QuickStats: Rate of Unintentional Traumatic Brain Injury (TBI)–Related Deaths Among Persons Aged 24 Years and Under, by Age Group

October 16, 2020

From 1999 to 2018, death rates for unintentional TBI among persons aged 24 years and under declined across all age groups.

During the 20-year period, TBI-related death rates declined from 3.7 per 100,000 to 1.5 among children aged 0–4 years, from 3.0 to 0.9 for children and adolescents aged 5–14 years, from 14.7 to 4.4 for adolescents and young adults aged 15–19 years, and from 14.1 to 6.9 for young adults aged 20–24 years.

For most of the period, rates were highest for persons aged 20–24 years followed by those aged 15–19, 0–4, and 5–14 years.

Source: National Center for Health Statistics, National Vital Statistics System, Mortality Data. https://www.cdc.gov/nchs/deaths.htm.


Fact or Fiction: Suicide rates among young people in the Northeastern United States have not increased much over the last decade

September 11, 2020

Source: National Vital Statistics System


Fast Food Intake Among Children and Adolescents in the United States, 2015–2018

August 14, 2020

Questions for Cheryl Fryar, Health Statistician and Lead Author of “Fast Food Intake Among Children and Adolescents in the United States, 2015–2018.”

Q: Why does NCHS conduct studies on fast food consumption among children and adolescents?

CF: We focus on fast food for this report because fast food continues to play an important role in the American diet. Fast food has been associated with poor diet and increased risk of obesity. In a previous report, we described the percentage of calories consumed from fast food among children and adolescents during 201-2012. This report provides an update on the daily percentage of calories consumed from fast food by children and adolescents aged 2-19 years during 2015-2018 and trends since 2003.

Q: How did the data vary by age groups, sex and race?

CF: There were some demographic differences in the daily percentage of calories consumed from fast food. Adolescents aged 12–19 consumed a higher percentage of calories (16.7%) from fast food than younger children (11.4%) aged 2-11 years. Girls consumed a higher percentage than boys and non-Hispanic white adolescents consumed a lower percentage than the other race and Hispanic origin groups. This brief report did not examine confounders that may possibly explain demographic differences.

Q: Was there a specific finding in the data that surprised you from this report?

CF: While there really wasn’t anything in this report that I hadn’t expected to see or that was surprising to me, this report’s trends analysis is of interest. The daily percentage of calories from fast food in children and adolescents decreased from 14.1% in 2003–2004 to 10.6% in 2009–2010, and then increased to 14.4% in 2017-2018.

Q: How did you obtain this data for this report?

CF: The National Health and Nutrition Examination Survey (NHANES) is the source of the data.  Since 1999, NHANES has been conducted on a continuous basis, and visits approximately 15 counties each year of various population size.  The survey conducts at home health interviews and health examinations in mobile examination centers (MEC) with nearly 5000 people each year.   Information on nutrient intake was obtained from one 24-hour dietary recall interview administered in-person at the MEC.  Specifically, anyone who reported obtaining any food or beverage from “restaurant fast food/pizza” was someone who consumed fast food on a given day.  Dietary recalls cover intake for any given day, specifically the 24-hour period prior to the dietary recall interview (midnight to midnight).

For survey participants < 6 years of age a proxy was used (who was generally the person most knowledgeable about the child’s food intake). For children ages 6- 8, interviews were conducted with a proxy and with the child present to assist in reporting intake information. Interviews of children ages 9-11, were conducted with the child and the assistance of an adult familiar with the child’s intake. Adolescents 12 years or older answered for themselves.

Q: What is the take home message for this report?

CF: The take-home message for this report is that more than one-third (36.3%) of U.S. children and adolescents consume fast food on a given day. Overall, children and adolescents consume, on average, 13.8% of their daily calories from fast food.  And, on a given day, over 11% of children and adolescents consume more than 45% of their daily calories from fast food.

Diet and exercise play important roles in helping individuals achieve and maintain their health.  The USDA/HHS’ Dietary Guidelines for Americans 2015 provides guidance in healthy food choices.  In addition, HHS’ 2018 Physical Activity Guidelines for Americans provides guidance for all ages in improving health through physical activity.

Racial and Ethnic Differences in Mortality Rate of Infants Born to Teen Mothers: United States, 2017–2018

July 31, 2020

Questions for Ashley Woodall, Health Statistician and Lead Author of “Racial and Ethnic Differences in Mortality Rate of Infants Born to Teen Mothers: United States, 2017–2018.”

Q: Why did you decide to focus on teenagers for this report?

AW: There has not been much research on infant mortality using national data that focuses on specific maternal age groups. Teenagers are an age group of particular interest because infants born to teenagers have higher infant mortality rates compared with infants born to women in older age groups. Consequently, we wanted to explore the recent patterns in infant mortality for teenagers in the United States.

Q: Can you summarize some of the findings?

AW: In 2017–2018, infants born to teenagers aged 15–19 had the highest rate of mortality (8.77 deaths per 1,000 live births) compared with infants born to women aged 20 and over. Among teenagers, infants of non-Hispanic black females had the highest infant mortality rate (12.54) compared with non-Hispanic white (8.43) and Hispanic (6.47) females. Among the five leading causes of infant death, the largest racial and ethnic difference in mortality rates was found for preterm- and low-birthweight-related causes, where rates were two to three times higher for infants of non-Hispanic black teenagers (284.31 per 100,000 live births) than infants of non-Hispanic white (119.18) and Hispanic (94.44) teenagers.

Q: Was there a specific finding in the data that surprised you from this report?

AW: We were surprised by the large racial and ethnic disparity in deaths for preterm- and low-birthweight-related causes. This finding suggests that preterm birth and low birthweight are significant contributing factors for death among infants born to non-Hispanic black teenagers.

Q: Can you explain the difference between total infant, neonatal, and postneonatal mortality rates?

AW: Infant mortality is the death of a baby before his or her first birthday. It is calculated by dividing the number of infant deaths during a calendar year by the number of live births reported in the same year. It is expressed as the number of infant deaths per 1,000 live births. Neonatal mortality rate is the death of a baby during the first 27 days after birth, per 1,000 live births. Postneonatal mortality rate is the death of a baby between 28 days to under 1 year after birth, per 1,000 live births.

Q: What is the take home message for this report?

AW: The different mortality patterns seen among infants born to teenage mothers illustrate the racial and ethnic disparities in infant mortality and suggest that preterm birth and low birthweight are major public health concerns for infants born to non-Hispanic black teenagers.

Sexual Activity and Contraceptive Use Among Teenagers Aged 15-19 in the United States, 2015-2017

May 6, 2020

Questions for Gladys Martinez, Health Statistician and Lead Author of “Sexual Activity and Contraceptive Use Among Teenagers Aged 15-19 in the United States, 2015-2017.”

Q: Why does NCHS conduct studies on sexual activity and contraception?

GM: We conduct studies on sexual activity and contraceptive use to better understand the risk for sexually transmitted diseases, birth and pregnancy rates, and differences between groups in the U.S. reproductive age population.

For this report they are crucial for understanding differences in the risk of teen pregnancy and to put into context recent declines in the U.S. teen birth rate.

Q: Can you summarize how the data varied by sex and age groups?

GM: There has been a decline in the percentage of male and female teens who ever had sex from 1988 to 2017.  But the percentage of male teens who ever had sex continues to decline in most recent time period 2011-2015 to 2015-2017, but has remained the same for female teens.

Male and female had similar:

  • cumulative probabilities of having had sex at each age in their teen years
  • relationship between age at first sex and contraceptive use: teens with younger ages at first sexual intercourse were less likely to use a method of contraception

Q: Was there a specific finding in the data that surprised you from this report?

GM: For the first time since we have been collecting these data, the cumulative probabilities of having had sex by each age in the teen years were similar for young males and females.

Ever use of implant is 15% which is an increase from 2011-2015 when it was only 3%.

Q: How did you obtain this data for this report?

GM: Data for this report are from the 2015-2017 National Survey of Family Growth, a nationally representative in-person survey of men and women aged 15-49 in the United States.

Q: Do you have older data that is comparable beyond 2002?

GM: Yes, we have been tracking these data since the 1970s and the earliest published NSFG report shows data from 1988.

Attempts to Lose Weight Among Adolescents Aged 16–19 in the United States, 2013–2016

July 17, 2019

Questions for Lead Author Kendra McDow, Health Statistician, of “Attempts to Lose Weight Among Adolescents Aged 16–19 in the United States, 2013–2016.”

Q: What was the most significant finding in your report?

KM: Almost 40% of adolescents 16-19 years old tried to lose weight in the past year and the groups with the highest percentages were girls, Hispanic teens and teens with obesity.

Q: Why do more Hispanic teens attempt to lose weight than other race/ethnic groups?

KM: Yes, that was an interesting finding. Data from another source – the Youth Behavioral Risk Surveillance System (YBRSS) support this finding. In 2017 YBRSS also found that Hispanic teens were more likely to try to lose weight compared to other racial/Hispanic-origin groups. Our study did not look at motivations or the reason why adolescents attempt to lose weight. This a great area for further study!

Q: Do we have any sense of whether the number/percent of teens trying to lose weight has increased or declined over time?

KM: Our study period was from 2013-2016. For this analysis we didn’t look at trends but we started to look into this and found some changes in the way the data were collected over time. We need to explore this more fully. Trend analysis using YRBSS (9th through 12th graders) showed a significant increase in weight loss attempts from 1991 through 2017 (41.8% to 47.1%).

Q: What type of exercising do teens do to lose weight?

KM: Exercise was the most commonly reported method to lose weight. Our study did not specifically look at the type or intensity of exercise adolescents are doing to lose weight. Regular physical activity among adolescents is important for life-long health.

Q: Is there a public health “take home message” here?

KM: Teens are employing multiple methods to lose weight. The vast majority, over 83%, of teens trying to lose weight were exercising. Over half were drinking water and almost half were eating less. And certain populations are more likely to attempt to lose weight, including girls, Hispanic adolescents and adolescents with obesity. The American Academy of Pediatrics recommends the promotion of healthy weight loss and adoption of healthy eating and physical activity.

Q: Anything else you’d like to add?

KM: We saw that the majority of adolescents who attempted to lose weight used recommended lifestyle modification strategies of healthy eating and exercise. In addition to exercise, drinking more water and eating less, 44.7% of adolescents reported they ate less junk food or fast food and 44.6% ate more fruits, vegetables and salads. This is promising! Of note, 16.5% (1 in 6 adolescents) reported skipping meals as a weight loss method. The American Academy of Pediatrics discourages unhealthy weight loss strategies, such as skipping meals and dieting, and encourages healthy eating and physical activity behaviors for adolescents

Drug Overdose Deaths Among Adolescents Aged 15-19 in the United States: 1999-2015

August 16, 2017

Questions for Sally Curtin, Statistician and author of “Drug Overdose Deaths Among Adolescents Aged 15-19 in the United States: 1999-2015

Q:  Do trends in overdose deaths among teens reflect the trends of older adults in the U.S.?

SC: There are some similarities, but also differences.  Both teens and older adults experienced the sharp increases from 1999 through the mid-2000s.  But unlike older adults, whose rates continued to increase, teenagers actually had a decline in drug overdose death rates through 2014, before an upturn in 2015.  All of this decline was for males as the rates for females stabilized from 2004-2013 before increasing again.


Q: Do we know why trends for teens dropped during the first several years of the millennium?  And why they increased sharply in 2015?

SC: There are many public health initiatives to combat the rising drug overdose death rates.  While we do not know the exact reason for the decline, we know the specific drugs that were involved—opioids, cocaine, and benzodiazepines.  For the opioids, it was the frequently prescribed drugs—methadone and natural and semisynthetic (oxycodone, morphine) that had declines for teens since the mid 2000s.  Other opioids such as heroin and synthetic opioids (including fentanyl) fluctuated but generally increased over the 1999-2915 study period.  The continued rise in drug overdose deaths involving heroin and synthetic opioids from 2014 to 2015 contributed to the uptick between those years.


Q: What are the differences in overdose deaths by gender and race?

SC: We did not examine race in this report because the numbers were too small for some groups.  By gender, the drug overdose death rate for males was higher for females for every year of the 1999-2015 period and was 70% higher in 2015.  While males had a greater increase in drug overdose death rates than females between 1999 and the mid-2000s, they also declined by about a third between 2007 and 2014 before increasing again.  The rate in 2015 was still lower than the 2007 peak.  Females had an increase, albeit smaller than for males, and then their rate stabilized between 2004-2013 before increasing again.


Q:  What type of drugs are killing these teens?

SC: As for the population at large, the majority of drug overdose deaths involve opioids.  When we examined the specific type of opioid involved, heroin is the leading drug involved and rose fairly steadily throughout the study period.  Synthetic opioids (including fentanyl) were lower than other opioid drugs through the early years of the period, but then doubled between 2014 and 2015.  This large increase for synthetic opioids has also been observed for the population at large.

We did not look at combinations of drugs.  Often, there is more than one drug involved so the categories we show are not mutually exclusive.

Antidepressant Use in Persons Aged 12 and Over: United States, 2011-2014

August 16, 2017

Questions for Laura Pratt, Psychiatric Epidemiologist and Author of “Antidepressant Use in Persons Aged 12 and Over: United States, 2011-2014

Q:  Are more people taking antidepressants now vs. in the past?

LP:   Yes, in our data brief, figure 4, you can see how antidepressant use has increased over time from 1999-2002 to 2011-2014.  Slightly less than 8% of the U.S. population took antidepressants in 1999-2002 while almost 13% took antidepressants in 2011-2014.  This is an increase of about 65%.  The rates of increase were similar for males and females, but twice as many females took antidepressants as males at all time points.


Q: Is there any particular age group in which antidepressant use is higher?

LP:   Among all persons and among females, antidepressant use was highest in persons 60 years of age and older.


Q:  Does this mean that rates of mental illness are on the rise?

LP:   Our report does not look at rates of mental illness.  But in general, prescription drug use is also related to healthcare access and utilization, and, in mental health particularly, many studies have shown high rates of under-treatment.  The situation with a large percent of people with depression, for example, not receiving treatment has improved over time.  Increases in healthcare utilization and treatment of depression would result in a higher rate of antidepressant use whether or not the rates of mental illness increased.


Q:  What are the risks or dangers of antidepressant use?

LP:   The first antidepressants that were available had many side effects and could cause overdose death.  The vast majority of overdose deaths related to these drugs were intentional (suicides). The newer antidepressants in use today have fewer side effects and have a much lower risk of overdose.  Antidepressants do not produce a “high” and are not drugs of abuse.


Q:  Any other findings you feel are noteworthy?

LP:   It was very noteworthy that non-Hispanic white persons ages 12 and older continue to have rates of antidepressant use that are between 3 and 5 x higher than persons in other race and Hispanic origin groups. I was also surprised to see that 25% of people who take an antidepressant have taken it for more than 10 years.  In our first antidepressant data brief, the percent of people taking an antidepressant for more than 10 years was 13.6%.  Interestingly, the percent of persons taking antidepressants who took them for more than 2 years was 61% in 2005-08 and increased to 68% in 2011-2014.

QuickStats: Percentage of Children and Teens Aged 5–17 Years Who Missed >10 School Days in the Past 12 Months Because of Illness or Injury, by Sex and Age — National Health Interview Survey, 2013–2015

July 7, 2017


During 2013–2015, 3.9% of boys and 4.3% of girls missed >10 school days in the past 12 months because of illness or injury.

Among children aged 15–17 years, girls were more likely than boys to miss >10 school days (6.8% compared with 3.9%).

Among girls, those aged 15–17 years were more likely than girls aged 5–10 years and girls aged 11–14 years to miss >10 school days (6.8% compared with 3.2% and 4.0%, respectively).

Among boys, there was no difference by age.

Source: https://www.cdc.gov/mmwr/volumes/66/wr/mm6626a8.htm

Sexual Activity and Contraceptive Use Among Teenagers in the United States: 2011-2015

June 22, 2017

Questions for Joyce Abma, Ph.D., Social Scientist and Lead Author on “Sexual Activity and Contraceptive Use Among Teenagers in the United States: 2011-2015

Q: Is the bottom line here in this study that teens are less sexually active than in the past?

JA: Yes. Although this has changed very gradually, fewer teens have ever had sex than was the case three decades ago. In the late 1980s, just over half of female teens and 61% of male teens had had sex, and the most recent data through 2015 show this percent is well under half: 42% for females and 44% for males.- So males have had a particularly large decrease in the percent who have ever had sex during the teen years.

Over the past 3 decades, since 1988, the percent of teens who had ever had sex has been declining gradually. (decreasing from over half – 51% for females and 60% for males, to under half – 42% for females and 44% for males in 2011-15). Since 2002, however, the decline slowed and there has been no significant change for female or male teens. And this plateau continued through the most recent time period, 2011-2015.

Q: Are the teens of today also more likely to use contraception than past generations?

JA: Yes. Although even about 3 decades ago, in the late 1980s, contraceptive use was common among teens – for example 84% of males used a method at last sex in 1988 – they have become increasingly more likely since then. In the most recent data, 2011-2015, 95% of males used a contraceptive method at last sex. Related to this increase among females is another big change across the time period: the development and availability of a wider variety of contraceptives for females. These include Depo-Provera injectable, implants, emergency contraception, the patch, and more recently, the IUD has been re-designed and recommended for teens. These newer hormonal methods are starting to be used more commonly, but use of the pill remains common as well among female teens.

Q: With such a sensitive topic, do you meet with a lot of resistance in trying to collect this data?

JA Actually, the response rate for the survey is 70%, meaning of the people eligible for the survey, 70% agree to participate and complete it. Generally, people recognize the importance, validity and value of the survey. Those who participate tend to find it an interesting and positive experience. And many topics are covered, including some questions about education, health services, attitudes and opinions, questions about children, and relationships.

Q: Do these findings include teens with same-sex partners?

JA: No, this report covers only sexual intercourse with opposite-sex partners. The purpose of the report is primarily to understand risk behaviors for pregnancy among teens, thus the focus is only on opposite sex sexual activity.

Q: Any other important points of note?

JA: There are several interesting findings in this report, both in terms of sexual activity as well as contraceptive use among teens. For example, teens who had not yet had sex – which is over half of all teens — were asked to identify the main reason they hadn’t yet had sex, from 5 possible reasons. Female and male teens were very similar in the reasons they chose. Female and male teens both chose “against religion or morals”, followed by “don’t want to get (a female) pregnant”, and “haven’t found the right person yet” as the most common reasons. So female and male teens seem to be thinking along the same lines when considering the issue of not being sexually active.

As for contraceptive use, recently the IUD and contraceptive implants have been re-designed and are recommended by reproductive health professionals for teens to reduce the chances of pregnancy. These methods, referred to as “LARC” – for “long-acting reversible contraception”– are important because they offer protection for multiple years, they don’t require regular action on the part of the teen, and their failure rates are extremely low. These methods are still relatively rarely used among teens but are being used more often: 6% of teens had ever used either of these two methods as of the 2011-15 data.