title: At-school substance use as a marker for serious health risks.
abstract: OBJECTIVE
  At-school substance use is associated with increased rates of violence and delinquency. However, whether at-school substance use is a useful marker for other serious health risks and whether this association varies by gender or substance is still unclear.
  
  
  METHODS
  We analyzed data from the national 2011 Youth Risk Behaviors Survey of 15,698 ninth to 12th grade students. We used multivariate regressions controlling for age and race and evaluated whether at-school marijuana and alcohol users were more likely than out-of-school users to exhibit 9 serious health risks (exposure to intoxicated driving, fighting, carrying a weapon at school, substance use with intercourse, experiencing intimate partner violence, being forced to have intercourse, experiencing depression, suicidal ideation, and attempting suicide). We included interaction terms to determine whether this association varied by gender or substance.
  
  
  RESULTS
  At-school alcohol and marijuana use were both associated with increased odds of all 9 serious health risks. The association between at-school substance use and fighting and being forced to have sex was greater for boys than for girls. Associations did not vary significantly by substance. Specificity of at-school substance use for serious health risks ranged from 0.93 to 0.96, and positive predictive values ranged from 0.23 to 0.69, well above the ranges for out-of-school use and nonuse.
  
  
  CONCLUSIONS
  Students found using alcohol or marijuana at school should be immediately and carefully screened for other serious health risks that pose significant present dangers; this might represent a critical opportunity to identify troubled youth.
authors.affiliation: Department of Pediatrics/Children's Discovery and Innovations Institute, University of California Los Angeles, Los Angeles, Calif. Electronic address: rdudovitz@mednet.ucla.edu.
authors.forename: Rebecca N
authors.initials: RN
authors.lastname: Dudovitz
authors.affiliation: David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Calif.
authors.forename: Kelsi
authors.initials: K
authors.lastname: McCoy
authors.affiliation: Department of Pediatrics/Children's Discovery and Innovations Institute, University of California Los Angeles, Los Angeles, Calif; Department of Health Policy and Management, University of California Los Angeles, Los Angeles, Calif; RAND, Santa Monica, Calif.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Chung
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D002648:Child; D003863:Depression / Q000453:epidemiology; D000066448:Driving Under the Influence / Q000706:statistics & numerical data; D000069581:Exposure to Violence / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D000066511:Intimate Partner Violence / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008385:Marijuana Smoking / Q000453:epidemiology*; D012306:Risk; D012307:Risk Factors; D012309:Risk-Taking; D012574:Schools; D012737:Sex Factors; D012742:Sex Offenses / Q000706:statistics & numerical data; D012725:Sexual Behavior; D013334:Students / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000453:epidemiology*; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000706:statistics & numerical data; D000066608:Underage Drinking / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014754:Violence / Q000706:statistics & numerical data; D055815:Young Adult
keywords: alcohol use; gender; marijuana use; school health