SEXUAL HEALTH BEHAVIORS BY SCHOOL LEVEL SOCIOECONOMIC STATUS AND URBANICITY, NATIONAL YOUTH RISK BEHAVIOR SURVEY (YRBS) 2015-2017

Purpose: The economic and social conditions in which high school students live and learn (i.e., social determinants of health [SDOH]) influence both academic achievement and health outcomes. Although the Youth Risk Behavior Survey (YRBS) is the longest established, nationally representative, comprehensive surveillance system monitoring health-related behaviors among high school students, the survey does not include individual-level indicators for SDOH. This is the first study to stratify YRBS data by school-level socio-economic status (SES) and urbanicity to examine their association with sexual health behaviors. Methods: The national YRBS is a cross-sectional survey conducted biennially among a nationally representative sample of public and private students in grades 9e12. YRBS data from 2015 (N= 15,624, response rate= 60%) and 2017 (N= 14,765, response rate= 60%) were combined, and then linked with extant data to identify school-level estimates for SES (percentage of students eligible for free- and reduced-price meals [%FRPM]) and urbanicity (urban, suburban/town, or rural) among students attending public schools. %FRPM was categorized as low poverty (25% of students or less), average (26%-75%), and high poverty (more than 75%). This study examined whether sexual health behaviors (currently sexually active, 4+ lifetime sexual partners, condom use during last sexual intercourse, hormonal birth control during last sexual intercourse, condom and hormonal birth control during last sexual intercourse [dual use protection], and drank alcohol or used drugs before last sexual intercourse) varied by %FRPM and urbanicity. Adjusted Prevalence Ratios (APR) were calculated using logistic regression models that controlled for sex, race/ethnicity, and grade. Associations were considered significant at p