In a survey of high school students in dozens of states, Arkansas held the top spot in the percentage of students who had ever been forced to have sex, driven while drinking, seriously considered suicide or been bullied on school property.
The state was also No. 1 in the percentage of students who were considered obese, had ever been diagnosed with asthma or had suffered sports-related concussions in the previous year.
Those were just some results from the 2017 Youth Risk Behavior Survey indicating that Arkansas high school students were more at risk of harm from a variety of sources, and more likely to engage in unhealthy or dangerous behavior than their peers in other states.
The survey of students in grades 9-12 is conducted every two years by the U.S. Centers for Disease Control and Prevention and by participating state health and education agencies.
Given Arkansas' high poverty rate, research linking low family income to an increase in behavior problems could help explain some of the findings, including the high percentage of Arkansas students who said they had been bullied or had considered suicide, said Richard Livingston, a professor of child and adolescent psychiatry at the University of Arkansas for Medical Sciences.
"The impact of something bad is worse if your supports are more lacking," he said. "If you're struggling to make ends meet and pay your rent and eat, than any stressor is going to seem magnified."
Likewise, living in poverty is a "major risk factor" for developing asthma, said Tamara Perry, an associate professor at UAMS and Arkansas Children's Hospital.
The reasons for the link aren't entirely known, but she noted that exposure to environmental factors, including allergens from mice and cockroaches, can increase the risk of developing the illness.
The state's high obesity rate may also contribute, since obesity is associated with an increased risk of developing asthma, she said.
"To know that Arkansas is leading the nation with asthma diagnoses makes it imperative for us as health care providers to continue to do research and to reach out to patients to try to make sure that we are doing everything that we can to, first of all, prevent asthma if we can and also treat it appropriately when we know that a patient has asthma," Perry said.
Joe Thompson, director of the Arkansas Center for Health Improvement, said some of the CDC survey findings may be helpful to the commission on school safety appointed by Gov. Asa Hutchinson earlier this year.
Compared with their peers in other states, the survey, released earlier this month, found that Arkansas students were more likely to have carried weapons on school property in the past 30 days and to have been threatened or injured with weapons at school.
"This is a pretty strong wake-up call I think that youth across Arkansas are at a greater degree of risk than previously has been recognized," he said.
Arkansas' results were based on a survey of 1,682 students and were mathematically weighted to be representative of all public high school students in the state.
Although the national estimates are based on a sample that includes every state, state-by-state results were released for only 39 states. Survey methodology and questions, along with the data, can be found at bit.ly/2JRekdk.
Minnesota, Oregon, Washington and Wyoming did not participate in the survey. Results for Alabama, Georgia, Indiana, Mississippi, New Jersey, Ohio and South Dakota were excluded because the response rates in those states weren't high enough to produce accurate estimates.
The results for each question also exclude states that did not include the question on their surveys.
The survey found that 19.2 percent of Arkansas students had been physically forced to have sexual intercourse at some point in their lives -- the highest rate among the 34 states with available data.
Those who had been forced to have sex included 22 percent of the state's female students and 16.1 percent of its male students.
The overall percentage was an increase from 2015, when 11.7 percent of students said they had been forced to have sex, although the increase wasn't considered to be statistically significant.
Nationally, the survey found that 7.4 percent of high school students had been forced to have intercourse.
On a similar measure, included for the first time in 2017, the survey found that 18.5 percent of Arkansas students had been forced to engage in sexual activity at least once during the past year.
That was the highest percentage out of 26 states for which data were available. It included 22 percent of female students and 13.9 percent of male students.
Nationally, 9.7 percent of students said they had been forced to perform sex acts.
Gary Wheeler, medical director at the state Department of Health, said the findings are "very, very concerning" and raise the issue of "whether we could do a better job of addressing this issue in families and schoolchildren."
"This just suggests that there's more of a culture of violence than I guess any of us would be comfortable with," he said.
Kristen Jozkowski, associate professor of community health promotion at the University of Arkansas, Fayetteville, said a lack of sex education in schools could contribute to the high rate of sexual assaults, as well as the state's high rates of teen pregnancy and students who have unprotected sex.
Among students who were sexually active, 19.8 percent of Arkansas students said they did not use any form of birth control the last time they had sex, compared with 13.8 percent of such students nationwide.
An Arkansas Democrat-Gazette survey last year found that 34 of the state's 262 public school districts don't teach sex education and that 85 percent of districts teach abstinence.
Without sex education, "you're not really providing context to young people about how to ask for sex or how to communicate consent to sex, which may facilitate sexual assault," Jozkowski said.
At the same time, programs that stress abstinence sometimes send counterproductive messages, such as that "boys are sort of uncontrollable with their sexuality" and that "it's women's job to rebuff men," she said.
And when children aren't used to talking about sex, they may be less likely to report assaults, Jozkowski said.
With regard to sports-related concussions, Arkansas' No. 1 ranking shouldn't be interpreted to mean that its school athletes are suffering such injuries at a higher rate than those in other states, said R.J. Elbin, director of the office for sports concussion research at UA-Fayetteville.
The survey found that 21.5 percent of Arkansas high school students had concussions in the past year from playing sports or being physically active.
By contrast, Arkansas schools reported just 16 concussions per 1,000 sports team participants in the 2016-17 school year, Elbin said.
The same year, Michigan, which is seen as a leader in tracking such injuries, reported 21 concussions per 1,000 participants, he said.
The CDC survey indicates that many such injuries may be happening outside of school-sponsored games and practices, he said.
"We need to have more concussion education in schools in general, not only for our scholastic athletes," he said.
The survey also found that in the previous 30 days, 26.3 percent of students had ridden in cars driven by someone who was drinking alcohol.
Among students who had driven cars in the previous 30 days, 10.7 percent said they had driven while drinking alcohol, and 46.2 percent said they had texted or sent email while driving.
Hope Mullins, program manager for research and evaluation at Arkansas Children's Hospital's Injury Prevention Center, said she talks to groups of students and others about the dangers of such behavior. Her daughter, Faith, was 17 years old when she suffered permanent injuries in 2011 after she was hit head-on by a driver who was texting.
Arkansas law prohibits texting and driving. A law passed in 2009 also bars drivers younger than 18 from using cellphones while driving.
"My message is that my child can be doing everything right, but if other parents aren't enforcing the laws with their own children, then other kids suffer the consequences," Mullins said.
Information for this article was contributed by Ginny Monk of the Arkansas Democrat-Gazette.
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