SB 548
Department of Legislative Services
Maryland General Assembly
2021 Session
FISCAL AND POLICY NOTE
Third Reader - Revised
Senate Bill 548 (Senator Augustine)
Education, Health, and Environmental Affairs Ways and Means
Public Schools - Centers for Disease Control and Prevention Surveys - Revisions
This bill requires the Maryland State Department of Education (MSDE), in coordination
with the Maryland Department of Health (MDH), to include at least five questions from
the Centers for Disease Control and Prevention (CDC) Youth Risk Behavior Survey
(YRBS) on adverse childhood experiences (ACEs) or positive childhood experiences in
the Youth Risk Behavior Surveillance System survey (renamed the Youth Risk Behavior
Survey/Youth Tobacco Survey (YRBS/YTS) under the bill to reflect current practice).
MSDE must work in coordination with MDH to implement the survey per current practice.
By May 31, 2023, and every even-numbered fiscal year thereafter, MDH must publish a
data summary and trends report with State and county-level data. The bill takes effect
July 1, 2021.
Fiscal Summary
State Effect: MDH general fund expenditures increase by approximately $50,000 in
FY 2023, FY 2026, and each even-numbered fiscal year thereafter to generate the required
report, as discussed below, with potential additional minimal costs in FY 2023 and 2024.
MSDE can coordinate with MDH using existing budgeted resources. Revenues are not
affected.
(in dollars) FY 2022 FY 2023 FY 2024 FY 2025 FY 2026
Revenues $0 $0 $0 $0 $0
GF Expenditure 0 50,000 - 0 50,000
Net Effect $0 ($50,000) ($-) $0 ($50,000)
Note:() = decrease; GF = general funds; FF = federal funds; SF = special funds; - = indeterminate increase; (-) = indeterminate decrease
Local Effect: Local school systems may need to dedicate slightly more time to Maryland
YRBS/YTS administration every other year, but the operational impact is likely minimal.
Revenues are not affected.
Small Business Effect: None.
Analysis
Current Law:
Youth Risk Behavior Survey and Youth Tobacco Survey
The Maryland YRBS/YTS is an on-site survey of students in Maryland public middle and
high schools, focusing on behaviors that contribute to the leading causes of death and
disability, including but not limited to, alcohol and other drug use, tobacco use, sexual
behaviors, unintentional injuries and violence, and poor physical activity and dietary
behaviors.
Questions on YRBS and YTS are generated by CDC and required by statute to be
administered in public middle and high schools across the State. MSDE must establish
procedures for the administration of YRBS. MSDE may omit up to one-third of survey
questions if the department considers the content inappropriate. As part of the Tobacco Use
Prevention and Cessation Program, MDH must administer YTS in cooperation with MSDE
and each selected school.
In practice, to reduce the burden on schools, MDH and MSDE formally agreed in 2013 to
partner and administer the two surveys jointly to a representative sample of students. MDH
funds the entirety of the survey and provides staff to oversee survey implementation and
development, including a contract for administration and training. MSDE provides
logistical support, assistance with survey questionnaire development, school
enrollment/selection, and training for school system personnel. The Maryland YRBS/YTS
survey is administered every even-numbered calendar year during the fall semester.
Youth Risk Behavior Survey Question Selection
MDH, in collaboration with stakeholders, selects and recommends specific survey
questions for consideration to include in the YRBS portion of the survey. MSDE considers
all questions on both the middle and high school survey and only requests removal of those
very few questions that may be deemed as too intrusive by students, parents, and
communities served by the schools. Parents and other constituent groups have shared their
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concerns with MSDE about a select few questions over the years, and those questions are
considered seriously by MSDE.
Parental Permission
YRBS utilizes a passive parental permission structure. MSDE must require a local school
system to provide each parent with a denial of permission form that may be returned to the
school. The denial of permission forms must be provided on the emergency contact
information forms distributed by public schools to each student or each student’s parent or
guardian. In addition, local school systems must notify parents that the survey is
confidential, survey responses will be kept private, students’ names will not be required on
the survey response sheets, that the survey is designed to identify risk behaviors, and how
a parent can obtain a copy of the survey questions and information from CDC.
Adverse Childhood Experiences
ACEs are potentially traumatic events that occur in a child’s life such as physical or
emotional abuse, neglect, caregiver mental illness or substance abuse, and household
violence. According to Harvard University’s Center on the Developing Child, the more
ACEs a child experiences, the more likely the child is to suffer from poor academic
achievement and health conditions such as heart disease, diabetes, and substance use later
in life. YRBS is designed to capture information on the prevalence of ACEs across the
country.
State Expenditures:
Survey Administration Costs
MDH advises that the agency is already working with partners to include at least five ACEs
or positive childhood experiences questions in YRBS. Therefore, the impact of the bill’s
requirement to include such questions is minimal.
Maryland Department of Health Required Reports
MDH further advises that the unit responsible for producing reports, the Prevention and
Health Promotion Administration (PHPA), requires an additional $50,000 to generate the
required data and trend report on YRBS data in applicable fiscal years. In prior years, CDC
provided State- and jurisdiction-level data summaries to MDH, which are available on the
MDH website. However, in future years, MDH advises that CDC will no longer provide
jurisdiction-level data tables and trend reports. Therefore, in order to create a report with
county-level data, PHPA will need to undertake a significant amount of additional data
analysis. Based on the cost of producing the Biennial Tobacco Study, and assuming the
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report requires about 2.5 months of work to produce analyses for each of Maryland’s
24 jurisdictions (two days per jurisdiction), MDH estimates that it will incur approximately
$50,000 in contracting costs to produce the report in each applicable fiscal year.
The Department of Legislative Services (DLS) concurs with this assessment and advises
that general fund expenditures increase by at least $50,000 in fiscal 2023 to complete the
initial report (due May 31, 2023). MDH may also incur an indeterminate amount of
additional expenditures to produce the initial report on an accelerated timeline from survey
completion. DLS also notes that the fiscal 2024 report (due May 31, 2024) would likely be
duplicative of the fiscal 2023 report, since both would cover the most recent survey
conducted in fall 2022. Therefore, MDH expenditures are assumed to increase only
minimally in fiscal 2024 to create a second report on the fall 2022 survey results. In
fiscal 2026, and in each even-numbered fiscal year thereafter, MDH expenditures increase
by approximately $50,000 to produce required reports.
Additional Comments: MSDE notes that certain questions such as those regarding forced
sexual encounters, which constitute a crime, create concern. If included, the survey would
yield data reflecting knowledge of a crime but not allow for the support needed to help the
victim of that crime since all responses are anonymous. MSDE further advises that
including ACEs questions, with no way to support victims, can cause secondary
victimization and harm.
Additional Information
Prior Introductions: None.
Designated Cross File: HB 771 (Delegate Queen) - Ways and Means.
Information Source(s): Baltimore City Public Schools; Montgomery County Public
Schools; Maryland State Department of Education; Maryland Department of Health;
Maryland Association of County Health Officers; Department of Legislative Services
Fiscal Note History: First Reader - February 11, 2021
rh/jc Third Reader - March 30, 2021
Revised - Amendment(s) - March 30, 2021
Revised - Updated Information - March 30, 2021
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Analysis by: Michael E. Sousane Direct Inquiries to:
(410) 946-5510
(301) 970-5510
SB 548/ Page 5


Statutes affected:
Text - First - Public Schools - Centers for Disease Control and Prevention Surveys - Revisions: 7-420 Education
Text - Third - Public Schools - Centers for Disease Control and Prevention Surveys - Revisions: 7-420 Education, 13-1004 Health General, 13-1003 Health General