1. Stephen Nkansah-Amankra, PhD, MPH, MA 1, Abdoulaye Diedhiou, MD, PHD, H.L.K. Agbanu, MPhil, Curtis Harrod, MPH, Ashish Dhawan, MD, MSPH 1 University of Northern Colorado/Colorado School of Public Health 138th American Public Health Association, Denver November 9, 2010 Correlates of Sexual Risk Behaviors Among High School Students in Colorado: Analysis and Implications for School Based HIV/AIDS Programs

2. Presenter Disclosures The presenter and Authors of the paper have no financial interests to disclose.  This paper has since been published in Maternal and Child Health Journal

3. Learning objectives 1.Describe patterns of antecedent HIV/AIDS risk behaviors among the sample population participating in Youth Risk Behavior Surveillance survey, 2005 2.Identify public health strategies to increase knowledge of partner HIV status. 3.Assess the role of social context associated with the correlates of HIV risk among this population.

4. Purpose  To evaluate the relationships among adolescent sexual risk behaviors, HIV/AIDS education and other antecedent risk exposures among respondents participating in the Colorado Youth Behavioral Risk Surveys, 2005.

5. Background and rationale  Population of persons infected with HIV/AIDS in the United States is the highest among the industrialized countries, and this trend is set to continue in next decades.

6. Background  Currently, available statistics show that in almost all age categories, minorities and adolescent population are more likely to be infected and or to die from the infection.  For example, 1 in 4 adolescent female has been diagnosed with at least 1 common STI.

7. Background  Similar patterns of risks across a range of adolescent sexual and reproductive health risk behaviors observed at the national level have also been reported in Colorado.  In 2007, non-Hispanic black and Latina adolescents had the highest teen births rate.  Specific STI’s were also highest among these racial groups.

8. Rationale  The need to understand the pattern of antecedent sexual risk behaviors in emerging disparities among adolescent population.  It is not clear how a school-based HIV/AIDS programs responds to concerns of adolescent needs, since previous reviews have been mixed.  Until recently, Colorado was one of the few states in the US that mandates abstinence only education.

9. Design & Methods  Secondary data analysis from the Colorado Youth Risk Behavioral Survey, 2005 The survey sampled in-school students in grades 9-12 In 2005, the survey was administered by 1498 students from 29 public schools across the state. The overall response rate was 60% Selection of schools was proportional to enrollment. The survey purposively oversamples African American and other minority students. Sampling weights included in all analysis.

10. Variables  Outcome variables: Sexual Risk Behavior, Age at First Sex, Number of Sexual Partners.  Independent variables: Gender, Physically forced sex, HIV/AIDS education, Substance use, Cigarette smoking, Alcohol use, Race, Sadness

11. Statistical Analysis  Chi square (for discrete variables) and multinomial ordered logistic regression were used to assess relationships among independent and dependent variables. Statistical significance was determined at P <.05.

12. Results-Descriptive  A total of 1474 with complete information on all variables was used for analysis.  Among the sample, nearly 64% of respondents were non-Hispanic white, while Hispanics represented 24% and Black and other minorities groups are 12%.

13.  Overall, 5.14% of respondents reported being physically forced for sex.  32.3% of respondents reported high risk sexual behavior.  Almost 11% used ≥3 substances  30% had ≥2 partners a month to the survey.  ≈85% of students received HIV/AIDS education  Male participants had higher prevalence of high risk sexual behaviors, and were more likely to initiate sex at a relatively younger age.

14. Results of Multinomial Logistic Regression  Predictors significantly associated with high sexual risk behaviors included being male (OR: 1.68; 95% CI: 1.02, 2.76),  Hispanic (OR: 2.71; 95% CI: 1.49, 4.93).  Physically forced sex (OR: 5.97; 1.80, 19.73).

15. Results: Findings  Risk categories of current drinking (both light and binge drinking) and smoking showed statistically significant effects on sexual risk behaviors.  No statistically significant relationship was found between in-school HIV program and any of the sexual risk behaviors.

16. Results  The ordinal logistic regression model for age at sexual debut (11-14 years) indicated the highest risk for young adolescent males (OR: 2.12, 95% CI: 1.21, 3.71), Blacks (OR: 3.44; 95% CI: 1.47, 8.04), and Hispanics (OR: 3.20; 95% CI: 1.70, 6.05) had higher odds of having their sexual debut at a relatively younger age (11-14 years).

17. Results  There was an 8-fold increase in the odds of early sexual debut when adolescents were physically forced for sex (OR: 8.05; 95% CI: 2.26, 28.64).  The ordinal logistic regression model analysis for the number of current sexual partners revealed that Latino racial groups had significantly higher odds of having 1 or more sexual partners compared with non-Hispanic white.

18. Discussion  Although there are overall declines in incidence of HIV infections and AIDS mortality worldwide, racial disparities in mortality and new infections continue to be higher for racial minorities and adolescents.

19. Discussion  With respect to in-school HIV education program, a number of trajectories may explain the lack of association with sexual risk behaviors.

20. Discussion  Social context of physically forced sex among the sample of adolescent population and associated life-long traumas. Developing adequate competencies among the most vulnerable adolescent population

21. Implications  Debate over abstinence-only education vs. comprehensive sexuality education.  The social context of physically forced sex and individual behavioral changes-a challenge for behavioral scientists.  Applying multilevel socio-ecological approaches

22. Limitations  Absence of key contextual determinants of health behaviors were not available for analysis.  Self-reporting of adolescent sexual and other risk behaviors may be subject to errors and social desirability bias.  The cross-sectional nature of the study makes it impossible to infer causal relationships among variables.

23. Conclusion  Efforts to control the HIV/AIDS epidemic among adolescents may need to focus on targeted interventions aimed at addressing gender- and racial/ethnic-specific risk exposures.  Broader implications are the need to develop targeted interventions, involving parents and community, in addressing underlying exposures such as sexual abuse.