This article was originally submitted to KHN.
As the covid-19 pandemic worsens the mental health crisis among America’s youth, a small group of states has quietly backed out of the nation’s largest public effort to track the behavior of high school students.
Colorado, Florida and Idaho will not participate in a key part of the Centers for Disease Control and Prevention’s surveys of youth risk behaviors that cover more than 80,000 students. For the past 30 years, state-level surveys, conducted anonymously every odd-numbered year, have helped shed light on the mental health stressors and safety risks of high school students.
Each state has its own rationale for opting out, but their withdrawal — when suicides and feelings of hopelessness are on the rise — has drawn the attention of school psychologists and federal and state health officials.
Some questions on state-level surveys, which can also ask students questions about their sexual orientation, gender identity, sexual activity and drug use, conflict with laws passed in conservative states. Intense political attention on teachers and school curricula has led to a reluctance among educators to have students participate in what were once considered routine mental and behavioral health assessments, some experts worry.
Reducing the number of states that participate in the CDC’s state-level survey will make it harder for those states to track conditions and behaviors that signal poor mental health, such as depression, drug and alcohol abuse and suicidal thoughts, experts said.
“Having this kind of data allows us to say ‘do this and not do that’ in really important ways,” said Kathleen Ethier, director of the CDC’s Division of Adolescent and School Health, which leads the series of health surveys known as Youth Risk Behavior monitoring system. “For any state to lose the ability to have that data and use that data to understand what’s happening to young people in their state is a huge loss.”
CDC developed the Youth Risk Behavior Surveillance System in 1990 to track the leading causes of death and injury among young people. It consists of a nationally representative survey of students in grades 9 through 12 and separate questionnaires at the state and local school level. Questions focus on behaviors that lead to unintentional injury, violence, sexually transmitted infections, pregnancy, drug and alcohol abuse, lack of physical activity, and more.
Colorado, Florida and Idaho’s decisions not to participate in the state-level questionnaires will not affect the CDC’s national survey or the surveys of local school districts in the states that conduct them.
Part of what makes the survey a powerful tool is the variety of information collected, said Noreen Dollard, senior analyst at the Florida Policy Institute, a nonprofit research and advocacy group. “This allows data to be analyzed by subgroups, including LGBTQ+ youth, so that the needs of those students who are at greater risk of depression, suicide, and substance abuse than their peers are understood and can be supported by schools and community providers,” said Dollard, who is also director of Florida Kids Count, part of a national network of nonprofit programs focused on children across the United States.
The CDC is still processing the 2021 data and has not released the results because of pandemic-related delays, said Paul Fulton, an agency spokesman. But trends from national surveys from 2009 to 2019 show that young people’s mental health has worsened over the previous decade.
“That’s why we started planning,” Ethier said. “When the pandemic hit, we were able to say, ‘Here are the things to watch out for.’
The pandemic has further exacerbated the mental health issues facing young people, said Angela Mann, president of the Florida Association of School Psychologists.
Nearly half of parents who responded to a recent KFF/CNN mental health survey said the pandemic has had a negative impact on their child’s mental health. Most said they were worried that issues such as self-harm and loneliness stemming from the pandemic could affect teenagers.
But the CDC study has flaws, said health officials from some states that have backed away from it. Not all high schools are included, for example. And the sample of students in each state is so small that some state officials said their schools have received little actionable data despite decades of participation.
That was the case in Colorado, which decided not to participate next year, according to Emily Fine, director of the Colorado Department of Health’s Schools and Youth Survey. Instead, she said, the state will focus on improving a separate survey called Healthy Kids Colorado, which includes questions similar to those in the CDC survey and questions specific to Colorado. The Colorado survey, which has been running for about a decade, included about 100,000 students statewide — nearly 100 times the number who participated in the CDC’s 2019 statewide survey.
Minnesota, Oregon, Washington and Wyoming, which also have their own youth surveys, either never participated or chose to skip the previous two CDC estimates. At least seven states will not participate in the statewide survey in 2023.
Fine said the state option is more beneficial because schools get their own scores.
In Leadville, a mountain town in Colorado, a youth coalition used results from the Healthy Kids Colorado survey to conclude that the county had higher than average rates of substance use. They also learned that Latino students in particular do not feel comfortable sharing serious issues such as suicidal thoughts with adults, suggesting that opportunities to flag problems early are being missed.
“I feel like most kids are telling the truth in these surveys, so I think it’s a reliable source,” said high school student Daisy Monge, who is part of a youth coalition that proposed a policy to educate adults in the community to improve relationships with young people.
Education officials in Florida and Idaho said they plan to collect more state-specific data using newly created questionnaires. But no country has developed a new survey, and it’s unclear what questions will be asked or what data will be collected.
Cassandra Palelis, a spokeswoman for the Florida Department of Education, said in an email that Florida intends to assemble a “task force” to design its new system.
In recent years, Idaho officials cited the CDC study data when they applied for and received an $11 million grant for a new youth suicide prevention program called the Idaho Lives Project. The data shows that the proportion of high school students who have seriously considered attempting suicide has increased from 15% in 2011 to 22% in 2019.
“It’s disturbing,” said Eric Studebaker, director of student engagement and safety coordination for the state Department of Education. Still, he said, the state worries about taking up class time to survey students and overstepping the bounds by asking questions that aren’t approved by parents.
Whatever the rationale, youth mental health advocates call the waiver short-sighted and potentially harmful because the exodus undermines national data collection. The pandemic has exacerbated stress on the mental health of all high school students, especially those who are members of racial or ethnic minority groups and those who identify as LGBTQ+.
But since April, at least a dozen states have proposed bills that mirror Florida’s Parental Rights in Education Act, which bans the teaching of sexual orientation and gender identity in kindergarten through third grade.
The law, which critics call “Don’t Say Gay,” and the intense political attention it has focused on teachers and school programs have a chilling effect on all age groups, said youth advocates such as Mann, a Florida school psychologist. “Some of these discussions about schools indoctrinating kids have turned into discussions about mental health services in schools,” she said.
Since the law was passed, some school administrators in Florida have removed rainbow flag “safe place” stickers showing support for LGBTQ+ students. Some teachers resigned in protest of the law, while others expressed confusion about what they were allowed to discuss in the classroom.
With data showing that students need more mental health services, dropping state-level surveys now could do more harm than good, said Francie Crepeau-Hobson, a professor of school psychology at the University of Colorado-Denver who used national data on youth risk behavior to analyze trends.
“It’s going to make it harder to really deal with what’s going on nationally,” she said.
KHN’s Colorado correspondent Ray Ellen Bichel contributed to this report.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and polling, KHN is one of the three main operational programs at KFF (Kaiser Family). KFF is a charitable, non-profit organization providing information on health issues to the nation.