Rhode Island Youth Risk Behavior Survey

What is the YRBS?

The Youth Risk Behavior Survey (YRBS), which is coordinated by the US Centers for Disease Control and Prevention (CDC), assesses the behavioral health risks of public school students. Originally developed for high school students in grades 9 through 12, some states also conduct a separate survey among middle school students in grades 6 through 8, using separate questionnaires with appropriate literacy levels for each student group.

The YRBS monitors adolescent health behaviors including unintentional injuries and violence; sexual behaviors related to unintended pregnancy and sexually transmitted diseases; tobacco, alcohol and other substance use; unhealthy dietary behaviors; and inadequate physical activity. The YRBS also measures the prevalence of obesity and asthma and the sexual identity and sex of sexual contacts.

Conducted every two years, the YRBS is a self-administered paper survey conducted among students while they are in school. States and territories, as well as some high-population counties, participate.

YRBS data are used to identify necessary public health interventions and target them to the geographic locations and youth who most need them. The data are also used to support new legislation, policies, and funding that promote health.

Our Experience with YRBS

We have experience and specialized expertise in working with large-scale population health surveillance datasets, such as the YRBS, and have administered the YRBS and other national school surveys in several states:

  • Rhode Island Youth Risk Behavior Survey (YRBS)

  • Virginia Youth Survey (VYS)

  • Maine Youth Drug and Alcohol Use Survey (YYDAUS) – Sample design, analysis, and reporting

  • Maine Youth Risk Behavior Survey (YRBS)

  • Illinois Youth Tobacco Survey

  • Maine Youth Tobacco Survey

YRBS in Rhode Island

Since 2007, we have administered the YRBS in Rhode Island six times, will conduct it for the seventh time in 2019. Although not all states do this, Rhode Island surveys both high school and middle school students.

The standard CDC YRBS module is 89 questions for high school, with the option of dropping some questions and adding others to get to the total of 99 questions that the CDC permits. For 2019, Rhode Island added questions about transgender identity and socially assigned gender expression.

“The YRBS is very important because we want to understand certain populations that may be at risk,” said Tara Cooper, MPH, who serves as RI BRFSS Administrator/YRBS Coordinator for the Rhode Island Department of Health. (The BRFSS is the Behavioral Risk Factor Surveillance System, which is a comparable survey for adults.)  “For some of the new questions we’ve added, the data help us gain a greater understanding of gender expression and gender nonconformity and how they relate to health risks among students. The data also help us develop inclusive curriculum and school policies.”

For 2019, Rhode Island also added questions about homelessness, food insecurity, water consumption, and flavored tobacco and tobacco products for a total of 99.

“The YRBS gives us the opportunity to take a deeper dive into certain issues as we try to understand risk behavior,” continued Cooper. “It also gives us snapshots of behaviors that are trending up or down.”

Our Work in Rhode Island

The YRBS is a logistically complex project. All the steps in data collection must follow strict guidelines developed by the CDC so that state-by-state comparisons of the data will be possible.

On behalf of Rhode Island, we begin our work with a CDC-provided list of schools. The surveys are administered to a sample of classes within a selection of schools chosen to match the demographics of the state. The key to success is achieving a representative sample by maximizing the schools and students that participate. The CDC requires a response rate of at least 60%.

To get enough schools and students to participate requires persistence and persuasion, because permission and cooperation must be obtained at many levels, from school superintendents and school boards to principals, teachers, parents, and the students themselves.

“I rely on Market Decisions Research to educate, encourage, and sometimes convince school districts to participate,” said Cooper.

Schools are at times resistant because the survey takes away valuable class time and can be an imposition, and because in recent years, the demand for testing in schools has increased.

We first identify the school district and then secure permission from the superintendent (and school board if need be) to survey the schools. We use multiple contacts, including letters with information highlighting the purpose and importance of the YRBS, as well as emails, phone contacts, and often, follow-ups with more detailed information.

We then communicate with the principals to gain their permission to administer the survey at the schools. This again requires multiple contacts, including an overview of the administration process and benefits of participating in the YRBS, email reminders, and as many phone calls as necessary. Data collection begins once a school has agreed on a date for administration and designated a staff person to coordinate the work.

Serving as Our Clients’ Representatives

“Market Decisions Research is the face of the Rhode Island YRBS in the schools,” said Cooper. “I count on them to go in, administer the survey, and get out as quickly and efficiently as possible to minimize the disruption.”

Next, we work with school staff to schedule the date of the survey and obtain class rosters to plan for the data collection.

In Rhode Island, rather than relying on teachers, we train survey monitors (mostly former teachers and teachers’ aides) in the YRBS protocols. Multiple monitors administer the survey in selected classrooms. Proper monitoring of the YRBS is very important, because the students need to feel secure about sharing sensitive personal information. They need to feel certain every effort has been made to protect their confidentiality and privacy.

Competent Leadership and Scrupulous Attention to Details

“Market Decisions Research brings in qualified teams to closely monitor the YRBS,” said Cooper. “I have a lot of confidence in them going into schools.”

Completed surveys are counted and separated so that the data level of participation for each classroom can be calculated. Careful documentation is another important aspect of coordinating the YRBS. We track both the number the students enrolled in the class and the number the students who actually take the survey—students may opt out if they choose. We make sure the number of surveys taken line up with the number of surveys we collect. Completed survey forms (Scantron answer sheets filled in with pencil) are cleaned up and then labeled and shipped to a third party for data entry.

“I also have confidence in Market Decisions Research, because they consistently submit such proper and accurate documentation,” continued Cooper. “They make recommendations about how to streamline the process going forward.”  

In 2017 we surveyed 2,221 high school students in 19 schools achieving an overall response rate of 67% and 1,484 middle school students in 19 schools achieving an overall response rate of 66%.  This was sufficient to weight the data to provide robust and representative information about the student population in Rhode Island.


MDR has administered the RI YRBS seven times since 2007.

Rhode Island added questions about transgender identity and socially assigned gender expression in the 2019 administration.

“Market Decisions Research is the face of the Rhode Island YRBS in the schools,” said Tara Cooper, MPH, YRBS Coordinator. “I count on them to go in, administer the survey, and get out as quickly and efficiently as possible to minimize the disruption.”

Nathaniel Mildner - Practice Leader