Early initiation of sexual intercourse and associated health risk behaviors among US High school students – national Youth Risk Behavior Survey, 2011-2013

Background:  Knowing which health risk behaviors are associated with early initiation of sexual intercourse (i.e., first sexual intercourse before age 13 years) can help inform and improve school-based programs that promote sexual health.

Objective: To describe the prevalence of early initiation of sexual intercourse and identify associated health risk behaviors.

Methods: We analyzed data from the 2011 and 2013 national Youth Risk Behavior Surveys. Each survey employed a nationally representative three-stage cross-sectional sample of students in grades 9-12. Using sex-stratified logistic regression models that controlled for race/ethnicity, we calculated adjusted prevalence ratios to measure associations between age at first sexual intercourse and 38 other health risk behaviors among students ages ≥17 years.

Results: Early initiation of sexual intercourse was reported by 2.8% of female and 7.9% of male students. Compared to students who never had sexual intercourse, students who initiated sexual intercourse early were significantly more likely to engage in more than 30 health risk behaviors examined. The health risk behaviors most strongly associated with early initiation of sexual intercourse were illicit drug use and violence. Among students who ever had sexual intercourse, those who initiated early were significantly more likely to be currently sexually active (male students only), have multiple sex partners, not use a condom, not use any form of birth control, and use alcohol or drugs before their last sexual intercourse.

Conclusions: School-based programs to promote sexual health may want to encourage delay of initiation of sexual intercourse and coordinate with violence and drug use prevention programs.