Sexual behaviors and drug use among youth in dropout-prevention programs - Miami, 1994

Morbidity and Mortality Weekly Report, Dec 2, 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 freestanding 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1602 students in Miami public schools responded to the Youth Risk Behavior Survey (YRBS) (Dade County Public Schools, unpublished data, 1993); students in the dropout-prevention programs were ineligible to participate in YRBS.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 <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: 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).