Although 2025 MetroWest Adolescent Health Survey results indicate improved mental health and decreased substance use among Needham’s secondary students, the results are a mixed bag, suggesting significant levels of self-harm and issues around body image and gambling. The study also found disproportionate mental health challenges among minority groups.
“Some encouraging trends and many concerning trends,” Board of Health member Robert Partridge said in response to survey results.
MetroWest Health Foundation has administered the survey every two years since 2006, with the exception of 2020. A majority of Needham’s secondary students participated in the 2025 survey, with 1,352 responses from high schoolers and 807 responses from middle schoolers.
“I’m not sure that people realize how much data is collected here and how important it is,” assistant director of public health Julie McCarthy shared with the Board of Health during their June 26 meeting.
Epidemiologist Emily Conners, who presented survey results to the Board of Health, said students’ responses seem to indicate post-COVID improvements in mental health. Conners noted that, since 2023, mental health indicators improved across the board, with depressive symptoms dropping from more than 20% in 2023 to 15% in 2025.
“We’re coming back down to the levels before the pandemic, and hopefully that will keep trending downwards,” she said.
Gender questioning and attention disorders were relatively common among students participating in the 2025 survey. More than 13% of Needham high school participants and 12% of middle school participants identified as LGBTQ+ or questioning — higher than the 9.5% of youth nationally who identify as LGBTQ+, according to estimates shared by the nonprofit think tank Movement Advancement Project. More than 22% of Needham high school and middle school participants had been diagnosed with attention disorders by a health care provider.
Survey results suggest minority groups at the high school level are impacted most strongly by ongoing mental health challenges. Depressive symptoms among Needham high schoolers were highest for Hispanic/Latino students at 26% and Black students at 22%. Percentages of self-injury in the past 12 months were highest among Hispanic/Latino students at 14%. Depressive symptoms and self-injury rates were higher still among LGBTQ+ students (who reported 34% depressive symptoms, 37% self-injury) and students with disabilities, who reported 27% for both depressive symptoms and self-injury.
“I think this data really highlights that experiences are not uniform across all student groups,” said Conners, adding that the data could provide an opportunity for targeted programming and messaging.
A classroomful of suicide attempts
Self-harm and suicide was a concerning area. Putting the data in individual terms, roughly 31 high school students (out of 1,352 surveyed) and 23 middle school students reported having made a suicide attempt at some point in their lives.
“I think it’s easy to look at these percentages and think, ‘these are very small numbers,’” Conners said. “But it’s important to remember that, in both cases, this is at least a whole classroom full of students that have, in their lifetime, attempted suicide.”
Less substance use
Another significant theme reflected in 2025 survey results was substance use decline. Survey responses suggest decreased substance use across the board for Needham high schoolers in the past 10 years, with alcohol remaining the most commonly used substance.
“We’re pretty comparable to towns across the region in terms of vaping, marijuana use and prescription drug misuse,” Conners noted. “But we do see that Needham high schoolers are reporting a higher percentage of alcohol use when compared to the MetroWest average. This is consistent with historic data.”
Results showed an increase in substance use as a precursor to sexual activity at the high school level, with the use of alcohol and drugs before sexual intercourse climbing 15% in two years. Meanwhile, the use of protection with sexual activities declined, with condom usage dropping 10% since 2023.
“It will be interesting to track this trend over time and see if this is a true increase, or if we’re just kind of returning back to a baseline,” Conners noted.
Decreases in vaping and alcohol use for middle schoolers from 2023 to 2025 were accompanied by minor increases in cigarette and marijuana use. Middle schoolers also reflected higher percentages of fighting and weapon carrying than their high school peers — “those numbers cut in half in just about every category when comparing middle school to high school,” said Conners.
Gambling? Bet it’s boys
Male students in middle school and high school recorded higher rates of gambling, often through online platforms, on skill, lottery and casino games, fantasy sports and real sporting events. While gambling metrics have not changed over the past two rounds of surveys, Board of Health members expressed concern at this trend among Needham youth. Both violence and gambling habits are more common among male students, according to survey responses.
“We may want to figure out a way we can do some preventative work in [gambling],” said Ed Cosgrove. “I have a feeling this is going to turn into a big deal.”
“I agree,” said Partridge. “And exposure in young people is a predictor for risk of gambling as adults — we’re going to get more and more and more [youth] exposed. I think it’s really important data in an area where we can hopefully intervene.”
Director of Health and Human Services Tim McDonald noted the public health impact of online gambling is a new area of focus for the public health advocacy institute at Northeastern University. McDonald also said he is not aware of specific groups in town responding to the gambling trends among youth.
Half of high school girls trying to lose weight
Although male students seem more strongly involved in trends of gambling and violence, Needham’s female students are equally impacted by weight-related concerns. The percentage of female high schoolers attempting to lose weight, eat less or skip meals was more than 20% above their male peers. “It’s pretty astounding that around 50% of all female respondents in high school were trying to lose weight, as well as restricting their calories,” said Conners.
While survey results are typically presented to the School Committee in September, McDonald said the department is trying to be more intentional about engaging the committee earlier on. “Every year we’re trying to work on improving dissemination of the survey,” McCarthy added, noting that distributing survey results is a shared responsibility between schools and the public health department.
McDonald also noted that responses to survey results typically come from the department’s Substance Use Prevention team, Youth and Family Services, and the schools. Historically, these efforts have not been coordinated “in any way, shape or form.”
“We are trying to be more intentional,” he said. “It’s a balance, right? Everyone who works in town wants to help do things, [but] I think everyone also feels their plate is pretty full, so it’s a balance of figuring out what we can work on together, what are the key priorities. I think looking at this is almost overwhelming … we’re really trying to make an effort to be collaborative and systematic about how we try to respond to the information.”
McCarthy highlighted that the MetroWest Health Foundation, which funds the survey, will offer grants to help schools and municipalities incorporate programs based on survey data.
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