Non-medical use of prescription drugs among high school students is independently associated with sexual risk behaviors, United States, 2011-2013

Background: Substance use is associated with sexual risk behaviors among youth, but little is known about whether non-medical prescription drug use, an increasingly common behavior, is associated with sexual risk behaviors.

Methods:  Data from the 2011 and 2013 national Youth Risk Behavior Surveys, cross-sectional surveys conducted among a nationally representative sample of students in grades 9–12 (N=29,008) were used to examine the association between ever taking prescription drugs without a doctor’s prescription and sexual risk behaviors (lifetime sexual experience, current sexual activity, lifetime number of partners, and condom use and alcohol or drug use before last sexual intercourse).   Logistic regression models (adjusted for sex, race/ethnicity, grade, ever injection drug use, and use of alcohol, marijuana, heroin, cocaine, methamphetamines, ecstasy, and inhalants) estimated adjusted prevalence ratios (aPRs) and 95% confidence intervals (CI).   

Results:   Students who  took prescription drugs without a doctor’s prescription were more likely to have had sexual intercourse (aPR: 1.16; 95% CI: 1.11-1.22), be currently sexually active (1.26;1.20-1.33), have >4 sexual partners (1.45;1.33-1.58), drink alcohol or use drugs before last sexual intercourse (1.32;1.17-1.48) and not use a condom at last sexual intercourse (1.14;1.05-1.23).  A dose-response relationship was observed for each sexual risk behavior and the frequency of prescription drug use.

Conclusions:  Non-medical use of prescription drugs is associated with sexual behaviors that put youth at risk for sexually transmitted infections (STIs) and HIV infection.   Prevention efforts should focus on limiting access to prescription drugs and integrating education on substance use, STI, and HIV prevention in schools.