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Morbidity and Mortality Weekly Report
Thursday June 14, 1990
Current Trends
HIV-Related Knowledge and Behaviors Among High School Students --
Selected U.S. Sites, 1989
Since 1987, state, territorial, and local departments of education
have periodically assessed human immunodeficiency virus (HIV)-related
knowledge and behaviors among high school students (13-18 years of age)
in their jurisdictions (1). This report presents selected data from
surveys conducted by departments of education in 30 states, 10 cities,
and two territories during February-May 1989.
A questionnaire for anonymous self-administration was developed by
representatives from 71 state, territorial, and local departments of
education, with technical assistance from CDC. The questionnaire
contained 39 questions: five for assessing demographic characteristics
of respondents, 26 for HIV-related knowledge and beliefs, and eight for
intravenous (IV)-drug use and sexual behaviors. Each department of
education chose which of the 39 questions to administer: all sites
administered questions that assessed demographic characteristics and
HIV-related knowledge and beliefs; 25 sites, questions that assessed
IV-drug-use behaviors; and 19 sites, questions that assessed sexual
behaviors.
Sampling schemes varied among the 42 sites. Eleven sites* drew
probability samples from well-defined sampling frames of schools and
students, which allowed weighted results of known precision to be
computed. Ten sites** also drew probability samples of both schools and
students. However, documentation necessary to weight the data or to
estimate precision was not available. In general, the 21 other sites***
drew nonprobability samples of either schools or students.
School response rates ranged from 27% to 100%; student response
rates ranged from 41% to 92%. Sample sizes ranged from 303 to 10,279
students (Table 1). From 33% to 86% (median: 62%) of students from all
sites reported having been taught about acquired immunodeficiency
syndrome (AIDS) or HIV infection in school. The percentage of students
from all sites who reported having discussed AIDS or HIV infection with
their parents or other adults in their families ranged from 43% to 69%
(median: 56%).
Varying proportions of students knew that AIDS or HIV infection
cannot be transmitted by blood donation (32%-75% (median: 58%)),
mosquito or other insect bites (22%-67% (median: 48%)), use of public
toilets (44%-85% (median: 73%)), or blood tests (59%-82% (median:
73%)). Most students knew that AIDS or HIV infection can be transmitted
by sharing needles used to inject drugs (93%-100% (median: 98%)) or
from having sexual intercourse without using a condom (74%-98% (median:
88%)) (Table 2).
Rates of reported IV-drug use varied: 2%-5% of students (median:
3%) reported ever injecting cocaine, heroin, or other illegal drugs,
and 0.2%-3% (median: 0.9%) reported sharing needles used to inject any
drugs. In all but one site, more male than female students reported
these behaviors (Table 3).
Rates of reported sexual intercourse also varied: 27%-76% of
students (median: 56%) reported having had sexual intercourse at least
once. In addition, 7%-40% (median: 21%) reported ever having had four
or more sex partners. At each site, more male than female students
reported having had sexual intercourse at least once and ever having
had four or more sex partners (Table 4).
Reported by: S Adams, Alabama State Dept of Education. M Towery,
Arkansas Dept of Education. R Rich, Los Angeles Unified School Dist; J
Campana, San Diego Unified School Dist; M Lam, San Francisco Unified
School Dist; W White, California State Dept of Education. D
Sandau-Christopher, State of Colorado Dept of Education. J Arns,
Delaware State Dept of Public Instruction. J Sadler, District of
Columbia Public Schools. G Davis, Georgia Dept of Education. A
Horiuchi, Hawaii Dept of Education. J Hummer, Idaho Dept of Education.
J Harris, Iowa Dept of Education. J Grosko, Kansas State Dept of
Education. I Mudd, Kentucky Dept of Education. D Frost, Louisiana State
Dept of Education. J Cohen, Massachusetts Dept of Education. W Jubb,
Michigan Dept of Education. C Hungerford, Missouri Dept of Elementary
and Secondary Education. D Chioda, Jersey City Board of Education; D
Cole, New Jersey State Dept of Education. K Gaylord, New Mexico State
Dept of Education. G Abelson, New York City Board of Education; A
Sheffield, New York State Education Dept. R Frye, North Carolina Dept
of Public Instruction. C DeRemer, North Dakota Dept of Public
Instruction. K Stofsick, Ohio Dept of Education. J Richter, Oklahoma
State Dept of Education. J Warren, Oregon Dept of Education. M Sutter,
Pennsylvania Dept of Education. E Rosado, Puerto Rico Dept of
Education. A Ferreira, Rhode Island Dept of Education. M Carr, South
Dakota Dept of Education and Cultural Affairs. E Word, Tennessee State
Dept of Education. M Peterson, Utah State Board of Education. S Tye,
Dept of Education, Government of the Virgin Islands. P Hillard, Seattle
Public Schools; P Baldwin, Washington State Education Dept. B Johnson
Biehr, Chicago Public Schools, Illinois. D Scalise, The School Board of
Broward County; AN Gay, The School Board of Dade County, Florida. P
Simpson, Dallas Independent School Dist, Texas. Div of Adolescent and
School Health, Center for Chronic Disease Prevention and Health
Promotion, CDC.
Editorial Note: From 1988 to 1989, the number of state, territorial,
and local departments of education that conducted surveys about
HIV-related knowledge and behaviors among high school students nearly
tripled (from 15 to 42). This increase represents a notable step toward
establishment of state, territorial, and local school-based
surveillance systems for monitoring priority health-risk behaviors
among high school students.
HIV-related knowledge and behaviors among high school students are
cause for concern throughout the United States. Most importantly, these
surveys indicate that many students are at risk for HIV infection
because they use IV drugs and share needles or because they have sexual
intercourse with multiple partners. Many of these findings are similar
to those from surveys conducted in 1988 (1).
Although the findings in this report are based on a combination of
probability and nonprobability samples and comparisons of data among
sites should be made with caution, these results have assisted in
planning and evaluating broad programs in individual cities and states.
For example, the Michigan Department of Education used results from its
1988 and 1989 surveys to assist the State Board of Education in
supporting school-based HIV education programs that help students avoid
behaviors that result in HIV infection.
In addition to determining the prevalence of HIV-related risk
behaviors among high school students, surveys of this type should be
used to measure the prevalence of other priority health-risk behaviors,
such as drug, alcohol, and tobacco use; imprudent dietary patterns;
inadequate physical activity; behaviors that result in intentional and
unintentional injuries; and sexual intercourse that can result in
sexually transmitted diseases or unintended pregnancies. State,
territorial, and local departments of education have worked with CDC
and other federal agencies to develop the Youth Risk Behavior
Surveillance System. This system, implemented in 1990, will be used to
periodically measure changes in these priority health-risk behaviors.
To increase the number of sites with probability samples of ninth-
through 12th-grade students and the comparability of data among sites,
CDC is providing intensive technical assistance to interested
departments of education. Departments of education can use the results
from these surveys to plan and evaluate comprehensive school health
education programs that help students avoid these priority health-risk
behaviors.
Reference
1. CDC. HIV-related beliefs, knowledge, and behaviors among high school
students. MMWR 1988;37:717-21.
* Delaware, District of Columbia, Hawaii, Iowa, Kentucky,
Massachusetts, Pennsylvania, and South Dakota; Dallas, Jersey City, and
Miami.
** Alabama, Arkansas, California, Louisiana, Michigan, Missouri,
Oregon, and Rhode Island; Chicago and Seattle.
*** Colorado, Georgia, Idaho, Kansas, New Jersey, New Mexico, New
York, North Carolina, North Dakota, Ohio, Oklahoma, Puerto Rico,
Tennessee, Utah, Virgin Islands, and Washington; Fort Lauderdale, Los
Angeles, New York City, San Diego, and San Francisco.