 percent compared with 3 percent of teen boys.

That’s slightly higher than what female students reported nationally, with 14 percent saying they had been forced to have sex at some point in their young lives.

“This is truly alarming,” Ethier said. “For every 10 teenage girls you know, at least one of them, and probably more, has been raped.

“This tragedy cannot continue.”

About one in five lesbian, gay or bisexual students in North Carolina reported being  forced to have sex, a number four times higher than their heterosexual peers (5 percent). Students who identified as questioning or other were more than four times (23 percent) as likely to report being raped as heterosexual students.

“We know sexual violence is associated with mental health issues, substance abuse and also long-term health consequences,” the CDC’s Houry said.

Students and sex education

At UNC Chapel Hill, professor and researcher Dorothy Espelage said that as she discussed some of the data on suicide risk to one of her classes last week, it dawned on her that some of them had been high school students when the Youth Risk Behavior Survey data was collected.

So she asked them about some of the survey’s results, such as sexual violence.

Dorothy Espelage is the William C. Friday Distinguished Professor of Education at UNC Chapel Hill
Dorothy Espelage is the William C. Friday Distinguished Professor of Education at UNC Chapel Hill

“We talked about consent. They said there were no programs in their high schools focused on this, and my students are from all over,” Espelage said. “They only remember a list that went around: ‘100 ways to refuse sex from a guy,’ and one of them is ‘Tell them you’re on your period.’

“They couldn’t remember any prevention program or where it was taught in sex ed.”

And her research across the country shows that many students aren’t aware of their rights under Title IX, the federal civil rights law, that prevents sexual discrimination in education institutions. That can include sexual harassment, rape and sexual assault. 

People often think that Title IX is just about equality in sports, Espelage said. But the legislation also requires schools to have a Title IX coordinator and a process students can follow to report sexual violence, Espelage said.  

“We find that even when they understand consent, they don’t know how to report (sexual violence) in their schools,” she added.

Data limitations

The biennial survey has its limitations, Espelage said. It does not track the same students over a period of time, but rather offers just a snapshot. 

And it doesn’t talk about why something might be happening.

“What this doesn’t tell you is, are there differences based on district policies and practices?” Espelage said.

Researchers have used past survey data in conjunction with other data to show, for example, that rates of bullying victimization in districts and states varied depending on the definition of bullying and policies to address it, Espelage said.

That 2015 study published in JAMA Pediatrics showed compliance with Department of Education–recommended guidelines in anti-bullying laws was associated with lower rates of being bullied and cyberbullied among high school students from 25 states in the United States.

The CDC expects to publish on its site the full national survey from 2021 and local and state reports in April.

This article first appeared on North Carolina Health News and is republished here under a Creative Commons license.

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