P3.033: Using 2023 Youth Risk Behavior Surveillance System to Assess Indicators of Risky Sexual Behaviors in Adolescents

Background: This study investigates the relationship between mental health, in-school behaviors and adverse childhood events (ACEs) all relative to risky sexual behaviors in adolescents. We posit that recognizable factors such as mental health and in-school behaviors can serve as significant indicators of risky sexual behaviors. This can potentially be used to identify high-school age populations that may benefit from targeted intervention to promote safer sex practices. Such interventions are critical due to previously established associations between risky sexual behavior and negative outcomes, including teen pregnancy, STI transmission and poor mental health outcomes.

Methods: Demographic information, risk factors, and health-related behaviors from the 2023 Youth Risk Behavior Surveillance System (YRBSS) survey of 14,134 high school students were analyzed. Sexual activity, age of initiation, number of partners, contraceptive use, and substance use during sexual activity were selected as metrics based on background literature review. Point values were assigned via the High-Risk Sexual Behavior Stratification (HRSBS) Scale (Table 1) to reflect risk level of behaviors. Mental health correlations were assessed through questions on feelings of sadness and difficulty concentrating. In-school behaviors were examined based on grades, sports team participation, and quality of in-school social relationships. ACEs were assessed through YRBSS items that identified ACE association in their rationale.

Results: The sexually active population (n = 4523) was stratified into low (7-15 points), moderate (16-19 points), and high risk (20-49 points) categories based on total risk scores, with efforts made to achieve relatively even group sizes. Significance was determined using a chi squared test of significance with p value < 0.05. Mental health analysis revealed a negative correlation (rs = -0.073) between feelings of sadness and risky sexual behaviors, with significant differences among risk groups. A similar association was seen with difficulty concentrating (rs = -0.080). The perceived quality of in-school relationships reported no significant association between increased risk of behavior. In-school behaviors indicated a significant positive correlation (rs = 0.139) between lower grades and increasing number of in-school physical fights (rs = 0.168) when compared to higher risky sexual behaviors. Sports team participation showed no significant association. Additionally, when assessing ACEs and drug use, many factors considered identified a significant correlation with increasing risky sexual behaviors (Table 2).

Conclusion: Students reporting negative mental health outcomes are more likely to engage in risky sexual behaviors. Additionally, poor academic performance serves as a potential risk factor for risky sexual behaviors. Finally, an analysis of ACEs and adolescent drug use can also serve as an important predictor of engaging in high-risk sexual behavior. This research develops a systematic way to assess risk factors to be used by educators, counselors, and pediatricians to prioritize sexual health interventions for students at increased risk of engaging in high-risk sexual behaviors.