Trends in Sexual Risk Behavior and Unprotected Sex Among High School Students, 1991-2005: The Role of Substance Use

OBJECTIVES: To determine the trends in sexual activity and unprotected sex among substance-using youth, we examined data from the 1991-2005 Youth Risk Behavior Surveys on drug and alcohol use and sexual risk behaviors. METHOD: We examined the association of alcohol and illicit drug use with recent sexual activity and unprotected sex. We assessed linear trends in behaviors and assessed logistic regression models to examine the relationship of alcohol and illicit drug use on trends in the behavioral outcomes. RESULTS: Strong associations exist between recent sexual activity and alcohol and illicit drug use from 1991 to 2005. In the multivariate model, the odds ratio of having sex in the past 3 months for lifetime illicit drug users compared with nonusers was 3.84 (CI = 3.48-4.23). Among past-month alcohol users compared to nonusers, the odds ratio was 3.23 (CI = 2.93-3.58). Overall, the trend in sexual activity was downward but not for users of alcohol and illicit drugs. Among the sexually active, unprotected sex was not associated with alcohol use over this time period but was associated with illicit drug use. CONCLUSIONS: Illicit drug and alcohol use have a strong association with being recently sexually active. Trends in reported sexual activity declined during 1991-2005, but the trends among alcohol and drug users have not. Many youth remain at dual risk from both substance use and sexual behaviors.