Health Foundation Survey Shows Concern for Student Mental Health Needs

Findings: Rates of vaping and marijuana use have declined but mental health issues and cyberbullying have increased.

May 25, 2022

The MetroWest Health Foundation today released the results from its 2021 MetroWest Adolescent Health Survey (MWAHS), a biennial survey of middle and high school students in the 25-region served by the foundation. The survey is based largely on the Centers for Disease Control’s Youth Risk Behavior Survey and allows communities to understand, monitor and improve the health of the region’s adolescents. The 2021 survey, delayed a year due to the COVID-19 pandemic, was administered to 39,293 students.

Findings from the high school survey include:

Substance Use

  • Tobacco and Vaping: Use of conventional cigarettes has continued to decline at each time point since the survey began in 2006, with 11% of youth reporting lifetime smoking in 2021, down from a high of 35%. Despite the concerning increase in use of electronic vapor products found in the 2018 survey, reports are down sharply; in just three years, lifetime EVP use declined from 41% in 2018 to 24% in 2021. At the same time, perceived risk of using EVPs increased substantially.
  • Alcohol: Alcohol use among high school youth continued to decline in 2021, following a consistent trend over each survey administration since 2006. For the first time in 2021, fewer than half of high school youth report lifetime drinking (45%), down from 50% in 2018.
  • Marijuana: Although 2018 data showed small increases in marijuana use in high school, 2021 data indicates a sharp decline to levels well below any previously reported in the survey. From 2018 to 2021, lifetime marijuana use dropped by one-third, from 31% to 21%. The decrease in use occurred despite the opening of retail marijuana dispensaries in 2018.


  • Bullying: School bullying victimization in the past 12 months is reported by 17% of youth, down from a high of 28% in 2010, with little change over the past two surveys.
  • Cyberbullying: After declining from a high of 22% in 2012 to 18% in 2018, cyberbullying victimization increased to 22%. Females continue to report more cyberbullying than males.

Mental Health

  • Stress/Anxiety: Reports of stress are slightly lower in 2021 after increasing steadily since 2006. However, reports of anxiety symptoms are increasing. Two out of five students (42%) report feeling nervous, anxious or on edge at least half the days in the past two weeks, and 34% report being unable to stop or control worrying.
  • Depressive Symptoms and Suicidality: Reports of serious mental health problems increased sharply since the last survey. Depressive symptoms rose from 20% in 2018 to 27% in 2021, intentional self-injury rose from 14% to 19% and seriously considering suicide increased from 13% to 16%. Females, LGBTQ youth and students with disabilities report elevated levels of mental health problems.

Online Behavior/Sleep

  • Online Behavior: On the average school day, 57% of youth spend three or more hours on “screen time” not for schoolwork – a dramatic increase from 39% in 2018. Twenty-nine percent of youth spend three or more hours a day on social media alone, similar to prior years.
  • Sleep: Only one in four youth (27%) get eight or more hours of sleep on the average school night, up slightly from 24% in 2018.

“It is incredibly valuable to have timely data that provides an accurate picture of risk behaviors of our region’s youth” said Rebecca Donham, senior program officer at the MetroWest Health Foundation. “The data confirms that the mental health needs of students have increased since the pandemic began, but also provides good news in that community efforts to address vaping and other substance use have made a positive impact.” The MetroWest Health Foundation will invite school and community leaders to a full presentation of the data in May. Copies of the regional highlight reports can be found at

You can also watch a video presentation and discussion of the data by clicking HERE.

The foundation has underwritten the survey since 2006, making it one of the largest regional surveys of its kind. The information gleaned from the survey helps area schools and community agencies better plan health education and services to adolescents and is also used to frame the foundation’s funding priorities.

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