Trends in Sexual Risk Behavior among High School Students - United States, 1990, 1991, and 1993
Since the early 1980s, U.S. adolescents have experienced high rates of unintended pregnancies and sexually transmitted diseases (STDs), including HIV infection. Since 1990, CDC's Youth Risk Behavior Surveillance System has enabled measurement of priority health-risk behaviors among high school students at the national, state, and local levels. This report examines data from the 1990, 1991, and 1993 national Youth Risk Behavior Survey (YRBS) to describe trends in selected self-reported sexual risk behaviors among U.S. high school students. The YRBS was not conducted in 1992.
The YRBS employed a cross-sectional, three-stage, cluster sample of students in grades 9-12 in public and private schools in all 50 states and the District of Columbia. For 1990, 1991, and 1993, sample sizes were 11,631, 12,272, and 16,296, respectively, and the overall response rates were 64%, 68%, and 70%, respectively. To enable separate analysis of Black and Hispanic students, schools with high proportions of these students were over-sampled; numbers of students in other racial groups were too small for meaningful analysis. A weighting factor was applied to each student record to adjust for nonresponse and over-sampling. Trends were assessed only for sexual risk behaviors measured by questions identically worded in each survey year. To determine temporal differences, 95% confidence intervals were calculated for each estimate by using SUDAAN.
From 1990 to 1993, the percentages of high school students remained constant for those who reported ever having had sexual intercourse, such as sexually experienced, ever having had sexual intercourse with four or more partners, having had sexual intercourse during the three months preceding the survey (sexually active), having used alcohol or drugs before last sexual intercourse, and having used birth control pills at last sexual intercourse (Table 1). In contrast, the percentage of those who reported condom use at last sexual intercourse increased significantly, from 46.2% in 1991 to 52.8% in 1993 (Table 1); however, subgroup analyses indicated a significant increase in condom use only among females (from 38.0% to 46.0%) and Blacks (from 48.0% to 56.5%) (Table 2).
Editorial Note: During the 1980s, the proportion of adolescents who reported being sexually experienced increased substantially in the United States. The findings in this report indicate that, from 1990 through 1993, the proportion of high school students who reported being sexually experienced remained stable, while an increasing percentage of sexually active students used condoms, thereby reducing their risk for unintended pregnancy and STDS, including HIV infection.
The gender, grade, and race/ethnicity findings in this report may assist in identifying groups with higher prevalences of sexual risk behaviors. However, the underlying causes such as education levels, economic factors, or cultural influences, for within-subgroup differences could not be addressed in this study.
In 1991 and 1992, two health outcomes associated with sexual risk behaviors - live births and gonorrhea - also declined. Live-birth rates among those ages 15-19 decreased in 40 states and the District of Columbia, increased in eight states, and were stable in two states. In addition, rates of gonorrhea decreased among males ages 15-19 in 45 states and the District of Columbia and among females ages 15-19 in 41 states and the District of Columbia. Of the 41 areas reporting declines in live-birth rates, 34 also reported declines in gonorrhea rates for both males and females; six other states reported declines for either males or females. …