Age Bias, Missing Data, and Declining Response Rates in the National Youth Risk Behavior Survey and Their Influence on Estimates of Trends in Adolescent Sexual Experience, 2011–2023

Abstract Introduction The national Youth Risk Behavior Survey (YRBS) has experienced considerable declines in response rates, increases in missing data on sexual experience, and shifts in data collection – all of which raise questions about bias in estimates for sexual experience among US high school students. Methods We used weighted data from the YRBS for 2011–2023 (n = 110,409). We explored the impact of declining school and student response rates, missing data, and shifts in age distribution in 2021 on reported sexual intercourse. Using statistical decomposition, we estimated the percentage change in this outcome between 2019 and 2021 due to change in the age structure versus changes in reported behavior. Results From 2011 to 2023, school and student survey response rates declined (school 81% to 40%, student 87% to 71%, and overall, 71% to 35%). Missing data on ever had sex increased over time from 7.0% in 2011 to 29.5% in 2019 and 19.8% in 2023. The age structure in the YRBS national sample was similar from 2011–2019 and in 2023, but substantially younger in 2021. Statistical decomposition estimated that 50% of the change in sexual experience among female students between 2019 and 2021 and 30% of the change for male students was due to a change in the age distribution. Implications Declining response rates, increased missing data, and changes in the age structure of YRBS raise serious concerns about the validity of trends in the YRBS after 2019. A concerted national effort is needed to build support for the collection of YRBS and other public health surveillance data.