CDC and YRBS: Time for Transparency

This post is related to the Youth Suicide Rise project

CDC response to Washington Post questions related to my criticism of CDC misrepresentation of YRBS results was incomplete and misleading. Furthermore, CDC demonstrated abject inability to admit any mistakes.

Inability to admit error and lack of transparency will damage the integrity of both the CDC and its indispensable high school survey YRBS.

CDC has declined for weeks now to provide answers to some simple factual questions that I submitted to them -- questions related to my criticism of how CDC misrepresented 2021 YRBS results.

Now that Glenn Kessler at Washington Post published a fact checking article titled CDC News Release Magnified Spike in Sexual Violence against Girls, we can at least examine the CDC response to his questions (which were based largely on those raised by me).

As I warned a month ago in my criticism, the CDC response confirmed that the '27% increase' in lifetime r a p e stated in their press releases was based on a calculation with figures rounded to whole numbers: the actual relative increase was about 18.4% (11.4% -> 13.5%).

Note: I have to write r a p e with spaces because otherwise Google flags this post as sensitive and demands age verification from readers to access it. Sadly one more reason to leave Google Blogger (Google seems to have abandoned this platform a long time ago).

CDC: Inability to Admit Error (Part 1)

CDC did not admit any error regarding the 27% increase miscalculation -- they merely admitted 'difference' in outcomes: CDC acknowledges the differences in these calculations and those made from whole numbers.

The 27% increase was quoted by countless news outlets around the world in February, including ABC News, Time, USA Today, Yahoo News, U.S. News & World Report, Bloomberg News and so on and on.

The 27% jump was also cited in releases by professional organizations, such as the American Foundation for Suicide Prevention (ASFP):  15% report being forced to have sex (up 27% since measurement started in 2019). 

Little if any of this reporting can be expected to be corrected as long as CDC fails to admit it made any mistake at all in its presentation of the YRBS results. Consequently, much of the public will continue to be misinformed for decades to come.

CDC: Inability to Admit Error (Part 2)

The CDC did at least remove the 27% miscalculation from its YRBS press release page -- but did so stealthily, without acknowledging it was there and why it was removed.

We all make mistakes. When we make a serious one that may have had some public impact already, we should admit it and note the correction publicly.

Note: In my original criticism of CDC, I mistakenly included graphs about dating violence prevalence for all students, not girls specifically. This error did not strengthen my criticism -- the trends are roughly the same -- but of course I corrected the graphs and admitted my error in a Correction note at the bottom of my post.

CDC should be able to admit error and do so publicly.

CDC: Inability to Admit Error (Part 3)

CDC was unable to admit error even regarding the absurd 'first increase' falsehood in its press release assertion:

More than 1 in 10 (14%) had ever been forced to have sex—up 27% since 2019 and the first increase since CDC began monitoring this measure.

In reality there were numerous increases in the YRBS prevalence of r a p e among girls during the past two decades, including from 10.3% in 2001 to 11.9% in 2003 (>15% relative rise). This is why Kessler asked:

[The statement said the jump in forced to have sex “this was the “first increase since CDC began monitoring this measure.” But looking back, I see other increases: ie, 10.3 to 11.9 in 2001-2003, 10.5 to 11.8 in 2009-2011, 10.3 to 11.4 in 2015-2017. So why did CDC say this was the first increase?] 

CDC in response defended their blatantly false assertion:

CDC’s Youth Risk Behavior Survey Data Summary & Trends Report (DSTR) provides trends over the course of ten years. The recently released report provides insight on the changes that occur from the beginning to the end of the time period (in this case, 2011 to 2021). CDC began monitoring the 10 year trends in the 2017 DSTR (2007-2017). In that report and again for 2019 (2009-2019) there were no significant increases in forced sex across those time periods. 

Of course this was not the 'first' increase no matter how CDC spins it in their response (and the assertion had nothing to do with the Summary & Trends Report -- it was on the CDC press release page).

Even if we are restricted to 10-year trends -- which is not what the CDC press release stated -- Kessler correctly countered that the results rose from 10.5 percent in 2009 to 11.4 percent ten years later in 2019. 

Regardless, CDC not only refused to admit any mistake in calling the result the first increase since CDC began monitoring this measure, it decided to keep this falsehood on its press release page.

CDC Misleads 

Kessler also notes that CDC subtly inserted the word 'significant' into their defense of their 'first increase since CDC began monitoring this measure' nonsense.

I add to this that CDC also subtly evaded calling the 2011 to 2021 trend in r a p e (11.8 -> 13.5) 'significant' -- likely because it is not statistically significant per CDC YRBS definition (the 1.6 point jump from 10.3% in 2001 to 11.9% in 2003 had p=0.13 per a YRBS online app, so the 1.7 point jump from 2011 to 2021 is unlikely to be at p < 0.05).

CDC was also severely misleading in its response to Washington Post regarding the issue of questionnaire censorship: its reply implies that this is due to YRBS questionnaire differences between  national and state or local YRBS administrations, and that this 'variation' is taken are of by CDC data analysis.

In reality this is not the issue at all. The problem is that in 2019 the national administration, for reasons still unexplained, suddenly removed three sexual violence questions from 15% to 20% of its national questionnaires.

Again, this problem has nothing to do with the separate state and local versions of YRBS. The reference to this in the CDC reply is just a red herring.

CDC: Refusal to Answer Questions

While CDC failed to answer to any of my questions, it did answer at least a few of them when they were repeated by the Washington Post.

Not even the Washington Post, however, can get all the answers from CDC -- no matter how trivial it would be for CDC to answer them.

For example, Kessler asked point-blank:

Exposure to physical violence was 3.7 in 2019 – what was it in 2021?

Exposure to sexual dating violence was 5.5, what was it in 2021?

CDC flatly refused to provide that information to Washington Post.

See Appendix (Dating Violence Results Refusal) for possible reasons why CDC refused to provide such information.

There are simply times when it does not matter if you are one of the most prominent journalists in the country -- if CDC does not wish to answer it will not answer, no matter how easy it would be for it to provide the requested information.

One Question and One Request

Most of the questions I submitted to CDC should be answered by the full YRBS data release in April.

I'm willing wait. Not that I have a choice.

There is, however, one key question and one crucial request that the April release of YRBS data will not resolve.

The key question:

Why were the three sexual violence questions removed from roughly 15% of the YRBS questionnaires in 2019? Was this a decision made by CDC or was it made by individual states or schools districts or schools?

The answer to this is necessary if we are to understand the underlying reasons for the weakening of YRBS validity due to questionnaire censorship problems. 

The request:

Please release YRBS data where it is possible to tell if a 'missing answer' was due to

a) the student did not give any answer to the question

b) the answer from the student was marked 'missing' by CDC due to Logical Consistency Edit

c) the student was never asked the question

Without such data, researchers are severely yet needlessly limited in their analysis of YRBS results and trends.

If anyone agrees with me that this question and this request are important, please write to media@cdc.gov to inquire as to why there has been no response on this from CDC.

Appendix (Dating Violence Results Refusal):

A possible reason for the refusal by CDC to provide 2021 YRBS Dating Violence results is that the exposures to these types of violence continued to fall or stagnate, countering the rhetoric by CDC DASH director K. Ethier of blaming boys for supposed violence increases during the pandemic:

“We need to talk about what’s happening with teenage boys that might be leading them to perpetrate sexual violence.”

and then again blaming boys by implication for severe declines in the mental health of girls:

"So, not surprisingly, we're also seeing that almost 60% of teen girls had depressive symptoms in the past year, which is the highest level in a decade."

The 2021 ABES results indicated a great drop in dating among teens and a slight decline in violence risks among those who did date (compared to the 2019 YRBS).

This obviously raises the question as to why blame boys, rather than adult men, for (supposed) increases in sexual abuse of girls during the pandemic, precisely the time when interactions between girls and boys of similar age decreased.

And yet the two dating violence indicators -- the most direct evidence of abuse by boys (rather than adult men) that we have -- were removed from the 2021 YRBS Summary & Trends document, even though they were included in the 2019 YRBS Summary & Trends document. 

The 2021 YRBS dating results might raise further doubts about the theory that the very real mental health declines among girls were in large part due to a concomitant wave of adolescent violence by boys.