1165: Colorado's Healthy Kids Survey Reveals Encouraging Trends for Youth Well-Being

JOHN SHEEHAN: 

This is Public Health Review Morning Edition for Tuesday, July 14, 2026. I'm John Sheehan with news from the Association of State and Territorial Health Officials.

Strong prevention efforts and supportive environments are making a measurable difference in the lives of Colorado's young people. Emily Fine, school and youth survey manager in the Prevention Services Division at the Colorado Department of Public Health and Environment, discusses findings from the 2025 Healthy Kids Colorado survey, highlighting record low rates of persistent sadness, suicidal thoughts, and suicide attempts among youth.

Emily also explains why protective factors such as trusted adults, family support, and a sense of belonging at school are critical to improving health outcomes where challenges remain for LGBTQ+ youth, and how Colorado's youth-centered approach to data collection is helping communities make smarter, more responsive public health decisions.

EMILY FINE: 

The Healthy Kids Colorado Survey is our state's most comprehensive survey on the health and well-being of young people. It's an anonymous and voluntary opportunity for young people to report their health status, and we administer in public middle and high schools every two years. So, the Healthy Kids results really help public, private, and community organizations better understand the young people in their communities and how to support their health and well-being. Healthy Kids data has helped inform the distribution of millions in funding to communities across the state, including local public health departments, school districts, and nonprofits, all to support Colorado youth.

SHEEHAN: 

And we're discussing the 2025 results today. Was there anything surprising or different about the data from this cycle?

FINE: 

We're very excited that youth mental health is improving. So, since 2025, the percentage of youth experiencing persistent feelings of sadness or hopelessness in the past year increased, until it peaked at 40% of high schoolers during the pandemic in 2021. We saw dramatic improvements in 2023 at 26%, and this actually continued into 2025 with 22% of youth experiencing persistent feelings of sadness or hopelessness. That's actually a record low for us. We also found that thoughts of suicide are down. This survey shows record lows in youth reporting that they seriously considered suicide in the past year, at 10% in 2025, down from 11% in 2023, and suicide attempts in the past year are at a record low at 5% in 2025. These lows are really remarkable as these indicators did not change between 2015 and 2021. We also found that youth are increasingly viewing substance use with more caution. So, in 2025, survey results showed that current youth substance use declined or remains stable across many substances, including marijuana, cigarettes, prescription pain medicine misuse, and alcohol. We did find a small yet concerning increase in current vaping among high school youth. It's up to 10% from 9% in 2023. Additionally, for the first time, we asked new questions about the use of flavored tobacco and nicotine products. We found that 92% of youth who currently vape are using flavored vapes, and 83% of youth who currently use oral nicotine pouches.

SHEEHAN: 

Okay, but it sounds like the headline I would take away from that is that the trend lines for the most concerning of those data points is going the right way. It's going down.

FINE: 

Yes, correct.

JOHN SHEEHAN: 

Are there any other takeaways from the data that that makes you hopeful?

FINE: 

We have so many positive and hopeful stories coming out of our 2025 results. So more high school youth are tapping into protective factors, which are resources that really help youth deal with stressful situations and events, like seeking help from supportive parents and guardians and other caring adults, connecting with their peers, feeling like they belong at their schools and communities. So, from analyzing results year after year, we know that all youth can thrive when they have access to these protective factors. So, our analysis shows that youth who feel like they belong at school were 73% less likely to seriously consider suicide. Youth who have parents who ask what they think before making most family decisions were 68% less likely to seriously consider suicide, and youth who have an adult to go to for help with a serious problem were 60.3% less likely to seriously consider suicide. So, we also conduct youth focus groups with high schoolers and middle schoolers to really ground our statewide survey results in real life experiences. And we heard from our focus groups that youth are identifying with a changing culture around substance use. So, responses to multiple survey indicators demonstrate increased perception of harm or risk across most substances. Youth said that their generation knows more about how harmful these substances are for their health, and that substance use prevention for them started at a really young age. So, our high school youth also recognize the importance of building healthier routines. So, more youth reported that their stress level is manageable most days. We also saw positive movements and other protective factors like decreased screen time and increased sleep.

SHEEHAN: 

And from the data and from your analysis, can you tell what areas, whether around sustained public health efforts, around prevention and increasing protective factors, and prioritizing certain populations, can you tell sort of what areas need to be prioritized?

FINE: 

Yes, and thanks so much for this question. It's really important to dig deeper. While mental health is improving overall, if we only look at totals, we're missing nuances. So, our LGBTQ+ youth in Colorado continue to experience worse mental health and report suicidal thoughts and behaviors at three to four times the rate of their cisgender and straight peers. This really illuminates the importance of continuing to provide tailored, caring, and focused support to close the gap. So, our analysis of Healthy Kids results show that this gap dissipates, it actually disappears, when our LGBTQ+ youth have access to the same protective factors as our straight and cisgender youth, like feeling safe and feeling like they belong at school, having clear family rules, and supportive parents and guardians. These results really provide a clear path for how we can take action to support our LGBTQ+ youth in Colorado.

SHEEHAN: 

And what do you think is different about Colorado's approach to data collection with youth? It certainly seems like there's a qualitative approach to it that informs the analysis.

FINE: 

Yes, and first I'd like to give a big shout out to the 134,431 young people who participated in the 2025 Healthy Kids Colorado Survey, we pledge to honor what you shared with us. I'd also like to thank the parents and guardians who carefully considered and agreed to their child's participation, our school and district survey champions, our huge network of advocates within communities who really value data-driven decision making, and our incredible survey team at the Colorado School of Public Health at CU Anschutz for making all of this happen. Our system really prioritizes returning local results first. So, while we're talking about our statewide results today, schools actually get their own data back within three weeks of surveying, which really enables them to use the results right away, and as you mentioned, Colorado's approach also includes youth in every part of our survey cycle. So, we conduct paid youth focus groups to test new questions. We check in about their survey experience for quality improvement, including how we message the survey and inform youth about how to participate, we also complement our statewide results with insights into their real-world experiences. We really ensure that decision making is directly shaped by youth voices.

SHEEHAN: 

And there's clearly a lot of care in, you know, prioritizing youth voices. What kind of care is put into, you know, question selection and making sure that you're getting at the right questions to get the data that you need?

FINE: 

So, some of our questions on the Healthy Kids Colorado Survey we've asked for years and years, and they come from national validated surveys like the Youth Risk Behavior Survey or the Communities That Care Survey. We also lead a really collaborative instrument refinement process where Colorado youth, parents, school personnel, local and state organizations can weigh in on adding new questions about emerging and important adolescent health topics. So, new questions are assessed for survey fit if there's shared interest among programs and partners, if the data will be actionable, and then final decisions are made by a steering committee with representatives from numerous state agencies. Just to give some examples of some youth-led changes to the survey over the years, they include. Expanding how we ask youth about their identities, experiences with consent and sexual violence, and asking about body image and eating disorders-those were all youth-led changes.

SHEEHAN: 

And you know, so putting, again, the power in the hands of the people who you're trying to get information about and ultimately to serve, would that be a recommendation of yours to other states or other agencies who are trying to think about how they approach youth based surveying?

FINE: 

Yes, we try to prioritize youth voices in everything we do. So, incorporating ongoing feedback from youth to ensure that the data interpretation and decision making are really informed by the lived experience of young people, and I have some other things to prioritize as well, including returning results to schools and districts as quickly as possible, and also offering schools support for interpretation. We also recommend that you include as many youth as possible in your survey efforts, and don't be afraid to try new things. So, in 2025, we really enhanced our sample design by utilizing replacement sampling. So, before the administration of the survey, schools were randomly selected for our sample through two lists, an original sampled list and a replacement sample list. If an originally sampled school declined to participate, we invited its geographic match from the replacement sample list. So, replacement sampling really increased our overall response rates and the amount of publicly available representative regional data. So as a result, 19 of Colorado's 21 health statistics regions have publicly available data, and this is up from 17 regions in 2023 and 15 regions in 2021, so don't be afraid to try new things. And then lastly, if you're surveying in schools, provide funding to schools as a thank you for participating. Student wellness funding is really scarce these days. So, one small school district shared with us that they created a student wellness center with their survey participation stipend so their students now have a calm and reflective space to relax, de-stress, or attend telehealth counseling sessions.

SHEEHAN: 

Emily Fine is school and youth survey manager in the Preventive Services Division at the Colorado Department of Public Health and Environment.

ASTHO and Satcher Health Leadership Institute at Morehouse School of Medicine, with support from CDC, invites qualified professionals to apply to the next cohort of the Developing Executive Leaders in Public Health, or DELPH, program. Qualified public health professionals must be currently employed at a local, island territory, tribal, or state public health department. Federal employees are not eligible to participate in the DELPH program. The application window for the 2027 DELPH program closes on July 31. Learn more at the link in the show notes.

Public health agencies rely on clear, accessible policies to guide day-to-day work, but over time, those systems can become difficult to navigate or keep up to date. Austin Public Health recently took a closer look at its policy review and development process, after recognizing that certain policies and procedures were outdated and the existing system was not working as efficiently as possible, with support from the public health infrastructure grant and technical assistance from ASTHO, the department improved how the agency reviews, maintains, and accesses its policies. Find a link to the blog post in the show notes.

This has been Public Health Review Morning Edition. I'm John Sheehan for the Association of State and Territorial Health Officials.