Co-occurring Physical Fighting and Suicide Attempts Among U.S. High School Students

Examining Patterns of Early Alcohol Use Initiation and Current Binge Drinking

Monica H. Swahn, PhD, MPH; Robert M. Bossarte, PhD; Jane B. Palmier, JD, MPH; Huang Yao, MA


Western J Emerg Med. 2013;14(4):341-346. 

In This Article


We based our analyses on data obtained from the 2009 national Youth Risk Behavior Survey (N = 16,410). Students voluntarily completed the anonymous, self-administered questionnaire during a regular class period, following parental consent. Details of the study and the sampling strategy have been described elsewhere.[29] Briefly, the survey employed a 3- stage cluster sample design to produce a nationally representative sample of students in grades 9–12. All regular public, Catholic, and other private school students, in grades 9 through 12, in the 50 States and the District of Columbia were included in the sampling frame. Puerto Rico, the trust territories, and the Virgin Islands were excluded from the frame. Moreover, schools were selected systematically with probability proportional to enrollment in grades 9 through 12 using a random start. The survey sampled 196 schools. In terms of the class selection, all classes in a required subject or all classes meeting during a particular period of the day, depending on the school, were included in the sampling frame. Systematic equal probability sampling with a random start was used to select classes from each school that participated in the survey. The overall response rate was 71% (school response rate 81% and student response rate 88%). Analyses of this complex multistage survey were conducted with the SAS 9.1 and SUDAAN 10.0 statistical software packages to accommodate the sampling design and to produce weighted estimates.

Risk factors included in multivariate analyses were based on previous research and incorporated measures of low academic grades, weapon carrying, sadness, binge drinking and other drug use. The specific wording of these questions and the prevalence for each measure are provided in Table 1. All variables included in the analyses were already dichotomized in the public domain dataset. However, early alcohol use initiation and the outcome variables were manually recoded as described below. Consistent with past research, we coded early alcohol use initiation as a three 3-level variable to include those initiating alcohol use prior to age 13, those who initiated alcohol use after age 13, and those who were not alcohol users.[8,13,21,22] The outcome measure was based on the 2 questions that assessed any involvement in a suicide attempt or any involvement in physical fighting, both within the past 12 months. We combined the 2 measures to create a 4-level outcome variable to indicate involvement in both suicide attempts and physical fighting, involvement in physical fighting only, involvement in suicide attempts only, and involvement in neither suicide attempt nor physical fighting.