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History of the Local YRBS
 
About the YRBS
The Youth Risk Behavior Survey (YRBS) has been administered in secondary schools throughout Cuyahoga County with support from a variety of funders and community sponsors since 1995. In 2008 the administrative and program components of the Center for Adolescent Health merged with the Center for Health Promotion Research, thus incorporating the YRBS project under one community surveillance umbrella. The YRBS is a cross-sectional tool developed by the Centers for Disease Control and Prevention (CDC) to track adolescent risk behavior over time. The national YRBS has tracked the major causes of morbidity and mortality for adolescents since 1991. Nationwide, the YRBS is conducted every two years among students in grades 9-12. In Cuyahoga County, the YRBS is conducted every year (7-8 grades in even years and 9-12 grades in odd years).
 
This information is important to collect at the national level, but it can also be beneficial to collect this data on the local level in order to compare the risk behaviors of local teens with those of teens in other communities in Ohio as well as with those behaviors in other urban communities across the country. In the future, these data can help the community plan and fund new health programs or community health initiatives, as well as provide a way to judge how well existing programs are working.  
 
YRBS Data Collection & Analysis 
The YRBS is conducted using a two-stage cluster sample design that mimics the sampling method of the CDC and its national YRBS. In the first stage of sampling, schools are selected with probability proportional to school enrollment size. This means that schools with larger enrollments have a greater chance of being selected to take part. In the second stage of sampling, classrooms are selected in each chosen school. Classroom selection is random, though schools are given the option to alternatively have the survey administered to the entire student body (i.e., every classroom). All students in the selected classrooms are eligible to participate.

Data are collected in one of two ways: paper and pencil or electronically. Paper and pencil surveys have been the method of choice in the past and are still given to most schools. Responses from paper and pencil surveys are scanned onto computers and verified using Teleform software. Recently, electronic based surveys were introduced and some schools chose this method of administration. Survey Monkey is used to design and collect individual responses electronically. The electronic version of the survey saves time and money but is unfortunately not feasible for all surveyed schools. Regardless of collection method, data are combined into one data set for the entire county. Data are then weighted to the population of students within Cuyahoga County and analyses are conducted using the weighted data.

YRBS data has been collected from schools throughout Cuyahoga County at either the high school or middle school level every year since 2000. The YRBS was also conducted at the city level as part of the Steps to a Healthier Cleveland program from 2005 to 2009. While the PRCHN generally does all data management and weighting in house, the Steps YRBS data was managed and weighted by Westat, an independent contractor with the CDC.
 
History of CWRU's Collection of YRBS Data
 
Until its merger with the Center for Health Promotion Research in 2009, the Center for Adolescent Health was the sole coordinator of the Youth Risk Behavior Survey project in Cuyahoga County.  As such, a modified version of the YRBS was first administered among 8th grade students annually from 1996 - 1999. Beginning in 2000, administration of the YRBS has been principally supported by the Child and Family Health Service/Maternal and Child Health (CFHS) program. Survey administration was expanded into high schools throughout Cuyahoga County, resulting in the 2002 Inner Ring YRBS Report, the 2003 Outer Ring YRBS Report, the 2004 CMSD YRBS Report, and the 2004 Cuyahoga County YRBS Report.  The 2004 Cuyahoga County YRBS Report combines data from 2002-2004 into a comprehensive picture of Cuyahoga County. In addition, the survey process was expanded into middle schools county-wide, resulting in the 2005 CMSD Middle School YRBS Report, the 2004-5 First Ring YRBS Report, and the 2008 Cuyahoga County Middle School YRBS Report.

Collaboration 
Interest in local data has increased as the value of this information continues to be recognized. School-based health and risk behavior surveillance was included as an integral component of local grants sponsored by the CDC's Steps to a Healthier U.S., Child and Family Health Services, Cuyahoga County Board of Health, Cuyahoga County Comprehensive Partnership for Tobacco Reduction, the Cuyahoga County Commissioners Office, and the Drug-Free Communities Support Program through the Office of Juvenile Justice and Delinquency Prevention. With the Center for Adolescent Health these organizations formed an adolescent surveillance partnership to pool resources, to create a sustainable process thus insuring that reliable and consistent data collection would be maintained in Cuyahoga County well into the future. This plan has allowed the county to track changes in behavior over time, and to provide a consistent source of data for schools, community organizations and local government who work to improve the health of adolescents in Cuyahoga County. The surveillance partnership has also made decisions to provide some specialized surveys for in-depth analysis of hot-button topics, such as tobacco use.

Surveys in Cleveland Public Schools
The Center for Adolescent Health has been a collaborating partner with the Cleveland Municipal School District and has coordinated the administration of the Youth Risk Behavior Survey since 1996. A comprehensive high school YRBS survey was first piloted in Cleveland Public High Schools in 2001. Data from this survey were not representative of the entire school district, but provided some preliminary information which helped to inform the CMSD's Comprehensive School Health Plan unveiled in 2002. In 2004, over 2300 students from 18 CMSD high schools completed the YRBS resulting in the compilation of the 2004 CMSD YRBS Report.

Also in 2004, the Cleveland Department of Public Health sought and received a "Steps to a Healthier U.S." award dedicated to reaching every member of the city of Cleveland in order to reduce high local rates of asthma, diabetes and obesity by improving nutrition and physical activity and reducing tobacco use and exposure. This effort further expanded the process of data collection in CMSD and resulted in the 2005 CMSD Middle School YRBS Report and the 2008 CMSD Middle School YRBS Report, containing information about the risk behaviors of CMSD 7th and 8th grade students. With support from the CDC Division of Adolescent and School Health, the YRBS was administered in CMSD high schools in 2007 and 2009.

The 2002 YRBS was conducted in First Ring suburban school districts in April of 2002. Approximately 3500 students completed the survey, resulting in a representative sample and allowing the compilation of a large document, the 2002 Inner Ring YRBS Report, which outlines the results of this survey and provides the schools and their surrounding community with an accurate profile of the risks students in the Inner Ring are facing.