Healthy Sexual Behavior

Definition

Risky sexual behavior, defined as engaging in unprotected intercourse, sexual encounters under the influence of drugs or alcohol, having multiple partners, etc., can result in sexually transmitted infections (STIs) an infection that you can get by having sex, and unplanned pregnancies (1).

Engaging in high-risk sexual behaviors, such as unsafe sex and higher numbers of lifetime sexual partners, increases the likelihood of having an unplanned pregnancy or contracting sexually transmitted infections (STIs). Both unplanned pregnancies and STIs, have short and long-term consequences to health and the general well-being of families and communities at large (1).

The Centers for Disease Control and Prevention (CDC) estimates that there are around 20 million new STI infections annually. Although they only represent 25 percent of the sexually active population, almost half of these cases are among young people ages 15-24. With estimates as high as $16 billion, the cost of these diseases to the health care system is staggering (2). STIs can cause significant and harmful effects that can be costly to treat, such as:

• Reproductive health problems
• Complications during pregnancy — including fetal health problems
• Cancer
• Sexual transmission of HIV (human immunodeficiency virus) infection (2)

STIs are largely preventable if healthy sexual behaviors are adopted. Yet, they often go untreated due to the asymptomatic nature of many STIs — which don’t have common recognizable symptoms. This leaves the true burden of STI frequency often underreported. Untreated STIs can have substantial long-term health impacts, especially for adolescent girls and young women. The CDC estimates these undiagnosed infections cause at least 24,000 women to become infertile each year (2).

Health Disparities and Inequities

Each year in the United States, there are approximately three million unintended pregnancies. The highest rates are among women who are poor and low-income, cohabiting, ages 18–24 and women who belong to communities of color. The lowest rates are among women who are higher-income, white, college graduates and married. While the teen pregnancy rate has been falling overall, in 2016 there were still over 200,000 teen pregnancies across the United States (3). Pregnant teens are less likely than older women to receive the recommended levels of prenatal care. Pregnant teen mothers are more likely to have pre-term or low-birthweight babies, have an increased risk for STIs, increased chance of repeat pregnancies, are less likely to graduate high school and have an increased possibility of living in poverty, relying on public assistance to make ends meets (1).

Sources: PRAMS via CDPHE, US data: National Survey of Family Growth (2011);

Note: The percent of pregnancies that were unintended for Black women and women of another race were excluded from this chart for Jefferson County, due to low numbers of responses to the PRAMS survey.

Studies that look at the demographic makeup of those who have contracted STIs have shown that men and women who belong to communities of color have higher rates of STIs. These inequities are not caused by racial or ethnic heritage, but due to social conditions that are more likely to affect these individuals (5). In areas where communities of color have higher STI prevalence (higher percent of people with the disease), individuals are at higher risk of contracting STIs even when risky sexual behaviors are minimized (6). Other factors that can affect an individual's reproductive and sexual health decision making include access to affordable and quality medical care, social norms, educational attainment, age, income, geographic location, insurance status, sexual orientation and dependency on alcohol or other drugs (2).

Implications and Data for Jefferson County

Community Health Needs Assessment Focus Group Findings

Sexual health was not discussed as a major concern in the focus groups. However, parents stated a need for reproductive health education in schools as well as parent workshops to reduce sexual risk behaviors in adolescents.

Community Health Needs Assessment Key Informant Interview Findings

No concerns were stated by key informants around sexual behavior issues.

Teen Birth Rates

In 2008, Colorado launched the Colorado Family Planning Initiative (CFPI), which provided low or no-cost long-acting reversible contraceptives to low-income women who received services through a funded family planning center. The results of the program can be seen in the dramatic reduction of birth rates among teenagers in both Jefferson County and Colorado overall.

Between 2008-2016 (during the Colorado Family Planning Initiative) there was a 69% decrease in 15-17 year old birth rates and a 63% decrease in 18-19 year old birth rates in Jefferson County.

- Colorado Vital Statistics data

Colorado High School Student Behavior

20.6% of Colorado students who have had sex, drank alcohol or used drugs before their last sexual encounter.

- Healthy Kids Colorado Survey (2015)

Sexually Transmitted Infections

In Jefferson County, sexually transmitted infection (STI) rates are historically lower than Colorado STI rates overall.  While Chlamydia rates have remained relatively stable in Jefferson County from 2006-2016, Gonorrhea and Syphilis rates have increased. In the same time period, HIV rates have decreased overall, however in the last 5 years they have begun increasing again.

Note: In the charts below the scale for the rate of Chlamydia varies greatly from the scale of Gonorrhea. Similarly, while the scale for Syphilis and HIV are equal, they are very different from Chlamydia and Gonorrhea.

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Reference List

1. Robert Wood Johnson Foundation (2018). Sexual Activity. Retrieved from: http://www.countyhealthrankings.org/explore-health-rankings/what-and-why-we-rank/health-factors/health-behaviors/sexual-activity

2. Healthy People 2020 (2018, May 30). Sexually Transmitted Diseases. Retrieved from: https://www.healthypeople.gov/2020/topics-objectives/topic/sexually-transmitted-diseases

3. Guttmacher Institute (2016, September). Unintended pregnancy in the United States [Fact Sheet]. Retrieved from: https://www.guttmacher.org/sites/default/files/factsheet/fb-unintended-pregnancy-us_0.pdf

4. Healthy People 2020 (2018, May 30). Sexual and Reproductive Health: Life Stages & Determinants. Retrieved from: https://www.healthypeople.gov/2020/leading-health-indicators/2020-lhi-topics/Reproductive-and-Sexual-Health/determinants 

5. Centers for Disease Control (2017, February). STD Health Equity. Retrieved from: https://www.cdc.gov/std/health-disparities/default.htm

6. Hallfors, D., Iritani, B., Miller, W., Bauer, D. (2007). Sexual and drug behavior patterns and HIV and STD racial disparities: The need for new directions. American Journal of Public Health, 97(1): 125-132.

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Data Sources

PRAMS via CDPHE: Pregnancy Risk Assessment Monitoring System via Colorado Department of Public Health and Environment: https://www.colorado.gov/pacific/cdphe/vision-data-tool and http://www.chd.dphe.state.co.us/cohid/Default.aspx

National Survey of Family Growth: https://www.cdc.gov/nchs/nsfg/index.htm

Colorado Vital Records Statistics, CDPHE: http://www.chd.dphe.state.co.us/cohid/Default.aspx

HKCS: Healthy Kids Colorado Survey: https://www.colorado.gov/pacific/cdphe/hkcs

STI/HIV Surveillance Program, CDPHE: Colorado Department of Public Health and Environment: https://www.colorado.gov/pacific/cdphe/stihiv-data-and-trends

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Published on July 17, 2018