Similar disparities are evident in death rates for different subgroups of teenagers. American Indian/Alaskan native adolescents had the highest rate in 2003 (91 per 100,000), and those of Asian/Pacific Islander descent had the lowest (37 per 100,000). Black youth had the second-highest rate: 82 per 100,000. Deaths in this age group are largely preventable. A total of 75 percent of all deaths in the second decade of life are caused by vehicular injuries, homicide, or suicide, climbing from 47 percent for 10-year-olds to 81 percent for 18-year-olds. Trends in mortality from vehicular crashes support the proposition that many of the risks that affect adolescents can be mitigated through legislative interventions—an important reason to explore risk patterns closely. Deaths from vehicular crashes among young people fell by 38 percent between 1988 and 1992 and have stabilized at approximately 1992 levels. The primary reason, Blum observed, is the 1984 Uniform Drinking Age Act, which required states to raise the drinking age to 21 as a condition of federal funding.

Youth violence is another area, in Blum’s view, in which public policy has an important influence. The United States has a higher rate of deaths by firearm among children and youth than the rates of the next 25 industrialized nations combined. Despite an almost 50 percent decline in the nation’s overall victimization rate between 1993 and 2005, 3.4 million teens annually are victims of violence. Data from the Youth Risk Behavior Surveillance System (YRBSS) also show that, in 2005, 4.2 percent of male adolescents and nearly 11 percent of females reported having been physically forced to have sex, although this type of violence is often difficult to measure (CDC, 2009). One-third of all firearm deaths among young people are self-inflicted. YRBSS data indicate that, in 2005, 17 percent of youth contemplated suicide and 13 percent said that they had made a suicide plan.¹

Turning to morbidity, Blum highlighted trends in substance use from the Monitoring the Future survey (http://monitoringthefuture.org). There has been a decline of approximately 20 percent among young people who report having used an illicit substance in the past month: in 2005 that figure was 16 percent, compared with over 19 percent 4 years earlier. Alcohol use has declined from a high in 1979, when more than 70 percent of 12th graders reported having used it in the past 30 days, to just over 40 percent in 2005 (there were similar declines for 8th and 10th graders). Cigarette smoking is at the lowest point since the Monitoring the Future survey began data collection, with 14 percent of 12th graders smoking daily, compared with 24 percent in 1997, for example. In contrast, the use