Date of Award

Spring 5-12-2017

Degree Type


Degree Name

Master of Public Health (MPH)


Public Health

First Advisor

Dr. Matthew J. Hayat

Second Advisor

Dr. Betty Lai

Third Advisor

Dr. John Robert Lutzker


INTRODUCTION: Suicidal behavior is a serious public health problem among adolescents in the United States (U.S). It is a complex phenomenon and process that may originate with suicidal thoughts and evolve over time into plans or attempts, or can more rarely be an impulsive act. A suicidal attempt may result in injury, disability or death. As adolescents are in a transitional period between childhood and adulthood, they are more vulnerable to adverse effects from health behaviors that put them at higher risk for suicidal behavior. The goal of this research was to examine high-risk health behaviors and assess their associations with suicidal risk.

METHODS: This research analyzed data from the Youth Risk Behavioral Surveillance System study data (YRBSS) from 2013 and 2015, to examine and quantify associations between health behaviors and suicide risk. Time trends were analyzed for changing relationships between health behaviors and suicide risk. They were examined with YRBSS data collected from 1991 to 2015. Suicide risk was defined as a categorical 3-level outcome. Statistical models were used to estimate associations with health behaviors and suicide risk. Analyses were stratified by sex. Odds ratios and 95% confidence intervals were reported.

RESULTS: Results of 2013 and 2015-year data showed that students who identified as feeling hopeless or sad, involved in abusing drugs such as cocaine or methamphetamine, involved in weight controlling behaviors such as vomiting or using laxatives, and/or involved in fights resulting in injury, were at increased risk for suicidal behavior. After controlling for race/ethnicity, age, and grade level, time trends from 1991 to 2015 showed students who identified as feeling hopeless or sad were at increased risk for suicidal behavior.

DISCUSSION: Adolescents were at higher risk for suicidal behavior when exposed to or involved in violence or other high-risk health behaviors. Teens exposed to or involved in violence at school or in their community should be screened to assess risk for suicidal behavior. Other factors to indicate potential for suicidal behavior include mental health issues, engaging in weight control measures, substance abuse, high-risk sexual behavior, or exhibiting aggressive or impulsive behavior. Additionally, screening may include flagging adolescents diagnosed with hopelessness or sadness. Interventions that may be effective with reducing the risk of suicidal behavior include pharmacotherapy, cognitive behavior therapy and social support. This research contributes to an improved understanding of health risk behaviors associated with suicidal behavior. This has implications for the development of preventive measures, including the design and testing of educational and public health interventions for promoting understanding of suicidal risk in adolescents.