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Current Trends Sexual Behaviors and Drug Use Among Youth in Dropout-Prevention Programs -- Miami, 1994

Youth who have dropped out of school have higher frequencies than youth who remain in school of behaviors that increase risk for sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV) infection (1). Youth identified as potential dropouts may be likely to take increased risks, but their STD/HIV risk status has not been adequately evaluated. To estimate the prevalence of risk behaviors among potential dropouts, investigators from the University of Miami School of Medicine surveyed students in two Miami dropout-prevention programs (school A and school B) and compared the findings with those from a survey of public school students in Miami. This report summarizes results of the surveys.

Schools A and B are affiliated with the largest nonprofit dropout-prevention organization in the United States, Cities in Schools, Incorporated (CIS). CIS programs serve approximately 97,000 students through 96 local programs in 27 states; CIS prevention programs for high school dropouts include health, social, and vocational services and academic curricula (2). The Miami programs are public/private collaborations that provide therapeutic case management, career education, a mentor program, pregnancy prevention, and caseworker home visits. CIS schools serve students who have been referred by the regular public school system because of academic difficulties and/or family or social problems; to become enrolled in the dropout-prevention program, students also must indicate commitments to completing high school.

The CIS schools in Miami differ in location and physical structure: one is free-standing and located in an urban neighborhood, and the other occupies the top floor of a high school building located in a middle class, suburban neighborhood. The student population at school A had a higher median age than that at school B (17 years versus 16 years), a higher percentage of students who were members of a racial/ ethnic minority group (94% versus 68%), and a higher percentage who were the first in their family to attend public school in the United States (50% versus 3%).

During March 1993, 1602 students in Miami public schools responded to the Youth Risk Behavior Survey (YRBS) (Dade County Public Schools, unpublished data, 1993); students in the dropout-prevention programs were ineligible to participate in YRBS. However, nine questions from the YRBS were included in a questionnaire administered to students in schools A and B in April 1994. Survey administrators informed students that the purpose of the questionnaire was to assess their risk as part of the evaluation of a planned STD/HIV intervention and that their anonymity would be protected. Of those who attended school on the days the surveys were administered, participation rates were 90.9% (70 of 77) at school A and 97.6% (80 of 82) at school B. * Data for both schools were standardized to the age distribution of YRBS respondents; YRBS data were weighted to adjust for nonresponse.

Although the prevalence of specific risk behaviors varied between the two schools, in general, prevalences were higher among students at schools A and B than among YRBS respondents Table_1. In particular, students from schools A and B were more likely than YRBS respondents to report ever having had sexual intercourse and to have been aged less than 16 years at sexual initiation. Among students reporting ever having had sex, respondents from schools A (33.3%) and B (32.3%) were more likely than YRBS respondents (19.5%) to report two or more partners during the preceding 3 months. When compared with YRBS respondents, students at schools A and B were more likely to have been pregnant or to "have gotten someone pregnant" than YRBS respondents. The prevalence of a report of previous STD or HIV/AIDS diagnosis was higher for school A (29.8%) than for school B (0) and for YRBS respondents (4.4%).

More respondents in schools A and B reported using drugs or alcohol before their last sexual intercourse (33.3% and 23.4%, respectively) than did YRBS respondents (13.5%). Among school A students, 15.3% reported ever having injected illegal drugs, compared with 1.0% of school B and 2.2% of YRBS respondents. Reported by: P O'Hara, BJ Messick, Univ of Miami School of Medicine; The School Board of Dade County, Miami; Florida Dept of Health and Rehabilitative Svcs. MG Kennedy, Emory Univ School of Public Health, Atlanta. JR Zinkin, Harvard Univ School of Public Health, Cambridge, Massachusetts. Behavioral and Prevention Research Br, Div of Sexually Transmitted Diseases and HIV Prevention, National Center for Prevention Svcs, CDC.

Editorial Note

Editorial Note: The findings in this report indicate that students enrolled in two dropout-prevention schools in Miami were, in general, more likely to engage in behaviors that could increase their risk for STDs/HIV infection than were their peers in the community public high school system. These findings are consistent with those from a study of a similar dropout-prevention program in southwestern Texas (3).

The findings from this survey are subject to at least two limitations. First, because of the small sizes of the enrollments at schools A and B, the analysis could not adjust for differences in the racial/ethnic distributions of youth in the two dropout-prevention programs. Second, because higher proportions of Miami residents than of the total U.S. population are racial/ethnic minorities or are foreign-born (4,5), these findings cannot be generalized nationally. However, regardless of racial/ethnic and other cultural factors, youth at risk for dropping out of school are a particularly inaccessible group for health educators because of high rates of absenteeism and the competing demands of remedial academic curricula. Youth who do drop out of high school are even less accessible by prevention efforts (6); an estimated 3 million (12.7%) persons aged 18-24 years surveyed during 1993 had dropped out of high school (7).

Based on the findings in Miami, STD/HIV prevention-service providers should consider three strategies for developing appropriate interventions for youth in dropout-prevention programs. First, more intensive STD/HIV-prevention programs should be targeted to students at risk for dropping out of school. Second, risk levels of students in dropout-prevention programs vary and should be assessed; for example, in this report, reported levels of injecting-drug use (IDU) ranged from 1% to 15%, indicating the need for information about reducing IDU-related HIV risk at one school. Third, prevention programming should be tailored to the diverse needs of specific student populations at educational risk and the effectiveness of the tailored approaches should be evaluated. The relation between academic risks and health risks underscores the importance of dropout-prevention efforts and of integrating comprehensive STD/HIV and substance-abuse prevention into educational curricula designed for youth at risk for dropping out of school.

The findings in this report are being used as baseline data to evaluate a peer-led STD/HIV prevention curriculum in Miami. During the 1994-95 school year, school A will offer the peer education activity as a course for credit.

References

  1. CDC. Health risk behaviors among adolescents who do and do not attend school -- United States, 1992. MMWR 1994;43:129-32.

  2. Cities in Schools, Incorporated. CIS quarterly profile. Alexandria, Virginia: Cities in Schools, Incorporated, March 31, 1994.

  3. Grunbaum JA, Basen-Engquist, K. Comparison of health risk behaviors between students in a regular high school and students in an alternative high school. J Sch Health 1993;63:421-5.

  4. U.S. Bureau of the Census. 1990 census counts on specific racial groups. Washington, DC: U.S. Department of Commerce, Bureau of the Census, 1993 (publication no. 1990 CB91-215).

  5. U.S. Bureau of the Census. The foreign-born population in the U.S. Washington, DC: U.S. Department of Commerce, Bureau of the Census, 1993 (publication no. 1990 CP3-1).

  6. Abrams D, Sheeran P, Abraham C, Spears R. Context and content: the impact of school-leaving and school-based health education on AIDS-relevant cognitions. AIDS Care 1992;4:245-58.

  7. U.S. Bureau of the Census. 1993 Current population survey, November, 1994.

* Total school enrollments on the day of questionnaire administration were 128 students in school A and 99 students in school B.



Table_1
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TABLE 1. Percentage of adolescents aged 15-20 years who indicated selected health
risks, by school enrollment status -- Miami, Youth Risk Behavior
Survey (YRBS), 1993, and Cities in Schools, Incorporated (CIS), survey, 1994
===================================================================================
                                                             CIS Survey +
                                    1993 YRBS *           ------------------
                             ------------------------     School A  School B
Risk                         (n=1602)     (95% CI &)      (n=77)@   (n=82)@
-----------------------------------------------------------------------------------
Ever had sexual
  intercourse **                58.8      (51.2-66.5)       87.7      73.5

Age (yrs) at first
  sexual intercourse
     <12                        17.1      (12.1-22.1)       11.7      14.3
   12-13                        23.9      (21.8-26.0)       15.0      21.9
   14-15                        37.1      (33.2-41.0)       63.2      50.7
    >=16                        21.8      (18.8-24.8)       10.0      13.1

Number of sex partners
  during preceding 3 months
  None                          32.9      (30.4-35.4)       35.4      17.9
  One                           47.4      (42.2-52.6)       25.7      49.8
  Two or more                   19.5      (13.4-25.6)       33.3      32.3
Used condom at last sexual
  intercourse **                55.7      (50.6-60.8)       42.7      63.8
Consumed alcohol or drugs
  before last sexual
  intercourse                   13.5      (10.0-17.0)       33.3      23.4

Been or gotten
  someone pregnant **
   1 time                        5.3      ( 3.6- 7.0)       23.6      13.5
  >=2 times                      1.6      ( 0.8- 2.4)        2.8       1.5

Been told by a doctor
  or nurse that respondent
  had a sexually transmitted
  disease ++                     4.4      ( 3.8- 5.1)       29.8         0

Ever injected illegal
  drugs **                       2.2      ( 1.5- 2.8)       15.3       1.0

Ever been taught
  about HIV/AIDS ++
  in school                     90.2      (89.0-91.3)       92.0      93.4


 * SUDAAN was used to weight Miami YRBS data for nonresponse.
 + These percentages represent all consenting students in both CIS schools in 
   Miami. Because these are parameters of a population rather than statistics 
   of a sample, confidence intervals are not necessary.
 & Confidence interval.
 @ Standardized to the age distribution of the total population participating in
   the 1993 YRBS.
** School A students reported significantly more risk behavior than School B
   students (p<0.05).
++ Human immunodeficiency virus/Acquired immunodeficiency syndrome.
===================================================================================

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