Risk differences seen among youth of color
By Anita Brakman, MS
Director of Education, Research & Training
Physicians for Reproductive Choice and Health
New York City
Melanie Gold, DO, FAAP, FACOP
Clinical Professor of Pediatrics
University of Pittsburgh School of Medicine
Staff Physician
University of Pittsburgh Student Health Service
In June 2012, the Centers for Disease Control and Prevention (CDC) released the U.S. Youth Risk Behavior Surveillance Summary (YRBS) for 2011.1 In the first paragraph, say the most significant finding from the report. While the statistics indicate that much is unchanged since 2009 among youth as a whole, when it comes to sexual matters, health risk disparities remain among minority youth.
In collaboration with state, territorial, and local education and health agencies, as well as tribal governments, the CDC conducts the national school-based survey every two years to monitor priority health risk behaviors, as well as to analyze the prevalence of conditions such as obesity and asthma among young people. The 2011 survey included data from 47 states, six territories, two tribal governments, and 22 local surveys of students in grades 9-12. It was conducted from October 2010 to February 2012. While the survey measures several categories of risk behavior, the data on behaviors that contribute to unintended pregnancy and sexually transmitted infections (STIs) might be most useful to clinicians providing reproductive and sexual health service to youth.
Examining the data as a whole, reported rates of most sexual behaviors have not changed significantly since the last survey in 2009. Forty-seven percent of students reported they have ever had sexual intercourse, and fewer than 34% reported having been sexually active within the last three months. Both of these percentages decreased since data was first collected in 1991, but they have been unchanged for the last decade.
The trend is similar when looking at pregnancy and STI rates. Reported rates of condom usage and using a contraceptive method to prevent pregnancy have increased among sexually active students since the early '90s, but there have been no significant strides in recent years. Forty-percent of sexually active students currently report using condoms at last intercourse, and 87% report using a contraceptive method to prevent pregnancy. The percentages were 37% and 89% in 2003, respectively, with a margin of error revealing that these small differences are statistically insignificant.
Education lacking
One significant change reported was a decline in the percentage of students who reported ever having been taught about AIDS or HIV infection in school.
Eighty-four percent of students reported they have been taught about these topics, but that percentage declined from 87% in 2009. It is part of a declining trend that has been noted since the peak of 92% reported in 1997. With nearly half of students reporting they have intercourse and more than half reporting not using condoms at last sex, the decline in education about HIV and AIDS is disturbing and problematic. Given the declining education about HIV and AIDS in schools, it is essential that healthcare professionals enhance their provision of education and counseling to adolescents about healthy sexual behaviors and risk reduction.
The lack of education around HIV and AIDS is most pronounced among Hispanic students, who reported even less education in this area compared to their black and white peers. Fewer than 13% of black students and 14% of white students (statistically the same) reported never being taught about these topics, while 23% of Hispanic students reported lacking this content in school. This difference highlights that while trends may be moving toward healthier sexual behaviors overall among teens, stark differences still exist. These may explain some of the ongoing health risk disparities among minority youth.
Check the differences
Some overall trends also can mask these differences among minority youth.
For example, 82% of Hispanic students report using a contraceptive method to prevent pregnancy at last sex, part of a positive trend among this group over the past 20 years. However, these students still are at much higher risk than the 87% of black students and 90% of white students currently protecting themselves and their partners in this way.
The data on black students shows an overall decrease in those reporting ever engaging in intercourse, dropping from 82% to 60% between 1991 and 2011. Unfortunately, trends for condom use and contraceptive methods for pregnancy prevention are not as encouraging. Black students' reports of condom use at last sex has been declining from 70% in 1999 to 65% in 2011. Similarly, the percentage of black students reporting they used no contraceptive method to prevent pregnancy at last sex had a small, statistically insignificant increase from 11% in 2003 to 13% in 2011. This data suggests that while fewer black students report they are having sex, those who are sexually active might be at higher risk for pregnancy and STIs than black students in the past. White and Hispanic students' reported behaviors seem to be more congruent, with overall decreases in reported sex corresponding with reported increases in condom use and pregnancy prevention.
More information needed
Comparing the data for youth of color alongside white counterparts highlights health disparities. Unfortunately, the YRBS does not report data among other racial or ethnic groups, and it does not reflect those that are biracial or multiracial. Additionally, the survey does not collect data on respondents' poverty level, parental employment status, documentation or immigration status, parental educational attainment, or other indicators that might create a more nuanced picture of why these disparities exist or how lack of education or access to health information or services play a part in health outcomes.
Large studies such as the YRBS cannot tell providers all they need to know about caring for individual youth. Learning more about your local patient population and taking an individual sexual history remain keys to identifying the healthy behaviors and potential risks for each adolescent patient in your practice.
Tools such as the American Medical Association's Guidelines for Adolescent Preventive Services (GAPS) psychosocial screening tool (available at http://bit.ly/SFxE9H) and HEEADSSS (the screening acronym for Home, Education/employment, Eating, Activities, Drugs, Sexuality, Suicide, and Safety) can aid in taking adolescent histories with a more focused approach. Nevertheless, the YRBS data is useful in providing a context for understanding individual patients and comparing individuals with the U.S. population as a whole.
Reference
- Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance — United States, 2011. MMWR 2012; 61(4):1-162.
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