Substance Use and Sexual Risk Behaviors Among Youth

According to the Surgeon General’s Report Facing Addiction in America1, the misuse of substances such as alcohol and drugs is a growing problem in the United States. Although substance misuse can occur at any age, the teenage and young adult years are particularly critical at-risk periods. Research shows that the majority of adults who meet the criteria for having a substance use disorder started using substances during their teen and young adult years. Teen substance use is also associated with sexual risk behaviors that put young people at risk for HIV, sexually transmitted diseases (STDs), and pregnancy.2,7 To address these issues, more needs to be done to lessen risks and increase protective factors for teens.

What We Know

Studies conducted among teens have identified an association between substance use and sexual risk behaviors such as ever having sex, having multiple sex partners, not using a condom, and pregnancy before the age of 15 years of age.2,7

Researchers have found that as the frequency of substance use increases, the likelihood of sex and the number of sex partners also increases.3 In addition, studies show that sexual risk behaviors increase in teens who use alcohol, and are highest among students who use marijuana, cocaine, prescription drugs (such as sedatives, opioids, and stimulants), and other illicit drugs. Teens who reported no substance use are the least likely to engage in sexual risk-taking.4

According to the 2017 National Youth Risk Behavior Survey (YRBS), 40% of high school students have ever had intercourse and 29% of high school students are currently sexually active. Of the students who are currently sexually active, 19% drank alcohol or used drugs before last sexual intercourse.5

Fast Facts

Of the students who are currently sexually active:

  • 19% drank alcohol or used drugs before last sexual intercourse
  • 29% of high school students are currently sexually active
  • 40% of high school students have ever had intercourse

Risk Factors and Prevention Activities

Substance use and sexual risk behaviors share some common underlying factors that may predispose teens to these behaviors. Because substance use clusters with other risk behaviors, it is important to learn whether precursors can be determined early to help identify youth who are most at risk.

Primary prevention approaches that are most effective are those that address common risk factors. Prevention programs for substance use and sexual risk behaviors should include a focus on individuals, peers, families, schools, and communities. When students’ school environments are supportive and their parents are engaged in their lives, they are less likely to use alcohol and drugs and engage in sexual behaviors that put them at risk for HIV, STDs, or pregnancy.6

Common risk factors for substance use and sexual risk behaviors include:

  • Extreme economic deprivation (poverty, over-crowding)
  • Family history of the problem behavior, family conflict, and family management problems
  • Favorable parental attitudes towards the problem behavior and/or parental involvement in the problem behavior
  • Lack of positive parent engagement
  • Association with substance using peers
  • Alienation and rebelliousness
  • Lack of school connectedness

For primary prevention activities targeting substance use and sexual risk behaviors to be effective, they should include:6

  • School-based programs that promote social and emotional competence
  • Peer-led drug and alcohol resistance programs
  • Parenting skills training
  • Parent engagement
  • Family support programs

What CDC is Doing

CDC is engaging in a variety of efforts to develop strategies to combat substance use and sexual risk behaviors among teens. Some efforts include:

  • Conducting further analysis of existing data from the YRBS, School Health Policies and Practices Study (SHPPS), and School Health Profiles (Profiles).
  • Improving YRBS questions pertaining to prescription opioids and other substances.
  • Conducting a three-year demonstration project called Teens Linked to Care (TLC). The project is supported by the Hilton Foundation and the CDC Foundation, and assesses the ability of rural communities to integrate substance use prevention and sexual risk prevention program activities in school-based settings.
  • Researching the topic of teen substance use and its association with a variety of risks and behaviors.
  • Conducting an analysis of local and state policies on teen substance use prevention.


  1. U.S. Department of Health and Human Services (HHS), Office of the Surgeon General, Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: HHS, November 2016.
  2. Clayton, H. B., Lowry, R., August, E., & Jones, S. E. (2016). Nonmedical use of prescription drugs and sexual risk behaviors. Pediatrics, 137(1), e20152480.
  3. Cavazos-Rehg, P. A., Krauss, M. J., Spitznagel, E. L., Schootman, M., Cottler, L. B., & Bierut, L. J. (2011). Number of sexual partners and associations with initiation and intensity of substance use. AIDS and Behavior, 15(4), 869-874.
  4. Lowry, R., Holtzman, D., Truman, B. I., Kann, L., Collins, J. L., & Kolbe, L. J. (1994). Substance use and HIV-related sexual behaviors among US high school students: are they related?. American Journal of Public Health, 84(7), 1116-1120.
  5. Kann, L., McManus, T., Harris, W. A., et al. (2018). Youth risk behavior surveillance—United States, 2017. MMWR Surveillance Summary, 67(8), 1-479.
  6. Hawkins, J. D., Catalano, R. F., & Miller, J. Y. (1992). Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: implications for substance abuse prevention. Psychological bulletin, 112(1), 64-105.
  7. Cavazos-Rehg, P. A., Krauss, M. J., Spitznagel, E. L., Schootman, M., Cottler, L. B., & Bierut, L. J. (2012). Brief report: pregnant by age 15 years and substance use initiation among US adolescent girls. Journal of Adolescence, 35(5), 1393-1397.