Methods| Following previous researchers, 5 we pooled the national and state YRBS from
1993 to 2017. These surveys are administered biennially to US high school students
(grades 9-12) and are used by government agencies to track trends in behaviors such as
unhealthy eating, sexual activity, and substance use. Data analysis began in December
2018. Institutional review board approval and participant consent were not required because
of the secondary nature of the data. Multivariate logistic regression analysis was used to …