2005 Massachusetts Youth Risk Behavior Survey
8
Many adolescents engage in sexual activity that may pose a serious threat both to their health and to their plans for the future. Early sexual activity, multiple sexual partners, and the lack of condom or other contraceptive use are associated with unintended pregnancy and with sexually transmitted diseases (STDs), including Human
Immunodeficiency Virus (HIV), the virus that causes AIDS.
Each year in the United States almost 750,000 adolescent females become pregnant, nearly 425,000 give birth, and 215,000 terminate pregnancies (8a). One-third of all unintended pregnancies occur among teenagers, and three-quarters of teenage pregnancies occur among adolescents who are not using any form of contraception
(8b). The United States has one of the highest rates of adolescent pregnancy, abortion, and childbearing in the
Western industrialized world (8c). Even though Massachusetts has one of the lowest teen birth rates in the country, in 2003, more than 5,000 infants were born to teenage mothers in the Commonwealth (8c).
Sexually transmitted diseases contribute to illness and death among adolescents, young adults, and newborns.
Almost one half of the nineteen million new STD infections each year occur among young persons under age 25
(8d)
.
Adolescent females are more susceptible than are older women to STDs (8e) and may suffer severe consequences from STDs, including pelvic inflammatory disease, ectopic pregnancy, infertility, and cervical cancer. Additionally, someone with an active sexually transmitted disease is more likely than a person without
STDs to become infected with HIV if exposed to the virus.
By 2004 in the United States, over 940,000 cases of AIDS had been diagnosed and close to 530,000 Americans had lost their lives to the disease (8f). Over 1.4 million Americans have been infected with HIV and approximately 40,000 new HIV infections occur each year (8g). By the end of 2005, over 27,600 HIV/AIDS cases had been diagnosed in Massachusetts alone; most were infected through unsafe sexual activity (8h).
HIV/ AID's is increasingly occurring in minority youth. Half of all new HIV infections occur in people under age 25
(8i) Through 2001, African Americans and Latinas accounted for 84% of cumulative AIDS cases among women age 13 to 19. African Americans and Latinos accounted for 62% of cumulative AIDS cases among men ages 13 to 19 (8f).
Since 1989, the Massachusetts Board of Education has recommended that all schools provide HIV/AIDS prevention education to all students in all grades within the context of comprehensive school health education.
Curriculum and instruction should be presented in a developmentally, linguistically, and culturally sensitive manner, and special efforts should be made to reach students at increased risk for HIV/AIDS infection, such as drug-involved youth, sexual minority youth, or members of communities disproportionately affected by the
HIV/AIDS epidemic. The Board also recommended that schools address the value of both delay of sexual activity and the use of condoms to prevent HIV/STD infection and pregnancy, and that schools consider making
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2005 Massachusetts Youth Risk Behavior Survey condoms available to secondary school students (8j). According to the Centers for Disease Control and
Prevention, “For people who are having sexual intercourse, condoms have been the surest way to prevent transmission of HIV and other sexually transmitted diseases. When used correctly and consistently, condoms provide an effective barrier, blocking the pathway of the HIV virus during sexual activities. Analysis of studies conducted by the National Institutes of Health found an 85 percent decrease in risk of HIV transmission among consistent users of condoms.” (8k)
Research has shown that comprehensive sexuality education programs that instruct students both on the value of postponing sexual activity and on the correct use of condoms are successful in delaying the onset of sexual activity and in increasing condom use among youth who choose to become sexually active (8l – 8p). Further, two recent studies provide evidence that both parents and the public in general support such a comprehensive approach (8q, 8r). The Massachusetts Department of Education HIV/STD Prevention Program supports the
Board’s recommendations for school-based AIDS prevention education that includes instruction on how to prevent HIV infection and instruction on the correct use of condoms.
Clear parent-adolescent communication can also be a strong deterrent to risky sexual behavior among youth. It is important that families communicate their values and expectations regarding sexual behavior to adolescents.
Several recent studies have demonstrated that parent-teenager discussions about sexuality and sexual risk were associated with lower rates of adolescent risk behavior(8s-8u).
The 2005 MYRBS asked students to report lifetime and recent sexual intercourse, including number and gender of sexual partners. It also asked about age at first intercourse, use of condoms for pregnancy and STD prevention, use of other forms of contraception, and use of alcohol or other drugs before sexual intercourse.
Students were also asked whether they had ever been or gotten someone pregnant, been tested for HIV or other
STDs, or been diagnosed with any sexually transmitted disease. Additionally, the 2005 MYRBS asked students whether they had ever been taught in school about AIDS or HIV infection, been taught how to use condoms, and whether they had a conversation with their parents or other family adults about sexuality and the prevention of
HIV, other STDs, and pregnancy.
KEY FINDINGS FROM THE 2005 MYRBS
 From 1995 to 2005, a significant decrease occurred in the percent of students who reported sexual intercourse before age 13 (8% in 1995 to 5% in 2005). Lifetime pregnancy has dropped to 5% from the high of 7% reported in 1997.
 Among adolescents who are currently sexually active, the proportion using alcohol or drugs the last time they had sexual intercourse declined significantly over the past decade, while condom use rose, with an especially sharp jump since 2003 (from 57% to 65%).
 The proportion of youth reporting lifetime or recent sexual intercourse, or reporting multiple partners has not changed significantly since 1995.
 Male students were more likely than females to report lifetime sexual intercourse, intercourse before age 13, and the use of alcohol or drugs before their last sexual intercourse.
 Older students were more likely than younger students to report lifetime and recent sexual intercourse, but less likely to report condom use at last intercourse.
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 Higher rates of lifetime sexual intercourse, intercourse before age 13, four or more lifetime partners, and recent sexual intercourse were observed among Hispanic students, Black students and students of
Other or Multiple Ethnicity than among White or Asian students.
 Students in urban communities had higher rates than their peers of sexual activity and partnerships but were more likely to have used a condom at last intercourse. They were also less likely than suburban students to have ever been diagnosed with HIV or another STD.
 Sexual minority youth had higher rates than their peers of most sexual risk behaviors.
 The majority of students (93%) were taught in school about AIDS or HIV infection; nearly half (48%) were taught in school how to use condoms. Adolescents who received AIDS education in school were significantly less likely than their peers to engage in many sexual risk behaviors.
LIFETIME SEXUAL INTERCOURSE
Slightly less than half of all high school students (45%) reported having ever had sexual intercourse, a percentage that has not changed significantly in the past decade. (Figure 8a)
70
60
50
40
Figure 8a. Lifetime and Recent Sexual Behaviors among Massachusetts High School
Students, 1995- 2005
30
20
10
0
Lifetime sexual intercourse
Sexual intercourse before age 13
Four or more lifetime partners
Recent sexual intercourse
Condom use at last intercourse (a*)
Substance use at last intercourse (a*)
Ever been or gotten someone pregnant
(*) Statistically significant improvement, 1995-2005, p < .05. (a) refers to students who had sexual intercourse in the past 3 months
More males than females reported having sexual intercourse in their lifetimes. Males were also more likely to have had intercourse before age 13 and to have had 4 or more lifetime partners. Gender differences in sexual intercourse within the past 3 months, however, were not significant. (Figure 8b)
The rate of lifetime sexual activity increased significantly with grade in school. By the end of 9 th grade, 29% of students had become sexually active. By the end of 12 th grade the rate more than doubled to 64%. (Figure 8c)
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2005 Massachusetts Youth Risk Behavior Survey
Figure 8b. Sexual Behaviors and Consequences among Massachusetts High School
Student by Gender, 2005
50
40
30
20
80
70
60
10
0
Lifetime sexual intercourse (*)
Sexual intercourse before age 13(*)
Four or more lifetime partners (*)
Recent sexual intercourse
Condom use at last intercourse(a)(*)
Substance use at last intercourse(a)(*)
Ever been or gotten someone pregnant (b)
Ever been diagnosed with HIV or STD(b)
(*) Significant difference between groups, p. <.05. (a) Refers to students who had sexual intercourse in the past 3 months; (b) Refers to students who had sexual intercourse in their lifetimes
Figure 8c. Sexual Behaviors and Consequences among Massachusetts High School
Students by Grade, 2005
60
50
40
30
20
90
80
70
9th Grade
10th Grade
11th Grade
12th Grade
10
0
Lifetime sexual intercourse
Sexual intercourse before age 13
Four or more lifetime partners
Recent sexual intercourse
Condom use at last intercourse(a)
Substance use at last intercourse(a)
Ever been or gotten someone pregnant(b)
Ever been diagnosed with
HIV or STD(b)
(a) Refers to students who had sexual intercourse in the past 3 months; (b) Refers to students who had sexual intercourse in their lifetimes
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2005 Massachusetts Youth Risk Behavior Survey
Black students (65%) and Hispanic students (59%) had higher rates of lifetime sexual intercourse than White students (42%) and Asian students (28%). Slightly more than half (52%) of all students of Other or Multiple
Ethnicity also reported lifetime sexual intercourse. (Figure 8d)
80
70
60
50
40
30
20
Figure 8d. Sexual Behaviors among Massachusetts High School Students by Race/Ethnicity, 2005
10
0
Lifetime sexual intercourse
Sexual intercourse Four or more lifetime partners before age 13
Recent sexual intercourse
Condom use at last intercourse(a)
Substance use at last intercourse(a)
Ever been or gotten someone pregnant (b)
Ever been diagnosed with
HIV or STD (b)
(a) Refers to students who had sexual intercourse in the 3 months before the survey; (b) Refers to students who had sexual intercourse in their lifetimes
Among all students, 13% report having had sex with four or more partners in their lifetimes.
Among students who had ever had sexual intercourse, those who had sexual intercourse for the first time before age 13 were significantly more likely to have had four or more lifetime partners than were students whose first sexual intercourse was later in life (64% vs. 24%).
RECENT SEXUAL INTERCOURSE
Thirty – four percent (34%) of students had sexual intercourse in the three months before the survey (i.e. recent sexual intercourse). This is a small increase from 30% reported in 2003 but the difference is not statistically significant.
The majority of students who had ever had sexual intercourse (76%) also reported recent sexual intercourse.
Among students who had sexual intercourse in the three months before the survey, the vast majority (78%) had intercourse with only one partner. Six percent (6%) had sexual intercourse with four or more partners.
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SEXUAL CONTACT
Fifty-nine percent (59%) of students (61% of males and 56% of females) reported ever having sexual contact with another person. “Sexual contact” was not defined on the survey.
Seventy-nine percent (79%) of students reporting that they had had sexual contact with another person also indicated that they had had sexual intercourse.
One student in twenty (5%) reported having some same-sex sexual contact. Rates for males and females were similar.
CONDOM USE, PREGNANCY PREVENTION METHODS, AND SUBSTANCE USE ASSOCIATED WITH
SEXUAL INTERCOURSE
More than half (65%) of students who had recent sexual intercourse used a condom during their last sexual intercourse. This continues a steady and significant increase in the rate of condom use.
Males were significantly more likely than females to report condom use at last intercourse.
Condom use at last intercourse decreased with grade in school. Students in the 12 th and 11 th grades were less likely to have used a condom at last intercourse than students in the 9 th and 10 th grades.
The vast majority of students (91%) who had recent sexual intercourse used some method of pregnancy prevention the last time they had sex. Rates for males and females were the same.
Among all sexually active students, condoms were the most commonly used form of birth control (54%), followed by birth control pills (25%). Eight percent (8%) used withdrawal, which is generally considered an ineffective method. Approximately 9% did not use any method of birth control, and 1% of sexually active students were not sure if any method was used.
Slightly less than one quarter (23%) of sexually active students used alcohol or drugs the last time they had intercourse. This is a significant decrease since 1999 (30%).
Male students were more likely than female students to report using alcohol or drugs the last time they had sexual intercourse (26% vs. 20%) however, this difference was not significant.
There were no significant differences by grade in the percent of sexually active students who used alcohol or drugs before the last time they had sex.
PREGNANCY AND SEXUALLY TRANSMITTED DISEASES
Five percent (5%) of all students reported having ever been or gotten someone pregnant.
Among students who had ever had sexual intercourse in their lifetimes, 10% of females had been pregnant and
9% of males reported having gotten someone pregnant.
Sexually experienced students in the 12 th grade were less likely to report having been or gotten someone pregnant than students in lower grades (7% of 12 th grade vs. 10% of 9 th and 10 th grades and 11% of 11 th grade).
Approximately 13% of all students (26% of sexually experienced students) had ever been tested for HIV infection or other sexually transmitted diseases (STDs). These rates have remained virtually unchanged since 1999.
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2005 Massachusetts Youth Risk Behavior Survey
Among sexually experienced youth, female students were also more likely than male students to have been tested for HIV or STDs (36% vs. 16%).
Sexually experienced seniors and juniors (31% and 28% respectively) were more likely than freshmen and sophomores (20% and 22% respectively) to have even been tested for HIV or another STD.
Five percent (5%) of all students (7% of sexually experienced students) had been told by a doctor or other health care professional that they had a sexually transmitted disease or were HIV positive. This is a slight decrease from 6% reported in 2003.
Male and female students were equally as likely to have been diagnosed with HIV or another STD (6% and 5% respectively).
Sexually experienced students in the 9 th grade were less likely to have reported being diagnosed with HIV or another STD (4%) than were sexually experienced students in the 10 th grade (8%), 11 th grade (7%) or 12 th grade
(7%).
Students in suburban communities were significantly more likely than their peers to have been diagnosed with
HIV or another STD (7% of suburban students vs. 4% of urban students and 3% of rural students).
SEXUAL BEHAVIOR AND OTHER RISK BEHAVIORS
As we have seen in other chapters of this report, sexual behavior was significantly associated with other risk behaviors. Specifically, sexually active students (i.e., students who had sexual intercourse in the three months before the survey) were significantly more likely than students who were not sexually active to report:
 Current alcohol use (70% vs. 36%)
 Binge drinking (46% vs. 16%)
 Drinking and driving (20% vs. 5%)
 Attempted Suicide (11% vs. 4%)
 Intentional self-injury (23% vs. 15%)
 Current smoking (35% vs. 13%)
 Daily smoking (13% vs. 3%)
 Weapon carrying (23% vs. 10%)
 Experiencing sexual contact against their will (17% vs. 6%)
 Experiencing dating violence (19% vs. 5%)
SEXUAL BEHAVIOR AND ACADEMIC ACHIEVEMENT
Sexually active students were significantly less likely than students who were not sexually active to report receiving mostly A’s, B’s or C’s in school (82% vs. 87%).
PROTECTIVE FACTORS FOR SEXUAL BEHAVIOR
Sexual intercourse in the three months before the survey was significantly less common among students who believed there was a parent or other adult family member they could talk to about things that were important
(33% vs. 42%), students who believed that they could talk to a teacher or other school adult if they had a problem
(32% vs. 41%), students who participated in volunteer or community service (30% vs. 38%), and students who participated in organized extracurricular activities (28% vs. 41%).
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2005 Massachusetts Youth Risk Behavior Survey
40
30
20
10
0
100
90
80
70
60
50
ADDITIONAL FINDINGS ABOUT SEXUAL BEHAVIOR
Four percent (4%) of all students describe themselves as gay, lesbian, or bisexual and 5% had same sex contact. In all, 6% of students could be considered sexual minority youth; that is, they either identified as gay, lesbian, or bisexual or had any same-sex sexual contact in their lifetimes.
Sexual minority youth were significantly more likely than other students to report lifetime sexual intercourse (72% vs. 44%), sexual intercourse before age 13 (18% vs. 4%), sexual intercourse with four or more partners in their lifetimes (32% vs. 11%), and recent sexual intercourse (55% vs. 33%). Among students who ever had sexual intercourse in their lifetimes, sexual minority youth were significantly more likely than other students to report having been or gotten someone pregnant (15% vs. 4%)(Figure 8j) and having been diagnosed with HIV or another STD (10% vs. 5%).
Compared to rural and suburban youth, students in urban communities had higher rates of:
 Lifetime sexual intercourse (54% vs. 48% of rural students and 37% of suburban students)
 Sexual intercourse before age 13 (7% vs. 4% of rural and suburban students)
 Sexual intercourse with four or more partners in their lifetimes (17% vs. 11% of rural students and 9% of suburban students)
 Recent sexual intercourse (41% vs. 34% of rural students and 28% of suburban students)
Students in urban communities were also more likely to report condom use at last intercourse than students in suburban or rural communities (67% of urban vs. 63% of suburban and 64% of rural).
HIV/AIDS AND PREGNANCY PREVENTION EDUCATION IN SCHOOL
Ninety-three percent (93%) of Massachusetts high school students reported that they had been taught about
AIDS or HIV in school. This percent has fluctuated only slightly over the past decade. (Figure 8e)
Figure 8e. Sexuality Education among Massachusetts High School Students, 1995 - 2005
Ever taught about
HIV/AIDS in school
Ever taught in school how to use condoms
Talked with parents about sexuality or prevention of HIV, STDs, or pregnancy, past year
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2005 Massachusetts Youth Risk Behavior Survey
Differences in AIDS education by gender or grade level were not statistically significant. (Figures 8f and 8g)
Figure 8f. Sexuality Education among Massachusetts High School Students by Gender,
2005
70
60
50
40
30
20
10
0
100
90
80
Ever taught about
HIV/AIDS in school
Ever taught in school how to use condoms (**)
Talked with parents about sexuality or prevention of HIV,
STDs, or pregnancy in past year(**)
100
90
80
70
60
50
40
30
20
10
0
(**) Significant difference between male and female students, p <. 01
Figure 8g. Sexuality Education among Massachusetts High School Students by Grade, 2005
Ever taught about
HIV/AIDS in school
Ever taught in school how to use condoms
Talked with parents about sexuality or about prevention of
HIV, STDs, or pregnancy, past year
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2005 Massachusetts Youth Risk Behavior Survey
Ethnic differences in AIDS education, however, were significant; Hispanic and Asian youth were less likely than
White youth to have received school AIDS education. (Figure 8h)
Figure 8h. Sexuality Education among Massachusetts High School Students by
Race/Ethnicity(a), 2005
White
Black
100
90
80
70
60
50
40
30
20
Hispanic
Asian
Other
10
0
Ever taught about
HIV/AIDS in school (*)
Ever taught in school how to use condoms (*)
Talked with parents about sexuality, or about prevention of
HIV, STDs, or pregnancy, past year (*)
(*) Statistically significant difference between groups, p. <.05.
Almost half (48%) of students reported ever being taught in school how to use condoms. More male students than female students report being taught how to use a condom in school, and students in the higher grades were more likely than 9 th and 10 th grade students to have received such instruction.
Black, Hispanic, and Other/Mixed Ethnicity students were more likely than White or Asian students to have been taught how to use a condom.
Slightly more than half (52%) of all high school students reported having at least one conversation in the 12 months before the survey with their parents or other adult family members about sexuality or ways to prevent HIV infection, other sexually transmitted diseases (STDs) or pregnancy. (Figure 8i)
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2005 Massachusetts Youth Risk Behavior Survey
Figure 8i. Frequency of Massachusetts Students Discussion of Sexual Topics with Parents or Family Adults in Past Year, 2005
About once a month or more
9%
Every few months
18%
No discussion in past year
48%
Once
25%
Students who had received HIV/AIDS education in school were more likely than those who had not to have had a discussion with family adults in the past year about sexual issues and preventing HIV, STDs and pregnancy.
Female students were significantly more likely than male students (58% vs. 46% respectively) to have reported talking to their parents about sexuality or ways to prevent HIV infection, other STDs, or pregnancy.
Students in all four grades were equally as likely to have talked with their parents about ways to prevent HIV infection, other STDs, or pregnancy.
Asian students were significantly less likely than students of other racial/ethnic groups to have talked to their parents at least once in the 12 months before the survey about sexuality or ways to prevent HIV infection, other
STDs, or pregnancy.
HIV/AIDS EDUCATION AND SEXUAL BEHAVIORS
Compared to their peers who were not taught in school about AIDS or HIV, students who received AIDS/HIV education in school had significantly lower levels of most measures of sexual risk, including lifetime or recent intercourse, multiple sexual partners, reported sexual intercourse before age 13, and any pregnancy or STD diagnosis. (Figure 8j)
Additionally, among sexually active youth, those who had received school instruction on proper condom use were significantly more likely than those who had not to have used a condom the last time they had sexual intercourse
(69% vs. 61%).
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2005 Massachusetts Youth Risk Behavior Survey
Figure 8j. Assocation Between School HIV/AIDS Prevention Education and Sexual Risk
Behaviors and Experiences, 2005
Lifetime sexual intercourse (*)
44.7
55.0
Sexual intercourse before age 13 (*)
4.4
11.7
16.6
Four or more lifetime partners (*)
24.9
Recent sexual intercourse (*)
33.3
45.0
Condom use at last intercourse (a)
65.7
57.5
Ever been or gotten someone pregnant (*)
Ever tested for HIV or STD
4.0
11.7
12.8
17.7
Received HIV/AIDS prevention education
Did not receive HIV/AIDS prevention education
Ever diagnosed with HIV or STD (*)
4.7
12.2
0 10 20 30 40
Percent of Students
50 60 70
(*) Statistically significant difference between groups, p. <.05. (a) Refers to students who had sexual intercourse in the past 3 months
ADDITIONAL FINDINGS ABOUT HIV/AIDS PREVENTION EDUCATION
Certain groups of students were more likely than their peers to report receiving sexuality education:
U.S. – born students were more likely than immigrant students to report being taught in school about AIDS or HIV infection; the gap decreases as years in the U.S. increase. Almost all (94%) of U.S. born students had received
HIV/AIDS education as opposed to only 68% of students living in the U.S. less than four years.
Homeless students were significantly less likely than other students to have received school HIV/AIDS education
(81% vs. 93%). Similarly, students receiving special education services had lower rates than other youth of receiving HIV/AIDS education (87% vs. 93%).
Sexual minority youth were significantly less likely than others students to have been taught in school AIDS or
HIV infection in school (85% vs. 93%).
Students in suburban and rural communities (95% and 93% respectively) were significantly more likely than urban students (90%) to report being taught about AIDS or HIV infection in school. However, urban students were more likely than suburban and rural students to be taught how to use a condom in school (55% vs. 42% and
45% respectively).
Several significant improvements have occurred in the sexual risk behaviors of Massachusetts high school students; specifically, more youth are using condoms if they are sexually active, and fewer report alcohol or drug use before sexual intercourse. Even so, a significant number of students enter high school already sexually
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2005 Massachusetts Youth Risk Behavior Survey experienced and over six in ten are sexually active by the end of their senior year. The results suggest that ageappropriate sexuality education should start well before high school to address responsible decision-making and improve communication and refusal skills before young people become sexually active. Also, comprehensive and experience-appropriate sexuality education should continue throughout high school both to encourage the delay of sexual initiation among students who are not sexually active and to stress the importance of condom use and contraception among sexually active youth.
Although nearly two-thirds of all sexually active students in 2005 used a condom the last time they had sexual intercourse, an unacceptably high percentage of sexually active high school students are still leaving themselves vulnerable to sexually transmitted diseases (STDs), including HIV infection, by not using condoms. In addition,
MYRBS results show a sharp drop-off in condom use among 12 th grade students, who are more likely than younger students to use hormonal contraception (such as birth control pills or Depo-Provera). Hormonal contraceptive methods are highly effective at preventing pregnancy but offer no protection against HIV or other sexually transmitted diseases. Therefore the concurrent decrease in condom use among older students is particularly troubling.
Different patterns of sexual risk-taking among different groups indicate that “targeted” prevention efforts may be important. For example, the significantly higher rates of early initiation of sexual activity among male students,
Hispanic and Black students, and students in urban districts, suggest that it is critical to ensure that these young people in particular receive prevention education before they reach high school.
Similarly, sexual minority youth have significantly higher rates than their peers of sexual risk behaviors and may be at particularly high risk of STDs and HIV infection (8p, 8w). Though these students may constitute a “hidden” and unacknowledged population in many schools, it is important that comprehensive school health education programs develop ways of addressing the particular health education and sexuality education needs of these young people.
Comprehensive school health programs that emphasize responsibility and healthy life choices can help young people move toward becoming sexually healthy adults. Schools and communities should work together to ensure that all students receive appropriate and effective sexuality education encouraging them to engage in healthier, more responsible sexual decision-making.
The large number of students who have received AIDS or HIV education in school points to the success of multiple efforts by health teachers, schools, state and community agencies, and others to expand instruction about AIDS/HIV. Education remains the strongest weapon available to fight against HIV/AIDS. The
Massachusetts Board of Education Policy regarding HIV/AIDS education recommends that students in every grade should receive such instruction, particularly students at increased risk. Unfortunately students who might be considered to be at high risk due to their sexual behaviors – including students in urban communities, sexual minority students, and non-White students – were somewhat less likely to have received HIV/AIDS education in school. These results indicate that increased efforts should be made to reach
students and to do so in a culturally- and age-appropriate manner.
It is also important to ensure that students get effective AIDS education, using approaches and programs that have been found to reduce adolescent sexual activity that might result in pregnancy or sexually transmitted
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2005 Massachusetts Youth Risk Behavior Survey disease. A number of AIDS prevention programs have been carefully evaluated and found to result in lower rates of risky sexual behavior. Common to all of these effective programs is their emphasis on reinforcing clear and appropriate values and avoiding sexual risk-taking, discussing media and social influences on sexual behavior, helping students personalize information about risks, and providing practice in communication, interpersonal negotiation, and refusal skills (8m). The more knowledgeable adolescents are about sexuality, the more likely they are to delay sexual activity. The Massachusetts Department of Education HIV/STD Prevention Program provides technical assistance to districts in developing and updating their HIV/AIDS prevention curricula.
Fortunately, the majority of young people are delaying sexual intercourse, and education programs should foster and encourage the attitudes and skills needed to maintain this behavior. However, young people also need varied and experience-appropriate approaches to AIDS prevention. For students who have already chosen to be sexually active, programs should promote responsible sexual decision-making and behavior. In this context, science-based education about condoms and their correct use ought to be included in HIV prevention programs.
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8a. Guttmacher Institute (2006). U.S. teenage pregnancy statistics: National and state trends and trends by race and ethnicity (Updated September 2006). Recovered November 5, 2006 from http://www.guttmacher.org/pubs/2006/09/12/USTPstats.pdf
8b. Westoff, C.F. (1988) Contraceptive paths toward reduction of unintended pregnancy and abortion.
, 4-13.
8c. Singh, S., & Darroch, J. (2000). Adolescent pregnancy and childbearing: Levels and trends in developed countries.
14-32.
8d. Weinstock, H., Berman, S., & Cates, W, Jr. (2004). Sexually transmitted diseases among American youth:
Incidence and prevalence estimates, 2000.
, 6-10.
8e. Centers for Disease Control and Prevention. (1995) Sexually transmitted disease surveillance, 1994. Atlanta,
GA: Author.
8f. Centers for Disease Control and Prevention (2005). HIV/AIDS surveillance report: HIV infection and AIDS in the United States, 2004. Recovered November 5, 2006 from http://www.cdc.gov/hiv/topics/surveillance/basic.htm#ddaids
8g. Anderson, J.E., Chanadra, A., & Mosher, W.D. (2005). HIV testing in the United States, 2002.
, No. 363.
8h. Massachusetts Department of Public Health (2006). The Massachusetts HIV/AIDS epidemic at a glance,
October 2006. Retrieved November 1, 2006 from http://www.mass.gov/Eeohhs2/docs/dph/aids/2007_profiles/epidemic_glance.pdf.
8i. Office of National AIDS Policy. Youth and HIV/AIDS 2000: A new American agenda. Washington, DC, White
House, 2000
8j. Massachusetts Board of Education (1990). Policy on AIDS/HIV prevention education. Quincy, MA: Author, and Massachusetts Board of Education (1991, August 27), Addendum to AIDS/HIV prevention education policy regarding condom availability in schools. Quincy, MA: Author.
. Atlanta, GA: Author. 8k. Centers for Disease Control and Prevention (2002).
8l. Kirby, D., Barth, R., Leland, N., & Fetro, J. (1991). Reducing the Risk: Impact of a new curriculum on sexual risk taking.
,
, 253-263.
8m.
Kirby, D. (2001)
DC: National Campaign to Prevent Teen Pregnancy.
Washington,
8n. Howard, M. & McCabe, J. (1990). Helping teenagers postpone sexual involvement.
21-26.
8o. Card, J. (1999). Teen pregnancy prevention: Do any programs work?
257-285.
8p. Goodenow, C., Netherland, J., & Szalacha, L. (2002). AIDS-related risk among adolescent males who have sex with males, females, or both: Evidence from a statewide survey.
203-210.
8q. Ito, K., et al (2006) Parent opinion of sexuality education in a state with mandated abstinence education:
Does policy match parental preference?
634-641.
8r. Bleakley, A., Hennessy, M., & Fishbein, M. (2006) Public opinion on sex education in US schools.
1151-1156.
8s. Whitaker, D. Miller, K., May, D., & Levin, M. (1999). Teenage partners’ communication about sexual risk and condom use: The importance of parent-teenager discussions.
117-121.
8t. Whitaker, D. & Miller, K. (2000). Parent-adolescent discussions about sex and condoms: Impact on peer influences of sexual risk behavior.
251-273.
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8u. Blake, S., Simkin, L., Ledsky, R., Perkins, C., & Calabrese, J. (2001) Effects of a parent-child communications intervention on young adolescents’ risk for early onset of sexual behavior.
, 52-62.
8v. Unusual as these pregnancy differences may seem, this result can be found in the 1995, 1997, 1999, 2001 and 2003 MYRBS data as well. The MYRBS does not collect data that would permit drawing clear conclusions about the causes of this finding, although one possible influence may be attempts on the part of the adolescents struggling with issues of sexual orientation to “prove” to themselves or other that they are not gay. See also
Saewyc, E., Bearinger, L., Blum, R., & Resnick, M. (1999). Sexual intercourse, abuse, and pregnancy among adolescent women: Does sexual orientation make a difference?
127-131.
8w. Garafalo, R., Wolf, C., Kessel, S., Palfrey, J., & DuRant, R. (1998) The association between health risk behaviors and sexual orientation among a school-based sample of adolescents.
895-902.
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