case study

Youth Risk Behavior Studies

We collaborated on representative youth health studies in Los Angeles County

Client: Los Angeles Unified School District (LAUSD)

The Issue

Every two years, the CDC conducts the nationally representative Youth Risk Behavior Survey (YRBS) in middle and high schools.

Since 2011, we have collaborated with the LAUSD on a supplemental survey conducted alongside YRBS on additional topics covering homelessness, cyberbullying, technology use, and sexual risk behaviors.

The Outcomes

We developed a supplemental survey instrument with topics not covered in the YRBS survey, plus a system to link the two surveys.

This supplemental survey provided important insights into youth health issues that informed LAUSD student health and education policies.

Results have been published in eight peer-reviewed articles.

Publications

Associations Between Sexting Behaviors and Sexual Behaviors Among Mobile Phone-Owning Teens in Los Angeles
Rice E, Craddock J, Hemler M, Rusow J, Plant A, Montoya J, Kordic T. Child Development. 2017. [Epub ahead of print]

Homelessness and Sexual Identity Among Middle School Students
Rice E, Petering R, Rhoades H, Barman-Adhikari A, Winetrobe H, Plant A, Montoya J, Kordic T. Journal of School Health. 2015;85(8):552-7.

Cyberbullying perpetration and victimization among middle-school students
Rice E, Petering R, Rhoades H, Winetrobe H, Goldbach J, Plant A, Montoya J, Kordic T. American Journal of Public Health. 2015;105(3):e66-72.

Cell Phone Internet Access, Online Sexual Solicitation, Partner Seeking, and Sexual Risk Behavior Among Adolescents
Rice E, Winetrobe H, Holloway IW, Montoya J, Plant A, Kordic T. Archives of Sexual Behavior. 2015;44(3):755-63.

Sexting and sexual behavior among middle school students
Rice E, Gibbs J, Winetrobe H, Rhoades H, Plant A, Montoya J, Kordic T. Pediatrics. 2014;134(1):e21-28.

Homelessness experiences, sexual orientation, and sexual risk taking among high school students in Los Angeles
Rice E, Rhoades H, Winetrobe H, Sanchez M, Montoya JA, Plant A, Kordic T. Journal of Adolescent Health. 2013;52(6):773-778.

Sexually explicit cell phone messaging associated with sexual risk among adolescents
Rice E, Rhoades H, Winetrobe H, Sanchez M, Montoya JA, Plant A, Kordic T. Pediatrics. 2012;130(4):667-673.

Sexuality and homelessness in Los Angeles public schools
Rice E, Fulginiti A, Winetrobe H, Montoya JA, Plant A, Kordic T. American Journal of Public Health. 2012;102(2):200-201.

Presentations

Online sexual solicitation and partner seeking in relation to sex risk behavior among adolescents
Winetrobe H, Rice E, Holloway I, Montoya JA, Plant A, Kordic T. Presented at: 140th American Public Health Association (APHA) Annual Meeting; October 27-31, 2012; San Francisco, California.

High school student sexting associated with sexual risk behavior
Rhoades H, Rice E, Winetrobe H, Sanchez M, Montoya J, Plant A, Kordic T. Presented at: 140th American Public Health Association (APHA) Annual Meeting; October 27-31, 2012; San Francisco, California.

Living outside the bubble: homelessness experiences and the impact on sexual risk behaviors among Los Angeles public school students
Barman-Adkihari A, Rice E, Winetrobe H, Rhoades H, Fulginiti A, Montoya J, Plant A, Kordic T. Poster presentation at: 140th American Public Health Association (APHA) Annual Meeting; October 27-31, 2012; San Francisco, California.

Supplemental Surveys Provided Important Insights into Student Health

We collected data using a supplemental survey to the Centers for Disease Control and Prevention’s Youth Risk Behavior Survey (YRBS) in Los Angeles Unified School District (LAUSD) middle and high schools in 2011, 2013, 2015, and 2019. The YRBS is conducted using a multistage cluster sampling approach in which LAUSD selects schools within the district with a probability proportional to their student enrollment. Approximately 3,000 students participate in each survey year. Data are weighted with respect to race and ethnicity to reflect the demographic distribution of students attending LAUSD.

Our partnership with LAUSD and USC revealed a great deal of valuable information on health issues affecting youth in Los Angeles, including those related to sexual behavior, sexting, homelessness, and cyberbullying.


Homelessness and Sexual Risk

Prior studies reported homeless adolescents engage in more sexual risk than their stably-housed peers. However, these comparisons were usually made post hoc by comparing community-based samples of homeless adolescents with school probability samples. Our studies used a random sample of high school students (2011; n = 1,839) and another of middle school students (2013; n = 1,320) to examine homelessness experiences and sexual risk behaviors.

Nearly 10% of middle school students in the study identified as LGBQ and 23.5% experienced at least one night of homelessness during the previous year. LGBQ students did not experience higher rates of homelessness overall. However, LGBQ students were over five times as likely as heterosexual students to have stayed in a public place and 63% as likely to have stayed in a shelter.

In the high school sample, homelessness experiences consisted of staying in a shelter (10.4%), a public place (10.1%), and with a stranger (5.6%). Lesbian, gay, bisexual, transgender, questioning (LGBTQ), younger, and male adolescents were more likely to experience homelessness. LGBTQ adolescents were also more likely to report staying with a stranger and less likely to report staying in a shelter. Compared to adolescents who stayed in shelters, adolescents who stayed with strangers and in public places were more likely to engage in unprotected sex at last intercourse.

Based on these findings, we recommended that efforts to reduce homelessness and sexual risk-taking need to recognize the specific vulnerabilities faced by LGBTQ students.


Sexting

Studies have found that sexting (i.e., the sending and/or receiving of sexually-explicit cell phone texts and images) is associated with sexual risk behavior among adolescents. However, as of 2011, no published study using a probability sample had examined associations between youth sexting and sexual activity and risk behavior.

Among the middle school sample (n = 1,285), 20% of students with text-capable cell phone access reported receiving a sext and 5% reported sending one. Students who text at least 100 times per day were more likely to report both receiving and sending sexts and to be sexually active. Students who sent sexts and students who received sexts were more likely to report sexual activity, including unprotected sex.

For the high school sample (n = 1,839) 15% of students who had access to a cell phone reported sexting; 53% reported knowing someone who had sent or received a sext. Adolescents whose peers sexted were 17 times more likely to sext themselves. Adolescents who themselves sexted were seven times more likely to report being sexually active and were more likely to not have used a condom at last intercourse. Non-heterosexual students were three times more likely to report sexting, and more likely to have engaged in sexual activity, including unprotected sex at last intercourse.

The results of these studies suggested that sexting, rather than functioning as an alternative to real-world sexual behavior, appears to be part of a cluster of risky sexual behaviors among adolescents, especially amongst non-heterosexual adolescents.


Cyberbullying

Our 2011 study examined correlations between gender, race, sexual identity, and technology use, and patterns of cyberbullying (internet bullying) experiences and behaviors among middle-school students (n = 1,285). In this sample, 6.6% reported being a cyberbully victim, 5.0% reported being a perpetrator, and 4.3% reported being a perpetrator-victim. Cyberbullying behavior frequently occurred on Facebook or via text messaging. Cyberbully perpetrators, victims, and perpetrators-victims all were more likely to report using the Internet at least 3 hours per day. Sexual-minority students and students who texted at least 50 times per day were more likely to report cyberbullying victimization. Girls were more likely to report being perpetrators-victims.

We concluded that cyberbullying interventions should be implemented in middle schools, and should account for gender and sexual identity, as well as the possible benefits of educational interventions for intensive Internet users and frequent texters.


Online Partner Seeking

Online partner seeking is associated with sexual risk behavior among young adults, but this association had yet to be explored among a probability sample of adolescents. Moreover, smartphone access and sexual risk taking online and offline had not been explored in the published literature.

In our 2011 supplemental survey of high school students (n = 1,831), students with smartphone access were more likely to report being solicited online for sex, being sexually active, and having sex with an Internet-met partner. Bisexual-identifying students reported higher rates of being approached online for sex, being sexually active, and not using condoms at last sex. Gay, lesbian, and questioning (GLQ) students were more likely to report online partner seeking and unprotected sex with an Internet-met partner. Additionally, having sex with an internet-met partner was associated with being male, online sexual solicitation, and online partner seeking. We concluded that Internet- and school-based sexual health programs should incorporate safety messages regarding online sexual solicitation, seeking sex partners online, and engaging in safer sex practices with all partners.