1. Trends in HIV-Related Risk Behaviors Among U.S. Adolescents: 15 Years of Progress Laura Kann, Ph.D. Richard Lowry, M.D. Nancy Brener, Ph.D. Danice Eaton, Ph.D. Howell Wechsler, Ed.D. Division of Adolescent and School Health National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention The findings and conclusions in this presentation are those of the authors and do not necessarily represent the views of the CDC.

2. Background Among 15-24 year olds in the U.S.… è 4,842 cases of HIV/AIDS è 9.1 million cases of sexually transmitted infections

3. Purpose è To examine secular trends in sexual risk behaviors and injection drug use among high school students in the U.S. during 1991-2005.

4. HIV-Related Risk Behaviors è Ever had sexual intercourse è Sexual intercourse with >4 persons è Current (during the past 3 months) sexual activity è Condom use (among sexually active students) è Lifetime illegal injection drug use

5. Subgroups è Overall è Female è Male è White (non-Hispanic) è Black or African American (non-Hispanic) è Hispanic or Latino

6. Methods è National Youth Risk Behavior Surveys (1991-2005) l Independent 3-stage cluster sample designs l Nationally representative of students in grades 9-12 l Oversampling of black and Hispanic students l Sample sizes – 10,904 to 16,296 l School response rates – 70% to 81% l Student response rates – 83% to 90% l Overall response rates – 60% to 70%

7. Survey Administration è Anonymous and voluntary è Parental permission following local procedures è Self-administered, computer-scannable questionnaire or answer sheet è Completed in one class period (45 minutes)

8. Data Analysis è Weighting l Based on student sex, race/ethnicity, and grade l Adjusted for oversampling of black and Hispanic students è Subgroup differences l T-tests è Temporal changes l Logistic regression analyses l Controlled for sex, race/ethnicity, and grade l Simultaneously assessed linear and quadratic changes

9. Results

10. Percentage of High School Students Who Ever Had Sexual Intercourse, by Sex and Race/Ethnicity,* 2005 * B > H > W National Youth Risk Behavior Survey, 2005

11. Percentage of High School Students Who Ever Had Sexual Intercourse, 1991 – 2005 *Significant linear decrease, p <.05 National Youth Risk Behavior Surveys, 1991 – 2005

12. Percentage of High School Students Who Ever Had Sexual Intercourse by Sex, 1991 – 2005 *Significant linear decrease, p <.05 National Youth Risk Behavior Surveys, 1991 – 2005

13. Percentage of High School Students Who Ever Had Sexual Intercourse by Race/Ethnicity, 1991 – 2005 *Significant linear decrease, p <.05 **Significant quadratic effect, p <.05 National Youth Risk Behavior Surveys, 1991 – 2005

14. Percentage of High School Students Who Had Sexual Intercourse with Four or More Persons During Their Life, by Sex* and Race/Ethnicity,** 2005 * M > F ** B > H > W National Youth Risk Behavior Survey, 2005

15. Percentage of High School Students Who Had Four or More Sex Partners During Their Lifetime, 1991 – 2005 *Significant linear decrease, p <.05 National Youth Risk Behavior Surveys, 1991 – 2005

16. Percentage of High School Students Who Had Four or More Sex Partners During Their Lifetime by Sex, 1991 – 2005 *Significant linear decrease, p <.05 National Youth Risk Behavior Surveys, 1991 – 2005

17. Percentage of High School Students Who Had Four or More Sex Partners During Their Lifetime by Race/Ethnicity, 1991 – 2005 *Significant linear decrease, p <.05 National Youth Risk Behavior Surveys, 1991 – 2005

18. Percentage of High School Students Who Were Currently Sexually Active,* by Sex and Race/Ethnicity,** 2005 * Had sexual intercourse with ≥ 1 persons during the 3 months preceding the survey ** B > W, H National Youth Risk Behavior Survey, 2005

19. Percentage of High School Students Who Were Currently Sexually Active, 1991 – 2005 *Significant linear decrease, p <.05 National Youth Risk Behavior Surveys, 1991 – 2005

20. Percentage of High School Students Who Were Currently Sexually Active by Sex, 1991 – 2005 *Significant linear decrease, p <.05 National Youth Risk Behavior Surveys, 1991 – 2005

21. Percentage of High School Students Who Were Currently Sexually Active by Race/Ethnicity, 1991 – 2005 *Significant linear decrease, p <.05 National Youth Risk Behavior Surveys, 1991 – 2005

22. Percentage of Sexually Active High School Students Who Used a Condom During Last Sexual Intercourse, by Sex* and Race/Ethnicity,** 2005 * M > F ** B > W > H National Youth Risk Behavior Survey, 2005

23. Percentage of Currently Sexually Active High School Students Who Used a Condom During Last Sexual Intercourse, 1991 – 2005 *Significant linear increase, p <.05 National Youth Risk Behavior Surveys, 1991 – 2005

24. Percentage of Currently Sexually Active High School Students Who Used a Condom During Last Sexual Intercourse by Sex, 1991 – 2005 *Significant linear increase, p <.05 National Youth Risk Behavior Surveys, 1991 – 2005

25. Percentage of Currently Sexually Active High School Students Who Used a Condom During Last Sexual Intercourse by Race/Ethnicity, 1991 – 2005 *Significant linear increase, p <.05 **Significant quadratic effect, p <.05 National Youth Risk Behavior Surveys, 1991 – 2005

26. Percentage of High School Students Who Ever Injected Illegal Drugs, by Sex and Race/Ethnicity, 2005 National Youth Risk Behavior Survey, 2005 * M > F ** H > W

27. Percentage of High School Students Who Ever Injected Illegal Drugs, 1995 – 2005 National Youth Risk Behavior Surveys, 1995 – 2005

28. Percentage of High School Students Who Ever Injected Illegal Drugs by Sex, 1995 – 2005 National Youth Risk Behavior Surveys, 1995 – 2005

29. Percentage of High School Students Who Ever Injected Illegal Drugs by Race/Ethnicity, 1995 – 2005 National Youth Risk Behavior Surveys, 1995 – 2005

30. Summary Ever Had Sexual Intercourse >4 Sexual Partners During Lifetime Currently Sexually Active Condom Use During Last Sexual Intercourse Lifetime Illegal Injection Drug Use Total Females Males White Black 01-05 Hispanic 91-01 91-99 99-05

31. Limitations è Data apply only to youth who attend school è Extent of under- or over-reporting cannot be determined

32. Conclusions è Despite overall decreases in sexual risk behaviors, many students still engage in behaviors that place them at risk for HIV infection è Efforts need to be intensified among black and Hispanic students

33. Recommendations è Continue efforts of parents and families, schools, youth serving community organizations, health care providers, the media, government agencies, and youth è Increase the availability of effective interventions that address HIV-related knowledge, skills, and behaviors and their determinants

34. YRBSS Information è www.cdc.gov/yrbs www.cdc.gov/yrbs l Questionnaire and item rationale l Morbidity and Mortality Weekly Report Surveillance Summaries l Youth Online l Data and codebooks for the national surveys l Publications, journal articles, and fact sheets