Physicians should consider providing patients with timely, understandable information related to their FP options, prior to the administration of treatment. Such discussions may lead to improved quality of life for individuals as they transition from patients to survivors.

Health risk behaviors practiced during adolescence often persist into adulthood and contribute to the leading causes of morbidity and mortality in the United States. Youth health behavior data at the national, state, territorial, tribal, and local levels help monitor the effectiveness of public health interventions designed to promote adolescent health. The Youth Risk Behavior Surveillance System (YRBSS) is the largest public health surveillance system in the United States, monitoring a broad range of health-related behaviors among high school students. YRBSS includes a nationally representative Youth Risk Behavior Survey (YRBS) and separate state, local school district, territorial, and tribal school-based YRBSs. This overview report describes the surveillance system and the 2019 survey methodology, including sampling, data collection procedures, response rates, data processing, weighting, and analyses presented in this MMWR Supplement. A 2019 YRBS participation map, survey response rates, and student demographic characteristics are included. In 2019, a total of 78 YRBSs were administered to high school student populations across the United States (national and 44 states, 28 local school districts, three territories, and two tribal governments), the greatest number of participating sites with representative data since the surveillance system was established in 1991. The nine reports in this MMWR Supplement are based on national YRBS data collected during August 2018-June 2019. A full description of 2019 YRBS results and downloadable data are available (https://www.cdc.gov/healthyyouth/data/yrbs/index.htm). Efforts to improve YRBSS and related data are ongoing and include updating reliability testing for the national questionnaire, transitioning to electronic survey administration (e.g., pilot testing for a tablet platform), and exploring innovative analytic methods to stratify data by school-level socioeconomic status and geographic location. Stakeholders and public health practitioners can use YRBS data (comparable across national, state, tribal, territorial, and local jurisdictions) to estimate the prevalence of healthrelated behaviors among different student groups, identify student risk behaviors, monitor health behavior trends, guide public health interventions, and track progress toward national health objectives.

II-2.

Our findings highlight the high prevalence of early introduction of solids and provide details on why mothers introduced solid foods early.

On May 18, 2021, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr).Approximately 60 million persons in the United States live in rural counties, representing almost one fifth (19.3%) of the population.* In September 2020, COVID-19 incidence (cases per 100,000 population) in rural counties surpassed that in urban counties (1). Rural communities often have a higher proportion of residents who lack health insurance, live with comorbidities or disabilities, are aged ≥65 years, and have limited access to health care facilities with intensive care capabilities, which places these residents at increased risk for COVID-19-associated morbidity and mortality (2,3). To better understand COVID-19 vaccination disparities across the urban-rural continuum, CDC analyzed county-level vaccine administration data among adults aged ≥18 years who received their first dose of either the Pfizer-BioNTech or Moderna COVID-19 vaccine, or a single dose of the Janssen COVID-19 vaccine (Johnson & Johnson) during December 14, 2020-April 10, 2021 in 50 U.S. jurisdictions (49 states and the District of Columbia [DC]). Adult COVID-19 vaccination coverage was lower in rural counties (38.9%) than in urban counties (45.7%) overall and among adults aged 18-64 years (29.1% rural, 37.7% urban), those aged ≥65 years (67.6% rural, 76.1% urban), women (41.7% rural, 48.4% urban), and men (35.3% rural, 41.9% urban). Vaccination coverage varied among jurisdictions: 36 jurisdictions had higher coverage in urban counties, five had higher coverage in rural counties, and five had similar coverage (i.e., within 1%) in urban and rural counties; in four jurisdictions with no rural counties, the urban-rural comparison could not be assessed. A larger proportion of persons in the most rural counties (14.6%) traveled for vaccination to nonadjacent counties (i.e., farther from their county of residence) compared with persons in the most urban counties (10.3%). As availability of COVID-19 vaccines expands, public health practitioners should continue collaborating with health care providers, pharmacies, employers, faith leaders, and other community partners to identify and address barriers to COVID-19 vaccination in rural areas (2).Data on COVID-19 vaccine doses administered in the United States are reported to CDC by jurisdictions, pharmacies, and

Infertility is a common result of cancer treatment; however, opportunities exist for patients to preserve fertility prior to treatment. Recent evidence suggests that healthcare providers, including nurses, do not consistently discuss fertility preservation (FP) with patients. This qualitative, cross-sectional pilot study used a focus group and in-depth interviews to explore knowledge, attitudes, and practice behaviors related to nurses' discussion of FP with patients with cancer. Results indicate that only half of the nurses discuss FP methods with patients, even though most believe that having discussions with patients about fertility is part of their role. Factors associated with the discussion of FP among nurses included (a) knowledge (FP procedures, fertility institutes and clinics, resources for patients, and practice guidelines), (b) attitudes (difficulty finding facilities, time constraints, role, comfort level, ethical issues, financial considerations, and patient characteristics), and (c) behaviors (patient initiation, physician behaviors, patient characteristics, and timing). Discussion should be stimulated among nurses about the role of nurses in the FP discussion, and educational interventions and practice guidelines should be developed that are aimed at oncology nurses to help facilitate discussions with patients.

Adolescent interpersonal violence victimization is an adverse childhood experience and a serious public health problem for youths, their families, and communities. Violence victimization includes dating violence, sexual violence, and bullying. Youth Risk Behavior Survey data for 2019 were used to examine physical and sexual dating violence; sexual violence by anyone; and bullying victimization, whether on school property or electronic, of U.S. high school students by sex, race/ethnicity, and sexual identity. In addition, this report explores frequency of dating violence and frequency of sexual violence among students who reported these forms of victimization and presents composites of dating violence and bullying. Findings reveal that 8.2% of students reported physical dating violence; 8.2% reported sexual dating violence; 10.8% reported sexual violence by anyone, of which 50% of cases were by a perpetrator other than a dating partner; 19.5% reported bullying on school property; and 15.7% reported electronic bullying victimization during the previous 12 months. Approximately one in eight students reported any dating violence, and one in four reported any bullying victimization. Female students; lesbian, gay, and bisexual students; and students not sure of their sexual identity reported the highest prevalence estimates across all five violence victimization types, any and both forms of dating violence, and any bullying victimization. Non-Hispanic white students reported the highest prevalence of bullying victimization. Among students experiencing physical or sexual dating violence or sexual violence by anyone, the most common frequency reported was one time during the previous year; higher frequency was more prevalent among male students compared with female students. These findings provide a contextual understanding of the prevalence of interpersonal violence of U.S. high school students, highlighting those with highest prevalence. Findings can be used by public health professionals to guide prevention efforts with youths in schools and communities.

Comparing their findings to a national study of college women, the authors report that being watched, followed or spied on, and sent unsolicited emails are stalking behaviors on the rise. They present implications for college health and future directions for research.