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Suicide is the second leading cause of death among high school-aged youths 14–18 years after unintentional injuries. This report summarizes data regarding suicidal ideation (i.e., seriously considered suicide) and behaviors (i.e., made a suicide plan, attempted suicide, and made a suicide attempt requiring medical treatment) from CDC’s 2019 Youth Risk Behavior Survey. Results are reported overall and by sex, grade, race/ethnicity, sexual identity, and sex of sexual contacts, overall and within sex groups. Trends in suicide attempts during 2009–2019 are also reported by sex, race/ethnicity, and grade. During 2009–2019, prevalence of suicide attempts increased overall and among female, non-Hispanic white, non-Hispanic black, and 12th-grade students. Data from 2019 reflect substantial differences by demographics regarding suicidal ideation and behaviors. For example, during 2019, a total of 18.8% of students reported having seriously considered suicide, with prevalence estimates highest among females (24.1%); white non-Hispanic students (19.1%); students who reported having sex with persons of the same sex or with both sexes (54.2%); and students who identified as lesbian, gay, or bisexual (46.8%). Among all students, 8.9% reported having attempted suicide, with prevalence estimates highest among females (11.0%); black non-Hispanic students (11.8%); students who reported having sex with persons of the same sex or with both sexes (30.3%); and students who identified as lesbian, gay, or bisexual (23.4%). Comprehensive suicide prevention can address these differences and reduce prevalence of suicidal ideation and behaviors by implementing programs, practices, and policies that prevent suicide (e.g., parenting programs), supporting persons currently at risk (e.g., psychotherapy), preventing reattempts (e.g., emergency department follow-up), and attending to persons who have lost a friend or loved one to suicide.

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.

We found marked variation by race and ethnicity, overall and within US states, in risks of COVID-19-associated orphanhood and death of grandparent caregivers among children.What's Known on this Subject: Caregiver death increases risks of short-term trauma and lifelong adverse consequences for children. One microsimulation research letter estimated parental deaths in the US to Feb 2021. A global study aggregated COVID-associated orphanhood and coresident caregiver deaths across 21 countries. What this Study Adds:We report overall and US state-specific findings, disaggregated by race/ethnicity, for COVID-19-associated orphanhood and death of grandparent caregivers. High rates of orphanhood, marked disparities, and state-specific differences show the overlooked burden among children at greatest risk, in states most affected. Authors' Contributions:Dr. Hillis guided the conceptualization and investigation, wrote the first draft of the Article, guided the writing, and led the reviews and revisions of the manuscript.Drs. Unwin and Ratmann contributed to the conceptualization or design of the work; the interpretation of the data; guided and performed the statistical analyses, verified the underlying data, led writing of the methods section, prepared all visualizations, and performed all analyses for and contributed to the Supplementary Material.Dr. Blenkinsop performed the statistical analyses, verified the underlying data, led writing of the methods section, prepared all visualizations, and performed all analyses for and wrote the Supplementary Material.Drs. Flaxman and Donnelly contributed to the conceptualization and the formal analyses, and reviewed and revised the manuscript critically for important intellectual content.

Intake of fish or omega-3 fatty acids may decrease risk of total and coronary heart disease death, but evidence from low-risk populations is less convincing. The authors assessed intake by using a food frequency questionnaire at baseline in a cohort of Iowa women aged 55-69 years. Among women initially free of heart disease and cancer (4,653 deaths over 442,965 person-years), there was an inverse age- and energy-adjusted association between total mortality and fish intake, with a relative risk of 0.82 (95% confidence interval: 0.74, 0.91) for the highest versus lowest quintile. Age- and energy-adjusted associations also were inverse (p for trend < 0.05), although not entirely monotonic, for cardiovascular, coronary heart disease, and cancer mortality. Adjustment for multiple other risk factors attenuated all associations to statistically nonsignificant levels. Estimated marine omega-3 fatty acid intake also was not associated with total or cause-specific mortality. In comparison, plant-derived alpha-linolenic acid was inversely associated with mortality after multivariable adjustment. Intake of neither fish nor marine omega-3 fatty acids was associated with breast cancer incidence. These findings do not argue against recommending fish as part of a healthy diet, as other evidence suggests benefit. Nevertheless, the authors of this 1986-2000 study could not verify that fish and marine omega-3 fatty acid intake had independent health benefits in these postmenopausal women.

Although specific foods or nutrients have not been linked consistently with risk of endometrial cancer, obesity and diabetes are associated with increased risk. These conditions may be influenced by the glycemic index or load of the usual diet. We therefore examined the association of glycemic index and load measured at baseline using a food frequency questionnaire in a cohort of 23335 postmenopausal women. Over 15 yr of follow-up, we identified 415 incident endometrial cancers. The average glycemic index was not associated with endometrial cancer occurrence. After adjustment for other risk factors, the average glycemic load was positively but weakly associated, with a relative risk of 1.24 (95% CI = 0.90-1.72) for the highest versus lowest quintile of glycemic load (P for trend = 0.08). This relative risk was 1.46 (95% CI = 1.02-2.08; P for trend = 0.02) among nondiabetic women, but the trend was in the opposite direction among diabetic women. Our study indicates that a higher dietary glycemic load may be a risk factor for endometrial cancer incidence in nondiabetic women.

BACKGROUND: Adolescent use of tobacco in any form is unsafe; yet the use of electronic cigarettes and other electronic vapor products (EVPs) has increased in recent years among this age group. We assessed the prevalence and frequency of cigarette smoking and EVP use among high school students, and associations between health-risk behaviors and both cigarette smoking and EVP use.

Background National and state-level self-reported frequency of fruit and vegetable consumption is available for high school students from the Centers for Disease Control and Prevention’s Youth Risk Behavior Surveillance System (YRBSS). YRBSS monitors priority health-risk behaviors among a nationally representative sample of US high school students and representative samples of students in states and selected large urban school districts. However, YRBSS measures intake in times per day and not the cup equivalents national goals use, which limits interpretation. Objective To help states track youth progress, scoring algorithms were developed from external data and applied to 2013 YRBSS data to estimate the percentages of high school students in the nation and 33 states meeting US Department of Agriculture Food Patterns fruit and vegetable intake recommendations. Design 24-hour dietary recalls were used from the 2007–2010 National Health and Nutrition Examination Survey to fit sex-specific models for 14–18 year olds that estimate probabilities of meeting recommendations as a function of reported frequency of consumption and race/ethnicity, adjusting for day-to-day dietary variation. Model regression parameters were then applied to national cross-sectional YRBSS data (N=12,829) and to data from the 33 states (N=141,006) that had complete fruit and vegetable data to estimate percentages meeting recommendations. Results Based on the prediction equations, 8.5% of high school students nationwide met fruit recommendations (95% confidence interval 4.9%, 12.1%) and 2.1% met vegetable recommendations (95% confidence interval 0.0%, 8.1%). State estimates ranged from 5.3% in Nebraska and Missouri to 8.9% in Florida for fruit and 1.0% in New Jersey, North Dakota, and South Carolina to 3.3% in New Mexico for vegetables. Conclusions This method provides a new tool for states to track youth progress towards meeting dietary recommendations and indicates that a high percentage of youth in all states examined have low intakes of fruits and vegetables.