Practice of Epidemiology Truth or Consequences: The Intertemporal Consistency of Adolescent Self-report on the Youth Risk Behavior Survey

Surveys are the primary information source about adolescents’ health risk behaviors, but adolescents may not report their behaviors accurately. Survey data are used for formulating adolescent health policy, and inaccurate data can cause mistakes in policy creation and evaluation. The author used test-retest data from the Youth Risk Behavior Survey (United States, 2000) to compare adolescents’ responses to 72 questions about their risk behaviors at a 2-week interval. Each question was evaluated for prevalence change and 3 measures of unreliability: inconsistency (retraction and apparent initiation), agreement measured as tetrachoric correlation, and estimated error due to inconsistency assessed with a Bayesian method. Results showed that adolescents report their sex, drug, alcohol, and tobacco histories more consistently than other risk behaviors in a 2-week period, opposite their tendency over longer intervals. Compared with other Youth Risk Behavior Survey topics, most sex, drug, alcohol, and tobacco items had stable prevalence estimates, higher average agreement, and lower estimated measurement error. Adolescents reported their weight control behaviors more unreliably than other behaviors, particularly problematic because of the increased investment in adolescent obesity research and reliance on annual surveys for surveillance and policy evaluation. Most weight control items had unstable prevalence estimates, lower average agreement, and greater estimated measurement error than other topics.