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While previous research has shown an association between substance use and risky sexual behavior, there is limited data on how these associations vary based on demographic modifiers such as race, sex, and sexual identity among sexually active adolescents. This study explores the association between current substance use (cigarettes, e-cigarettes, alcohol, and marijuana) and high-risk sexual behaviors (having multiple sexual partners and lack of condom use), examining how these associations vary by race, sex, and sexual identity. The 2023 Youth Risk Behavior Survey (YRBS) data was analyzed for 5420 adolescents attending U.S. public and private high schools. Multiple Logistic regression was used to examine associations, and interaction effects for race, sex, and sexual identity were introduced to the model to determine variations in associations. Overall adjusted analyses revealed current use of cigarette, e-cigarette, and alcohol was associated with higher likelihood of having multiple (2 or more) sexual partners in the past 3\u00a0months. Additionally, current marijuana use was associated with a higher likelihood of not using a condom during last sexual intercourse. A statistically significant interaction was observed only for the association between current marijuana use and condomless sex during last sexual intercourse (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.010). Stratified analyses indicated that this association varied by sexual identity and was stronger among heterosexual students compared to Lesbian, Gay, Bisexual, Queer, and other (LGBQ+) students. Results confirm the link between substance use and high-risk sexual behavior among youth, reinforcing our need for increased programming around substance use prevention and sexual health education. Heterosexual youth may be at increased risk for high-risk sexual behavior associated with their marijuana use, calling for tailored interventions that target the unique needs of this demographic subgroup.\n                  <\/jats:p>","DOI":"10.1007\/s10935-026-00898-7","type":"journal-article","created":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T08:12:39Z","timestamp":1769587959000},"page":"559-574","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Sexual Risk Behaviors and Current Substance Use Among Sexually Active Adolescents in the United States: Differences by Sex, Race, and Sexual Identity"],"prefix":"10.1007","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-9405-5852","authenticated-orcid":false,"given":"Precious Patrick","family":"Edet","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9742-4018","authenticated-orcid":false,"given":"Hannah K.","family":"Allen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8804-3755","authenticated-orcid":false,"given":"Ruaa","family":"Al Juboori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3631-5296","authenticated-orcid":false,"given":"Azad R.","family":"Bhuiyan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3951-0715","authenticated-orcid":false,"given":"Andrew","family":"Yockey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,28]]},"reference":[{"key":"898_CR1","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2023.1161034","volume":"11","author":"J Aagaard-Hansen","year":"2023","unstructured":"Aagaard-Hansen, J., Hindhede, A. 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International Journal of Environmental Research and Public Health, 21(7), Article 919.","journal-title":"International Journal of Environmental Research and Public Health"}],"container-title":["Journal of Prevention"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10935-026-00898-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10935-026-00898-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10935-026-00898-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T04:23:35Z","timestamp":1781929415000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10935-026-00898-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,28]]},"references-count":53,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["898"],"URL":"https:\/\/doi.org\/10.1007\/s10935-026-00898-7","relation":{},"ISSN":["2731-5533","2731-5541"],"issn-type":[{"value":"2731-5533","type":"print"},{"value":"2731-5541","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,28]]},"assertion":[{"value":"1 May 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 January 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 January 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The 2023 YRBS dataset is publicly available and contains no personal identifiable information. Its data collection and distribution are overseen by the CDC, ensuring compliance with applicable laws, regulations, and statutory guidelines (CDC,\n                      \n                      ,\n                      \n                      ).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical Approval"}},{"value":"The 2023 YRBS required active parental permission during the original data collection process, ensuring that only students with signed parental informed consent forms participated in the survey (CDC,\n                      \n                      ). As this study utilized publicly available, de-identified secondary data from the 2023 YRBS, additional informed consent was not required.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed Consent"}}]}}