Co-variation in sexual and nonsexual risk behaviors over time among U.S. high school students 1991– 2005

Background: Research on adolescent health risk behaviors demonstrates that risk behaviors often occur together, suggesting that youth involvement with one risk behavior status may inform understanding of other risk behaviors. Little is know about co-variation among sexual behaviors and other risk behaviors over time.

Methods: We analyzed 1991–2005 data (n ~ 107,000) from the Youth Risk Behavior Survey, a nationally representative survey of U.S. high school students. We categorized students into groups based on lifetime and recent involvement in nonsexual risk behaviors, such as smoking and drug use. We examined each group's prevalence of and trends for four sexual behaviors: ever sexual intercourse, 4+ lifetime partners, current sexual activity, and use of contraception at last sex. Logistic regression tested whether trends in sexual behaviors differed by nonsexual risk behavior groups. Quadratic terms assessed nonlinear (U-shaped) change over time.

Results: Involvement in both lifetime and recent nonsexual risk behaviors increased after 1991, peaked circa 1997-1999, and then decreased. Linear trends in sexual risk behaviors were similar across risk groups, with the exception of ever sexual intercourse which showed a quadratic trend for several risk groups. Ever had sex and 4+ lifetime sexual partners varied considerably by risk group; differences in current sexual activity and contraceptive use across groups were less pronounced.

Conclusions: These results suggest that prevention efforts have been successful across a broad range of adolescent groups, including those who engage in multiple nonsexual risk behaviors.