Journal of Adolescent Health
Volume 42, Issue 6 , Pages 573-579, June 2008

Sexual Risk Behavior 6 Months Post–High School: Associations with College Attendance, Living with a Parent, and Prior Risk Behavior

Social Development Research Group, School of Social Work, University of Washington, Seattle, Washington

Received 17 August 2007; accepted 16 November 2007. published online 20 February 2008.

Article Outline

Abstract 

Purpose

This study examined sexual risk behavior (SRB) among a community sample of youth in the fall after their senior year of high school. The primary goal was to examine associations between college and residential status and 3 measures of SRB: casual sex, inconsistent condom use, and high-risk sex.

Method

Data were from 834 participants in the Raising Healthy Children project who were surveyed annually during high school and in the fall of the post–high school year.

Results

Of the participants, 30% reported inconsistent condom use, 23% reported casual sex, and 11% reported high-risk sex in the fall after high school. Youth in college were less likely than noncollege youth to report SRB. The protective association between college attendance on one hand and casual sex and intermittent condom use on the other was fully explained by high school substance use, risky sex, and academic performance. The protective effect of college attendance on high-risk sex was partly explained by high school predictors. Living with parents at age 18–19 years was not related to SRB.

Conclusions

Results from this study indicate that the higher prevalence of SRB among noncollege youth is largely a continuation of patterns of higher risk behavior and lower academic performance during high school. College attendance was protective for the most high-risk sex measure. Findings suggest that human immunodeficiency virus and sexually transmitted infection prevention efforts are needed among young adults who are not attending college and among high school students who have earned poor grades, used drugs, or engaged in SRB.

Keywords: Sexual risk behavior, Emerging adulthood, College versus noncollege

 

The late teens and early 20s are peak times of risk for acquiring human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs). Adolescents and young adults are more likely than older adults to have multiple sex partners, to engage in unprotected sexual intercourse, and to select higher risk partners [1], [2]. The transition out of high school is characterized by changes in romantic relationships, residence, parenthood, employment, and education [3]. Changes in residential and school status, especially, may provide increased opportunity for heavy episodic drinking, drug use, and risky sex in young adulthood [4]. Much of the existing research on correlates of risky sexual behavior in young adulthood focuses on college or high-risk populations, and little research has focused on community samples of young adults. To date, no longitudinal study has compared the sexual risk behavior (SRB) of young adults in college versus those not in college and of those who continue to live with their parents versus those who do not. In this study we examine these associations in a community sample of young adults. In addition we consider whether these associations remain after adjusting for variables that may be associated with selection into college or residential status, as well as gender, ethnicity, childhood poverty, and relationship status.

Theories about the new freedoms, roles, and responsibilities associated with the transition to adulthood would suggest that the increased independence and self-governance that go along with college attendance and living away from home should result in increased risk behavior [4], [5]. Although the effects of college attendance on SRB have not been investigated, going to college has been linked repeatedly with increased heavy drinking [6]. Thus it also is plausible that college attendance may be associated with increases in other risk behavior, including SRB.

Little research to date has explored the effects of normative changes in residential status (i.e., living with parents or not living with parents) on SRB in emerging adulthood. Parental monitoring during middle and early high school, however, is a robust predictor of adolescent SRB [7], [8]. The increased self-governance and consequent lessening of parental monitoring associated with living away from home also may be associated with increased SRB. Again drawing a parallel with heavy drinking among college students, existing research strongly suggests that living away from parents may increase drinking [9], [10]. In fact some research suggests that living away from parents is more predictive of young adult heavy drinking than is college attendance [4], [9], [10]. Similar results may be found in regard to SRB.

Theory also suggests that, alternatively, individuals may carry on pre-existing patterns of behavior despite these status changes. For example, the Social Development Model hypothesizes that elevated levels of substance use and other problem behaviors lead to selection into socialization experiences that value drug use and other problem behavior, including risky sex. These socialization experiences in turn lead to reinforcement of drug use and other problems, more bonding with those involved in these behaviors, beliefs favorable to problem behavior, and more problem outcomes [11]. Drawing again on the substance use literature, past research has not supported an association between college attendance and changes in marijuana use [10]; rather marijuana use has demonstrated a high degree of stability from adolescence to early adulthood [10], [12], [13]. SRB may show similar patterns such that behavior observed in the transition to adulthood represents a continuation of earlier patterns as opposed to an adaptation to new roles and opportunities. For example there is evidence that youth who exhibit risk behaviors, especially substance use, during adolescence are less likely to attend college [14] and may be less likely to live with parents after high school. Continuity of behavior from high school to emerging adulthood constitutes a competing explanation for any observed relationship between college attendance or living situation and SRB.

The relationship between college attendance and SRB in emerging adulthood has been understudied. The present study adds to the literature by testing for associations between college attendance and living with parents and SRB in the fall after high school. Continuity of behavior from high school to the following fall is tested as a competing hypothesis.

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Methods 

Sample 

Participants were from the Raising Healthy Children (RHC) project, a longitudinal study of students drawn from 10 public schools in a suburban Pacific Northwest school district. RHC is a study of the etiology of problem behaviors and a randomized test of a preventive intervention. The 10 schools were paired on SES and attendance patterns. One member of each pair was randomly assigned to the experimental or treatment-as-usual control condition. Children who attended a regular first- or second-grade classroom through the spring and had a parent who spoke English, Spanish, Vietnamese, or Korean were eligible. Active consent letters were sent to eligible families. After receiving the advance letter, each family was approached through a home visit and invited to participate in the project. Further details of the RHC intervention have been reported previously [15], [16]. A total of 938 first- and second-grade students and their families (76% of those eligible) consented to participate in the project in the fall of 1993. An additional 102 students who had transferred to the study schools were enrolled in the fall of the subsequent year (total N = 1040). Data were collected annually in the spring through grade 12 and in the fall after the final year of high school for each of the 2 grade cohorts. The original sample was gender balanced (47% female and 53% male). The ethnic composition of the sample was 81% white, 7% Asian or Pacific Islander, 4% Hispanic, 4% black, and 3% Native American. Approximately 29% of participants received free or reduced-price school lunch in the first year of the project.

Approximately 83% (n = 865) of the original sample completed the interview in the fall after high school. At the fall data collection, participants ranged in age from 17.6–19.5 years (mean = 18.4, SD = .33). Attrition was not related to gender, ethnicity, or low-income status (i.e., whether they received free/reduced-price school lunch in the first 2 years of the project) at baseline. Participants who were married, divorced, or separated (n = 18) and participants who had been held back and were still in high school in the fall after what should have been their senior year (n = 13) were excluded, bringing the total sample size to 834.

Procedures 

The RHC questionnaires and procedures were approved by the University of Washington Institutional Review Board. Parents gave active written consent for themselves and the target child at the start of the study. The parental consent form described the longitudinal nature of the study, and was valid until the child reached the age of 18 years. Before age 18, students gave active written assent each year. After age 18, students gave active consent, either in writing or over the Internet at each survey timepoint. The 12th-grade spring survey was administered in person between March and June (<5% of interviews were completed in July and August) using a combination of Computer-Assisted Personal Interviewing (CAPI) and Computer-Assisted Self Interviewing (CASI). Sensitive questions were self-administered. The survey in the fall after high school was administered between September and December, with a small number of interviews (<5%) completed in January of the next calendar year. Questionnaire administration was timed so that the time frames for sex-related questions would refer to a period during which those participants who attended college were at college. About half of the sample completed the survey over the Internet and half were interviewed using the combined CAPI/CASI techniques. The majority of participants living out of state who did not complete the instrument over the Internet were interviewed in person; a small proportion (3%) were interviewed by phone. Analyses have indicated no differences in rates of reported sexual activity or SRB by survey mode [17].

Measures 

Sexual risk behavior 

Participants self-reported their SRB in the fall after high school. Three dimensions of risk were assessed: (1) inconsistent condom use; (2) casual sex; and (3) high-risk sex. Inconsistent condom use was based on whether the respondent reported having either vaginal or anal intercourse without “always” using a condom. Casual sex was based on whether the respondents reported that they had (a) sex with someone they did not “consider to be a boyfriend or girlfriend, that is [outside of] an exclusive relationship,” (b) sex with a partner the respondent had known for <2 weeks, or (c) more than one sexual partner in the prior month. High-risk sex was determined according to the following considerations. Use of latex condoms during vaginal and anal intercourse can reduce the spread of HIV and other sexually transmitted infections (STIs), as previously reported [18], [19], [20]; however in the context of a monogamous relationship with a known HIV/STI-negative partner, unprotected sex constitutes considerably less risk. Past research has linked number of sexual partners and the probability of contracting HIV and other STIs [20]; correct and consistent condom use with these partners, however, reduces this risk. By contrast, having unprotected sex with multiple or casual partners of unknown status is, arguably, more risky in terms of HIV and other STIs than either behavior in isolation [21]. Therefore a high-risk sex variable was created based on whether participants reported having both casual and unprotected sex. Participants who reported that they had sex with a man who had sex with other men, with a partner who was HIV-positive, or with an intravenous drug user also were categorized as having high-risk sex. All questions referred to the month before the interview.

Educational and residential status 

College status was measured in the fall after high school and was based on whether youth self-reported enrollment in a 2- or 4-year college. We combined 2-year and 4-year students because a large proportion of college students in the state of Washington begin at 2-year schools and then transfer to 4-year schools. Residential status was based on whether participants reported living with a parent in the fall after high school.

Prior risk behavior variables 

Academic performance, based on grade point average (GPA), was self-reported by participants in grades 9–12. These reports were averaged to obtain a measure of high school GPA. A dichotomous high school substance use variable was created by combining participant self-reports of any heavy episodic drinking (i.e., consuming 5+ drinks in a 2-hour period), cigarette smoking, or marijuana use in their last year of high school. Participants who reported any substance use were coded as users. A dichotomous high school SRB variable was constructed by combining participant reports of having had multiple partners or used condoms inconsistently in their last year of high school, or whether they had an early sexual debut (before the spring of ninth grade). Participants endorsing any one of these behaviors were coded as having had risky sex during high school.

Relationship status and demographic control variables 

In the fall after high school, participants were asked, “Are you in a romantic relationship with someone (that is, do you have a steady boyfriend or girlfriend)?” to determine their relationship status. Ethnicity was taken from school records at the outset of the study. Age and gender were self-reported by participants. Free/reduced-price lunch eligibility (indicating low socioeconomic status) in the first 2 years of the study was reported by parents.

Statistical analysis 

All analyses were done using SPSS version 12 (SPSS Inc., Chicago, IL). We used χ2 tests [22] to conduct preliminary analyses between dichotomous college/noncollege and living with parent/living away variables and dichotomous SRB variables. Multivariate testing was done using logistic regression [23]. For each outcome variable, a series of 2 regression models was run. The first model included control variables (gender, ethnicity, relationship status, childhood poverty), the college status variable, and the living situation variable. The second model added prior risk behavior variables to test whether associations between college status or living situation and the outcome variables persisted when high school GPA, SRB, and substance use were entered into the equation.

Care is needed when conducting etiologic analyses in studies including interventions to minimize threats to validity. Using χ2 and logistic regression analysis, we found no evidence of intervention or cohort effects on outcome variables, nor did we find interactions between predictors and intervention status or cohort. Therefore intervention and control groups and cohort groups were pooled, and the full sample was used for all analyses.

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Results 

Descriptive findings 

About 60% of participants lived with a parent and 45% were attending college (either 2- or 4-year) in the fall after high school. Of the participants, 25% both lived with a parent and were attending college, 36% lived with a parent and were not attending college, 20% were attending college but did not live with a parent, and 19% neither lived with a parent nor were attending college. About 63% of participants were sexually active in the month before the fall interview (Table 1). Approximately 30% of participants reported inconsistent condom use, ∼23% reported engaging in casual sex, and ∼11% reported high-risk sex. The majority of the high-risk sex reported by participants consisted of casual and unprotected sex. Having sex with men who have sex with men (n = 4), HIV-positive partners (n = 3), or intravenous drug users (n = 9) was rare. Table 1 also shows the prevalence of each SRB outcome by college and residential status. The prevalence of SRB was lower among college students than among nonstudents. Nonetheless a large proportion of college students engaged in SRB, especially unprotected intercourse (23%). No significant protective relationship between living with a parent and SRB was observed. Preliminary analyses suggest that the effect of college did not differ between those who lived with a parent and those who did not.

Table 1. Prevalence of past-month sexual activity and sexual risk behaviors for the full sample, by school status and by living situation
Full sampleSchool statusLiving situation
Not in collegeIn collegeNot with parentsWith parents
Had sex62.6%70.2%53.3%⁎67.6%59.3%⁎
Inconsistent condom use29.5%34.6%23.2%⁎31.8%28.0%
Casual sex22.6%28.6%15.2%⁎24.2%21.5%
High-risk sex11.0%15.9%5.1%⁎12.7%9.9%

Note: For school status comparisons, the reference category is “not in college.” For living situation comparisons, the reference category is “not with parents.”

⁎p < .05.

Table 2 displays correlations between key study variables. Consistent with the behavior continuity hypothesis, college attendance and high school GPA were negatively related to SRB, and high school SRB and substance use showed positive associations with SRB outcomes. Living situation after high school was not correlated with any of the SRB outcome variables. Living with a parent was negatively correlated with high school GPA but was not related to SRB or substance use during high school.

Table 2. Intercorrelations among key study variables
Predictor12345678910
1. Male—
2. Childhood poverty.02—
3. Inconsistent condom use−.10⁎−.01—
4. Casual sex.05.00.15⁎—
5. High-risk sex−.02.00.50⁎.60⁎—
6. In college−.09⁎−.18⁎−.13⁎−.16⁎−.14⁎—
7. Live with parents.15⁎−.01−.04−.03−.05−.11⁎—
8. High school GPA−.18⁎−.13⁎−.15⁎−.19⁎−.14⁎.48⁎−.16⁎—
9. High school risky sex−.08⁎.06.40⁎.27⁎.22⁎−.22⁎−.05−.19⁎—
10. High school drug use−.01.05.24⁎.32⁎.21⁎−.25⁎−.06−.28⁎.44⁎—

GPA = grade point average.

⁎p < .05.

Multivariate findings 

Predicting inconsistent condom use 

Results from Model 1 showed a significant relationship between both being in a romantic relationship and college attendance and consistency of condom use (Table 3). Youth who were in a relationship were at increased risk for inconsistent condom use, whereas youth who were in college were at decreased risk for inconsistent condom use. Living with a parent was not related to consistency of condom use. In Model 2, however, college attendance was no longer related to the probability of inconsistent condom use; rather high school GPA and high school SRB were predictive of condom use consistency. Once the high school predictors were entered, African American ethnicity was associated with a decreased probability of inconsistent condom use in Model 2.

Table 3. Multivariate logistic regressions predicting sexual risk behavior
PredictorInconsistent condom useCasual sexHigh-risk sex
Model 1Model 2Model 1Model 2Model 1Model 2
OR (95% CI)OR (95% CI)OR (95% CI)OR (95% CI)OR (95% CI)OR (95% CI)
Constant.21⁎.01⁎.65⁎.20⁎.27⁎.05⁎
Male.87(.62–1.2).94(.64–1.4)1.1(.79–1.6)1.1(.74–1.6).90(.55–1.5).93(.55–1.6)
Childhood poverty.76(.52–1.1).75(.49–1.1).75(.51–1.1).65(.42–1.0).72(.42–1.2).68(.38–1.2)
Ethnicity
Native American1.8(.70–4.9)1.1(.33–3.6)1.0(.36–2.8).86(.26–2.8)1.1(.30–3.8).70(.15–3.3)
Asian American.54(.24–1.2).77(.31–1.9)1.1(.54–2.4)1.8(.79–4.3).25(.03–1.9).31(.04–2.4)
Hispanic1.2(.53–2.6).96(.39–2.4)2.1⁎(1.0–4.4)2.2(.95–5.2)1.5(.59–3.9)1.2(.42–3.5)
African American.63(.23–1.7).32⁎(.11–.95)2.4⁎(1.1–5.3)1.6(.66–3.8).99(.28–3.4).45(.10–2.0)
In a relationship6.9⁎(4.8–9.9)6.1⁎(4.1–9.0).54⁎(.38–.77).32⁎(.22–.49)1.1(.71–1.8).80(.49–1.3)
College attendance.61⁎(.43–.87)1.1(.71–1.7).38⁎(.26–.55).73(.47–1.1).28⁎(.16–.48).45⁎(.25–.83)
Living with parent(s).88(.63–1.2).92(.63–1.3).70⁎(.49–.99).70(.47–1.0).66(.44–1.1).70(.43–1.1)
High school GPA—.74⁎(.58–.94)—.78⁎(.61–.99)—.89(.67–1.2)
High school risky sex—5.1⁎(3.3–8.0)—3.0⁎(1.9–4.7)—3.4⁎(1.8–6.6)
High school drug use—1.5(.97–2.4)—6.1⁎(3.4–11)—4.4⁎(1.8–11)
Overall χ2(df)160.64⁎(9)248.97⁎(12)48.06⁎(9)162.85⁎(12)35.85⁎(9)84.78⁎(12)
Δ χ2 vs. Model 1 88.33⁎ 114.79⁎ 48.93⁎

CI = confidence interval; OR = odds ratio.

Note: CIs for statistically significant ORs may include 1.0 because of rounding. The reference categories for comparisons are (comparison–reference group): male–female; childhood poverty (free lunch eligible)–non–free lunch eligible; ethnicity–Caucasian; in a relationship–not in a relationship; in college–not in college; living with a parent–not living with a parent; high school risky sex–no risky sex in high school; and high school drug use–no drug use in high school.

⁎p < .05.

Predicting casual sex 

Table 3 shows the results of the models predicting the probability of casual sex. In Model 1, both college attendance and living with a parent were associated with a lower probability of casual sex. Being in a relationship also was protective, but Hispanic and African American ethnicity were associated with increased risk for casual sex. In Model 2, the associations between college attendance and living with a parent and the probability of casual sex were no longer statistically significant. Relationships between Hispanic and African American ethnicity and casual sex also became nonsignificant in Model 2, but the protective effect of being in a relationship remained. High school GPA significantly reduced, and high school risky sex and drug use significantly increased, the probability of casual sex in the fall after high school.

Predicting high-risk sex 

In Model 1, college attendance was the only predictor that was significantly associated with the probability of high-risk sex (Table 3). The protective effect of college attendance remained in Model 2. Model 2 also showed main effects of high school SRB and drug use. No other predictors in Model 2 were related to the probability of high-risk sex.

For each of the 3 outcome variables, potential interactions between college attendance and living with a parent were tested but were not significant. Except for GPA, we report results based on dichotomous predictors for ease of interpretation. Tests using relationship duration as opposed to status, using each drug separately, and using number of drugs used in high school as opposed to any drug use resulted in patterns of significance identical to those reported here.

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Discussion 

This study tested the association between college attendance and living with a parent and 3 measures of SRB in the fall after high school: inconsistent condom use, casual sex, and high-risk sex. High school SRB, substance use, and GPA also were included to test the alternative hypothesis that individuals carry on pre-existing patterns of behavior that may account for selection into post–high school environments as well as governing behavior in these environments.

Results showed a consistent protective effect of college status on SRB at age 18–19 years, when controlling for demographic variables and relationship status in logistic regression models. Prior risk behavior and academic performance in high school, however, completely explained the observed relationship between college attendance and inconsistent condom use and casual sex. Previous risk behavior partially explained the relationship between college attendance and high-risk sex, although college attendance remained a significant and relatively strong protective variable. College students in this sample reported lower rates of SRB largely because they were more likely to do well in school and less likely to use drugs and to engage in SRB during high school. Thus, patterns of behavior that had been established in high school were continued in the fall after high school. High school GPA also was related to selection into college status. Living with a parent was only protective in 1 of 6 models examined and became nonsignificant after controlling for the high school predictors. We conclude that living with a parent is not a key predictor of SRB at age 18–19 years.

These findings are in direct contrast to theories on the transition to adulthood that argue that increased freedom and role experimentation should be associated with increased risk behavior [4], [5]. They also are in contrast to existing findings in the alcohol-related literature showing associations between college attendance and living away from home and increased heavy drinking in early adulthood [9], [10]. In prior studies, living away from home was more predictive of alcohol use in emerging adulthood than was college attendance. We found little evidence, however, for an association between living away from home and SRB.

Overall the findings are more consistent with literature on marijuana use in emerging adulthood and with theory that suggests that behavior patterns established in adolescence are continued into young adulthood [10]. It is possible, however, that youth require time to adjust to the new freedoms and increased self-governance that they experience after high school. It may be that studies using a follow-up period longer than the 6-month period used here would identify effects of college attendance and/or living away from parents that are not yet manifest in the present sample.

Study limitations 

The study has several strengths, including a relatively large sample size, measures of past risk behavior, and detailed questions about SRB; however some limitations should be kept in mind. First, although this sample included participants from multiple ethnic groups, the representation of nonwhite groups was not large enough for an investigation of interactions between ethnicity and college attendance or living with a parent. Second, the time frame for assessment of SRB was somewhat short (i.e., 1 month before the interview). This short time frame may have resulted in underestimates of the prevalence of SRB in the sample.

In conclusion, results from this study suggest that patterns of school performance, drug use, and SRB established in high school largely explain the difference in SRB prevalence between college-attending and non–college-attending youth in the fall after high school. This suggests that prevention efforts aimed at reducing substance use and risky sex and improving academic performance during high school among all youth should result in reductions in the prevalence of SRB in the transition to adulthood. Nearly one-third of young adults in this sample reported engaging in SRB, highlighting the need for universal HIV and STI prevention among this age group. In fact, strong continuity in SRB from the end of high school into early adulthood suggests that prevention efforts beginning earlier (i.e., at the start of high school) may be warranted. The protective effect of college attendance on the highest risk sex behavior suggests that youth who are not in college might receive special emphasis in these efforts. Preventive programming early in high school would also benefit these non–college-bound youth, who may be difficult to target once they leave high school.

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Acknowledgments 

This project was supported by grant R001DA08093 from the National Institute on Drug Abuse, Washington, DC. The authors gratefully acknowledge the staff, families, and students of the participating project schools for their support and cooperation in the Raising Healthy Children project. We also acknowledge the Social Development Research Group data collection team, and Tanya Williams for editing this manuscript.

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PII: S1054-139X(07)00639-8

doi:10.1016/j.jadohealth.2007.11.138

Journal of Adolescent Health
Volume 42, Issue 6 , Pages 573-579, June 2008

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