North Carolina high school students reported better mental health and fewer risky behaviors in the state's most recent youth survey, with results returning to and in some measures exceeding where they stood before the pandemic.
The 2025 North Carolina High School Youth Risk Behavior Survey was presented to the State Board of Education last week. It drew on 1,692 usable responses from students at 25 traditional public and charter high schools who voluntarily participated during spring 2025, weighted to represent public and charter students in grades 9 through 12.
The share of high schoolers who said they felt so sad or hopeless that they stopped doing their usual activities for at least two weeks fell to 29.7 percent, according to Dr. Ellen Essick, section chief for North Carolina Healthy Schools at the state Department of Public Instruction. That figure had spiked to 43 percent in 2021 and is now roughly in line with 2019.
Which Indicators Actually Moved
The improvements are spread across several categories rather than concentrated in one, which is part of why officials describe the pattern as meaningful.
Vaping fell sharply. About 13 percent of high schoolers reported using a vapor product, down from 21 percent in 2023, while cigarette use remained far lower. Illicit prescription drug use fell to roughly 10 percent from about 15 percent.
Substance use continued longer-term declines. Alcohol use, marijuana use and prescription pain medication misuse all dropped to their lowest recorded levels in two decades. Alcohol showed the steadiest decline, falling from 42.3 percent in 2005 to 16 percent in 2025.
Social media use also declined slightly over the last two years.
State Superintendent of Public Instruction Maurice Green said the survey reflects meaningful progress, particularly in improving student safety and reducing several risky behaviors, while adding that the findings reinforce the need to help every student feel safe, connected and prepared to learn. The department reported that North Carolina has returned to and exceeded pre-pandemic levels across nearly all reported measures.
Improvement Is Not the Same as Proof of Cause
This is where careful reading matters, and where coverage of survey results most often goes wrong.
The survey period coincides with years of increased investment in school behavioral health in North Carolina, and with a state law restricting cell phones in classrooms. Educators say the phone restrictions have reduced social media use during the school day and improved emotional wellbeing.
Those are plausible explanations. They are not demonstrated ones. A survey showing improvement alongside a period of investment establishes an association, not a causal effect. Multiple things changed at once, including the passage of time since pandemic disruption, and this survey design cannot separate them.
Several structural limitations belong here rather than buried later. The sample was 1,692 students at 25 schools, drawn from districts that allowed access, with voluntary participation. Students who declined may differ systematically from those who took part. All measures are self-reported. Only high school data were ready for presentation, so middle school comparisons were not available.
This was also the first administration combining the Youth Risk Behavior Survey with the Youth Tobacco Survey, a methodological change that can affect comparability with earlier years. The 2025 instrument ran to 120 questions.
The Picture That Has Not Improved
Officials presenting the results were explicit that better does not mean resolved. Close to three in ten high schoolers still reported persistent sadness or hopelessness, a level educators describe as elevated even after the decline.
National figures give the scale. The CDC's 2023 Youth Risk Behavior Survey found 39.7 percent of high school students experienced persistent feelings of sadness and hopelessness, 20.4 percent seriously considered attempting suicide, and 9.5 percent attempted suicide.
Advocates responding to the North Carolina results said more investment in school psychologists and social workers is needed, pointing to staffing ratios rather than program design as the constraint.
The department's own recommendations focus on coordination: clear referral pathways connecting mental health, basic needs and substance use supports, community partnerships, student services teams, and use of integrated student, teacher and administrative data to identify where needs concentrate and assess whether supports are working.
Risk is also not distributed evenly. National survey data consistently show differences by sex, sexual identity, grade level, and race and ethnicity, and a statewide average can move in a favorable direction while specific groups do not.
Steps for Parents Reading These Numbers
A statewide survey describes a population. It does not describe any individual teenager, and treating a favorable trend as reassurance about a specific child is a mistake.
Warning signs worth attention include persistent sadness or irritability lasting more than two weeks, withdrawal from friends or activities previously enjoyed, changes in sleep or appetite, declining school performance, giving away possessions, or any expression of hopelessness or of being a burden.
Parents who notice these should contact the child's pediatrician or primary care clinician, who can screen and refer. School counselors, school psychologists, and student services teams are also entry points, and in North Carolina those referral pathways are being formalized.
Any statement about wanting to die or not wanting to be here warrants immediate attention rather than monitoring. The 988 Suicide and Crisis Lifeline is available by call or text around the clock, and emergency evaluation is appropriate for acute risk.
Families without insurance can access care through federally qualified health centers on a sliding fee scale, and Medicaid covers behavioral health services for enrolled children.
The department plans to release middle school data separately, and the survey is administered every other year. MedicalDaily will report the middle school results and subsequent survey cycles.
Key Questions Answered
What did the survey find? North Carolina high schoolers reported improved mental health and fewer risk behaviors, returning to and in some measures exceeding pre-pandemic levels.
How large was the sample? 1,692 students at 25 traditional public and charter high schools, surveyed voluntarily in spring 2025.
How much did the mental health measure improve? Persistent sadness or hopelessness fell to 29.7 percent, down from a pandemic-era peak of 43 percent in 2021.
Did school investment cause the improvement? That has not been established. The survey shows an association with a period of increased investment, not a demonstrated causal effect.
Which behaviors improved most? Vaping fell to about 13 percent from 21 percent in 2023, and alcohol, marijuana and prescription misuse hit their lowest levels since 2005.
Does this mean teen mental health is fine? No. Close to three in ten students still report persistent sadness, and advocates say more school psychologists and social workers are needed.
Where can a family get help? The pediatrician, school counselors, and student services teams. For acute risk, the 988 Suicide and Crisis Lifeline is available by call or text.
