Efforts to prevent human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) in the United States must be targeted toward persons of all age groups at risk, including adolescents. Many high school students have reported engaging in behaviors that increase their risk for HIV infection (1,2). During April and May of 1989, 1990, and 1991, CDC conducted three national school-based surveys among high school students that addressed, in part, HIV-risk behavior and school-based instruction. This report summarizes findings from these surveys.

The three surveys were the 1989 Secondary School Student Health Risk Survey (SSSHRS) that addressed HIV-related knowledge, beliefs, and behaviors, and the 1990 and 1991 Youth Risk Behavior Surveys (YRBS) that addressed HIV-related topics and other selected risk behaviors (e.g., tobacco use and alcohol and other drug use). All three surveys used a similar multistage design to obtain representative samples of students in grades 9-12 from U.S. public and private schools. In 1989, 81% of selected schools and 83% (n=8098) of selected students participated in the SSSHRS. For the YRBS, response rates for selected schools and students in 1990 were 74% and 87% (n=11,631), respectively, and in 1991 were 75% and 90% (n=12,272), respectively.

Each survey included similar questions about HIV instruction, discussion of AIDS or HIV-infection topics with parents, and HIV-related risk behaviors. Because the 1989 survey did not include comparable questions regarding condom use and injecting-drug use (IDU), these behaviors were compared only for 1990 and 1991. After adjusting for demographic characteristics of the samples, logistic regression analysis was used to test for significant changes over time. All analyses were conducted on data weighted to account for sample design and nonresponse (3,4).

The percentage of students who received HIV instruction in school increased significantly during 1989-1991 (from 54% to 83% [p<0.05]) (Figure 1), as did the percentage of students who discussed AIDS or HIV infection with parents or other adults in their families (from 54% to 61% [p<0.05]). Furthermore, in each year, students who reported receiving HIV instruction in school were significantly more likely than those who did not receive instruction to report discussing AIDS or HIV infection with their parents or other adults in their families (p<0.05).

From 1989 to 1991, significant declines occurred in the percentages of students who reported ever having had sexual intercourse (59% to 54% [p<0.05]), having two or more sex partners during their lifetime (40% to 35% [p<0.05]), and having four or more sex partners during their lifetime (24% to 19% [p<0.05]) (Figure 2). These decreases occurred primarily from 1989 to 1990, and rates were similar for 1990 and 1991.

Among students who reported ever having had sexual intercourse, the overall percentage who reported using condoms did not change significantly from 1990 (46%) to 1991 (48%); however, when analyzed by age group, a significant increase was reported by sexually active students aged less than 15 years (46% versus 57% [p<0.05]). Rates for reported IDU did not change; less than 2% of students reported this behavior each year.

Reported by: Div of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: The findings in this report indicate that an increasing proportion of U.S. high school students are receiving instruction about HIV infection and are discussing topics related to AIDS and HIV infection with their parents. In addition, the findings suggest a decline in the proportion of students who report engaging in sexual behaviors that place them at risk for HIV infection -- an observation of particular importance given the previous trend of increasing sexual activity among selected subgroups of adolescents during the last 2 decades (5,6).

Despite the changes, many adolescents continue to report engaging in HIV-risk behaviors. Reducing these risks and meeting national health objectives for the year 2000 will require implementing HIV education as part of kindergarten through 12th grade comprehensive school health education, especially for students in grades 9-12 (7) (objectives 18.10 and 8.4) (8), and improving the effectiveness of instruction through coordinated school and community efforts.

References

1. CDC. Sexual behavior among high school students -- United States, 1990. MMWR 1992;40: 885-8.

2. CDC. Selected behaviors that increase risk for HIV infection among high school students -- United States, 1990. MMWR 1992;41:231,237-40.

3. Shah BV. SESUDAAN: standard errors program for computing of standardized rates from sample survey data. Research Triangle Park, North Carolina: Research Triangle Institute, 1981.

4. Shah BV, Folsom RE, Harrell FE, Dillard CN. RTILOGIT: procedure for logistic regression on survey data. Research Triangle Park, North Carolina: Research Triangle Institute, 1987.

5. CDC. Premarital sexual experience among adolescent women -- United States, 1970-1988. MMWR 1991;39:929-32.

6. Sonenstein FL, Pleck JH, Ku LC. Sexual activity, condom use, and AIDS awareness among adolescent males. Fam Plann Perspect 1989;21:152-8.

7. Holtzman D, Greene BZ, Ingraham GC, Daily LA, Demchuk DG, Kolbe LJ. HIV education and health education in the United States: a national survey of local school district policies and practices. J Sch Health 1992;62:421-7.

8. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives -- full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service 1991; DHHS publication no. (PHS)91-50212.

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