Trends in sexual risk behaviors, by nonsexual risk behavior involvement, U.S. high school students

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Although teens who engage in risky health behaviors such as smoking and drunk driving are likelier to participate in sexual activity than more cautious peers, interventions aimed at reducing sexual activity appear to be similarly effective in high-risk and low-risk teens, a new study finds.

No matter where they fell on the risk spectrum, teens seemed positively influenced by intervention messages in the 1990s and early 2000s, when there was a decline in sexual experience and number of sexual partners across the board.

“The three biggest changes in adolescent behaviors in the last 16 years have been delaying sex, increasing the use of condoms and reducing the number of partners,” said lead author John Santelli, M.D. “All three are areas that HIV education has clearly identified as goals.”

However, while interventions aimed at reducing risky sexual behaviors in adolescents seemed successful for a while, the new data also show that this trend might be reversing, Santelli said.

Santelli works with the Heilbrunn Department of Population and Family Health at the Mailman School of Public Health at Columbia University.

He and his colleagues analyzed data from the Youth Risk Behavior Survey - a nationally representative survey of U.S. high school students - collected from 1991 to 2007. They categorized students into groups according to risky behaviors - such as smoking or alcohol use - and then looked each group’s sexual activity when it came to four parameters: ever having sexual intercourse, having four or more lifetime partners, current sexual activity and the use of contraception during the last sexual experience.

The study appears online in the Journal of Adolescent Health .

Students who engaged in nonsexual high risk behaviors were three times more likely than lower risk students to say they had had four or more lifetime sexual partners. About 87 percent of students engaging in the highest risk behaviors had ever had sex, compared with only 13 percent of those engaging in low or no risk nonsexual behaviors.

Sylvana Bennett, M.D., of the University of California, San Diego Medical Center, also noted that the positive trend might be reversing, and that the reversal coincides with “a nationwide policy shift away from programs that included contraceptive information toward abstinence-only programs.”

She said “troubling findings of an increasing teen birth rate in 2006 and the increasing number of sexually experienced teens after a low in 1999,” just after “the federal government began limiting its funding to programs that did not mention contraception except to point out its limitations” in 2000.

“We don’t know why we were successful in the 90s,” Santelli said. “It looks like we were reaching the low-risk kids and the high-risk kids, but now it looks like [birth rates] might be coming up again - and that’s disturbing.”

Journal of Adolescent Health: Contact Tor Berg at (415) 502-1373 or or visit

Santelli J, et al. Trends in sexual risk behaviors, by nonsexual risk behavior involvement, U.S. high school students, 1991-2007. J Adolesc Health online, 2008.


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