70. Sexual Health Behaviors By School Level Socioeconomic Status And Urbanicity, National Youth Risk Behavior Survey (YRBS) 2015-2017

Abstract

The economic and social conditions in which high school students live and learn (i.e., social determinants of health [SDOH]) influence both academic achievement and health outcomes. Although the Youth Risk Behavior Survey (YRBS) is the longest established, nationally representative, comprehensive surveillance system monitoring health-related behaviors among high school students, the survey does not include individual-level indicators for SDOH. This is the first study to stratify YRBS data by school-level socio-economic status (SES) and urbanicity to examine their association with sexual health behaviors. The national YRBS is a cross-sectional survey conducted biennially among a nationally representative sample of public and private students in grades 9–12. YRBS data from 2015 (N= 15,624, response rate= 60%) and 2017 (N= 14,765, response rate= 60%) were combined, and then linked with extant data to identify school-level estimates for SES (percentage of students eligible for free- and reduced-price meals [%FRPM]) and urbanicity (urban, suburban/town, or rural) among students attending public schools. %FRPM was categorized as low poverty (25% of students or less), average (26%-75%), and high poverty (more than 75%). This study examined whether sexual health behaviors (currently sexually active, 4+ lifetime sexual partners, condom use during last sexual intercourse, hormonal birth control during last sexual intercourse, condom and hormonal birth control during last sexual intercourse [dual use protection], and drank alcohol or used drugs before last sexual intercourse) varied by %FRPM and urbanicity. Adjusted Prevalence Ratios (APR) were calculated using logistic regression models that controlled for sex, race/ethnicity, and grade. Associations were considered significant at p <0.05 level. Compared to students in low poverty schools, students in average (APR=1.33, 95% CI= 1.17-1.51) and high poverty schools (1.44, 1.19-1.73) were more likely to be sexually active, and students in average (1.44, 1.16-1.78) and high poverty schools (1.68, 1.22-2.32) were more likely to have four or more sexual partners. Compared to students in low poverty schools, students in high poverty schools were less likely to use a condom (0.84, 0.74-0.96) or hormonal birth control (0.78, 0.64-0.96) during last sexual intercourse, and students in average (0.79, 0.64-0.97) and high poverty schools (0.71, 0.54-0.94) were less likely to have used alcohol or drugs during last sex. Some sexual health behaviors differed by urbanicity. Compared to students in rural schools, students in suburban/town schools were less likely to be sexually active (0.89, 0.80-0.98); and students in urban schools were less likely to have used hormonal birth control (0.85, 0.73-0.99) and dual use protection (0.72, 0.56-0.92) during last sexual intercourse. High school students attending rural or high poverty schools have a higher prevalence of some sexual health behaviors that increase their risk for teen pregnancy and STIs, including HIV/AIDS. The Centers for Disease Control and Prevention’s YRBS provides an opportunity to examine the relationship between sexual behaviors and SES and urbanicity, key measures for adolescent social determinants of health.