It can be awkward to talk about, but sex is a part of every high schooler’s life.
In Colorado, about one of four high school students is currently having sex, and one of three have had sex at some point. Even for students who aren’t sexually active, high school is a time when they’re learning about sex, relationships and safety. Information and guidance come from a variety of (sometimes conflicting) sources — doctors, parents, teachers, friends, movies, the internet and more.
To figure out how this all translates to actual behavior, the Colorado Health Institute (CHI) turned to recently-released data from the 2015 Healthy Kids Colorado Survey (HKCS). We looked at sexual health across a range of topics including sexual activity, contraceptive use, sexually-transmitted infection (STI) prevention and sexual or relationship violence.
Some of what we found is concerning.
More than seven percent of high schoolers say they have been physically forced to have sex against their will. In a classroom of 30, that’s at least two students — a nine percent increase from the proportion that reported forced sex in 2013.
More students are initiating sex at younger ages. The percentage of high school students who reported having sex before age 13 increased to four percent in 2015 from three percent in 2013.
Despite recent legislation meant to increase sexual education standards and funding, 76 percent of students say they have been taught about HIV/AIDS in school — the lowest percentage since the survey began in 1999, and part of a consistent downward trend over those 17 years (with the exception of 2001).
More high school students are having unprotected sex. Sixty-one percent of students used a condom that last time they had sex, down from 64 percent two years ago. The number of students who don’t use any contraception at all increased from 10 percent to 12 percent.
There are a few bright spots. The number of students using the highly-effective LARC method of birth control grew considerably, from five percent to eight percent, and fewer students say they are having sex under the influence of drugs or alcohol.
And high schoolers in some parts of the state are engaging in healthier sexual behaviors. Condom use in Mesa County increased considerably, jumping to 73 percent in 2015 from 60 percent in 2013. In the mountainous counties of health statistics region 12, the proportion of students having sex without using birth control dropped by more than a third, from 11 percent in 2013 to seven percent in 2015.
But overall, Colorado struggles to move the needle on many measures of sexual health — and in some places, things are getting worse.
This report about sexual health in Colorado’s high schools is the fourth in a series by CHI delving into findings from the HKCS, which collects health information every other year from Colorado public school students. About 16,000 high school students took the 2015 survey.
Sexual Practice: Ever Had Sex
In 2015, 35 percent of high school students say they’ve had sex at least once in their life — up slightly from 33 percent in 2013.
This looks similar across most regions of the state, but in some southeastern counties (HSRs 6 and 7), rates are nearly 50 percent.
Boulder and Broomfield counties (HSR 16) has the lowest rate of sex among high schoolers at 29 percent, followed by Larimer County (HSR 2) at 31 percent.
Half of lesbian, gay, and bisexual (LGB) students say they have had sex, compared with 34 percent of their heterosexual peers. Students who are unsure of their sexual orientation are the least likely to have ever had sex (33 percent).
By the time students enter senior year, 55 percent have engaged in sex at some point.
Sexual Practice: Currently Sexually Active
In addition to more students having a history of sexual activity, more students are currently sexually active than they were two years ago. A student is considered currently sexually active if he or she has had sex in the past three months.
In 2015, 25 percent of Colorado high schoolers say they are currently sexually active, up from 23 percent in 2013.
Unsurprisingly, those areas with the highest and lowest rates of students who have ever had sex also had the highest and lowest rates of currently sexually-active students.
Sexual Practice: Age at Sexual Debut
The percentage of students who had sex for the first time before age 13 also appears to be on a slow rise, going from three percent in 2013 to four percent in 2015.
Interestingly, while students who are unsure of their sexual orientation are the least likely to report ever having had sex, those among them who have had sex are the most likely to report starting at age 12 or younger (12 percent). Nine percent of sexually-active LGB students and three percent of heterosexual students report initiating sex at this age.
There is great variability by race and ethnicity as well. Eight percent of black students and nine percent of American Indian/ laska Native students had their sexual debut before age 13, compared with two percent of white students.
Students in Denver County (HSR 30) are the most likely to report pre-teen sexual debut (six percent). The rate is three times lower in Boulder and Broomfield (HSR 16) and Larimer County (HSR 2).
Safer Sex: Contraception
First the bad news: the number of high school students who say they did not use any birth control during their last sexual encounter grew from 10 percent in 2013 to 12 percent in 2015.
The good news: among younger students, contraceptive use is increasing. Nine percent of sexually-active ninth graders say they did not use birth control in 2015, down from 14 percent in 2013.
And nearly twice as many students are using a long-acting reversible contraceptive (LARC) method. These methods (intrauterine devices and implants) are the most reliable forms of reversible contraception available — as effective at preventing pregnancy as sterilization.
Eight percent of students are now using a LARC method, compared with less than five percent two years ago. Colorado’s rate of LARC use is higher than the U.S. overall --- nationally, just three percent of sexually-active students use an IUD or implant.[i]
This consistently high use has been linked to the success of the Colorado Family Planning Initiative, which sought to improve LARC access for teens at Title X clinics. (Title X clinics are publicly-funded sites that provide comprehensive family planning services and more to low-income and underserved individuals.)
Use of LARC varies greatly across Colorado, from 16 percent in Denver County (HSR 20) to three percent in the northeast corner of the state (HSR 1). More remote counties, which have few or no Title X clinics, tend to have the lowest rates of LARC use.
Safer Sex: Condoms
The percentage of students who report using a condom during their last sexual encounter is also in decline. In 2015, 61 percent of sexually-active students used a condom, down from 64 percent in 2013 and 71 percent in 2011.
This is the reverse of a national trend of increased condom use since 1991.1
Why? It’s hard to say, but the trend does coincide with another pattern — despite 2013 legislation that intended to make sexual education more comprehensive in Colorado, every year, fewer and fewer students are reporting that they were taught about HIV/AIDS in school.
Without comprehensive education around HIV/AIDS, more students may see condoms as a tool for pregnancy prevention rather than protection from HIV or other STIs — in which case, using it in addition to another form of birth control could seem duplicative.
Safer Sex: Drugs and Alcohol
Alcohol, drugs and sex can be a dangerous combination. One of five high school students (21 percent) say they drank or used drugs before their last sexual intercourse, a slight improvement from 23 percent two years ago.
But this isn’t the same across all demographic groups. While in 2013, 28 percent of male students report the use of drugs or alcohol before sex compared with 17 percent of female students, this gender gap has narrowed. In 2015, 21 percent of male students and 19 percent of female students combined sex with drugs or alcohol.
Sex and Violence: Relationship Violence
Nine percent of students who dated someone in 2015 reported they were intentionally physically hurt by their partner at one point in the past year. This is a very slight improvement from the 10 percent that experienced dating violence in 2013.
Rates of relationship violence among high school students range from as high as 15 percent in Pueblo County (HSR 7) to a low of seven percent in the San Luis Valley (HSR 8).
More than one of 10 female students (12 percent) report having had a violent partner compared with seven percent of male students. Rates of dating violence were also much higher among students of Asian descent (18 percent) than white, black or Hispanic students (eight to nine percent).
But when it comes to relationship violence, the starkest contrast is between students of different sexual orientations. LGB students are nearly three times as likely to report they have been physically hurt on purpose by someone they were dating (20 percent) compared with seven percent of heterosexual students. Dating violence is even more common among students who are unsure of their sexual orientation (25 percent).
Sex and Violence: Forced Sex
More than seven percent of Colorado students report that they have been physically forced to have sex when they didn’t want to, up slightly from 2013.
That’s far too many students. And these rates are even higher in some parts of the state. In Pueblo County (HSR 7), which also has the highest rate of relationship violence, one of 10 of students have been raped.
Similar to dating violence, rape is a much larger problem for female students than male students. Girls are three times more likely to be forced to have sex against their will than their male peers (11 to four percent).
Lesbian, gay, and bisexual students are four times more likely to be physically forced to have sex (20 percent) than their heterosexual peers (five percent).