Background Although the relationship between sexual risk behaviors and substance use has been established, It remains to be studied if different types of substances have differences in the odds of sexual risk behaviors. Therefore, we aimed to identify the prevalence of sexual risk behaviors in high school students of the United States (US) and study the difference in the odds of sexual risk behaviors for various substances. Methods We performed a retrospective cross-sectional study using Youth Risk Behavior Surveillance System (YRBSS) data of 2019 that nationally represents US high school students in grades 9-12. We identified individuals with sexual risk behaviors as participants with four or more lifetime sexual partners and who did not use a condom during the last intercourse. Results Out of 11,191 participants, 463 (3.9%) engaged in sexual risk behaviors. The prevalence of substance use, including anabolic steroids (11.5 vs. 1.1%), cocaine (27.2 vs. 2.0%), marijuana (87.1 vs. 34.7%), alcohol (92.4 vs. 54.3%), e-cigarette (90.3 vs. 48.0%), and traditional cigarette (62.2 vs. 21.6%) was higher in participants with sexual risk behaviors compared to participants with no sexual risk behaviors (p<0.0001 for all substances). In regression analysis, anabolic steroid use was associated with the highest odds of sexual risk behaviors (adjusted odds ratio (aOR):4.87, 95%CI: 2.48-9.57; p<0.0001) followed by cocaine (aOR:3.80, 1.80-8.00; p=0.001), marijuana (aOR:3.36, 1.64-6.89; p<0.0001), alcohol (aOR:2.41, 1.05-5.55; p=0.039), electronic vapor products (2.05, 1.004-4.19; p=0.049), and traditional cigarette use (aOR:1.58, 1.10-2.28; p=0.016). We did not find a statistically significant increase in the odds of sexual risk behaviors for the rest of the substances. Conclusion Although the prevalence of sexual risk behaviors is low, the prevalence of substance use is significantly higher in participants with sexual risk behaviors. Among the different types of substances, anabolic steroid use has the highest odds of sexual risk behaviors. Therefore, clinicians should remain vigilant for anabolic steroid use when screening adolescents for substance use. Further large-scale randomized studies are needed to study the effects of anabolic steroids on sexual risk behaviors.
Background Although the relationship between risky sexual behaviors and substance use has been established, the interplay between different types of substances and risky sexual behaviors needs further exploration. We aimed to identify the prevalence of risky sexual behavior in US high school students and study the difference in the association of risky sexual behaviors with substance use mediated by the type of substances. Method We performed a retrospective cross-sectional study using Youth Risk Behavior Surveillance System (YRBSS) 2019 data that nationally represents US high school students in grades 9–12. We identified risky sexual behaviors as participants with four or more lifetime sexual partners who did not use a condom during intercourse. Results Out of 11,191 participants, 463 (3.9%) engaged in risky sexual behavior. 17- year old (37.1% vs. 23.0% ;p < 0.0001), >= 18-year old (26.0% vs. 12.8% ;p < 0001) and African American participants (16.8% vs. 10.3%; p = 0.04) had higher prevalence of risky sexual behavior. The prevalence of substance use among participants with risky sexual behavior was higher for all substances (p < 0.0001). In regression analysis, steroid use was associated with the highest odds of risky sexual behavior (aOR: 4.87, 95%CI: 2.48–9.57; p < 0.0001) followed by cocaine (3.80, 1.80-8.00; p = 0.001), marijuana (3.36, 1.64–6.89; p < 0.0001), alcohol (2.41, 1.05–5.55; p = 0.039), electronic vapor product (2.05, 1.004–4.19; p = 0.049), and traditional cigarettes (1.58, 1.10–2.28; p = 0.016). Conclusion Although the prevalence of risky sexual behaviors is low, the prevalence of substance use is significantly higher in participants with risky sexual behaviors. Among the different types of substances, anabolic steroid use has the highest odds of risky sexual behaviors. Clinicians should remain vigilant for anabolic steroid use when screening adolescents for substance use. Further research is needed to study the effects of anabolic steroids on health risk behaviors.
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