title: STD-/HIV-related sexual risk behaviors and substance use among U.S. rural adolescents.
abstract: OBJECTIVE
  The present study aims to examine the relationship between substance use and HIV/sexually transmitted disease (STD)-related sexual risk behaviors among a national sample of sexually active adolescents in rural settings.
  
  
  METHODS
  Participants included 9th-12th grade rural adolescents (N=5,745) who completed the 2003 national Youth Risk Behavior Survey. The independent variables were six substance use behaviors, including alcohol, marijuana, tobacco and cocaine use. The dependent variables were unprotected sex and the number of recent sexual partners. Univariate and multivariate logistic regression models were examined.
  
  
  RESULTS
  Smoking > or =3 days during the past 30 days was associated with unprotected sex. Alcohol or drug use before last sexual intercourse, having ever used marijuana, having ever used cocaine and drinking alcohol during the past 30 days were associated with having multiple sexual partners.
  
  
  CONCLUSIONS
  Results from the current study highlighted the need to provide youth with increased STD/HIV prevention knowledge in rural areas. Our finding confirmed that in order to achieve more effective STD/HIV prevention among high-risk substance-abusing youth, more intensive and better-tailored efforts will be needed to promote sexual risk reduction.
authors.affiliation: Department of Public and Community Health, School of Public Health, University of Maryland, College Park, MD 20742, USA. dralicey@umd.edu
authors.forename: Alice F
authors.initials: AF
authors.lastname: Yan
authors.forename: Yu-Wen
authors.initials: YW
authors.lastname: Chiu
authors.forename: Carolyn A
authors.initials: CA
authors.lastname: Stoesen
authors.forename: Min Qi
authors.initials: MQ
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006306:Health Surveys; D006801:Humans; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012309:Risk-Taking; D012424:Rural Population; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000453:epidemiology*; D019966:Substance-Related Disorders / Q000150:complications*; D014481:United States / Q000453:epidemiology