{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T08:38:24Z","timestamp":1770712704648,"version":"3.49.0"},"reference-count":18,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,12,23]],"date-time":"2021-12-23T00:00:00Z","timestamp":1640217600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["T32 AG023480"],"award-info":[{"award-number":["T32 AG023480"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of School Health"],"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>BACKGROUND<\/jats:title><jats:p>School\u2010based human immunodeficiency virus (HIV) education can reach most adolescents, but inconsistencies exist in state\u2010level content policies. The purpose of this study was to evaluate the associations between state\u2010level high school HIV education policies and adolescent HIV risk behaviors.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>This was a cross\u2010sectional analysis of the 2019 Youth Risk Behavior Survey linked to the Guttmacher Institute Sex and HIV Education report. Logistic regression models examined the associations of state\u2010level HIV education mandates and content policies with 3 HIV risk behaviors: (1) 4 or more lifetime sexual partners; (2) substance use before last sex; (3) condomless last sex.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Across 33 states, 128,986 high school students were included. Multivariable adjusted models demonstrated no associations between mandated HIV education and risk behaviors. Covering abstinence along with other safe sex options was associated with lower odds, whereas stressing abstinence was associated with higher odds of at least 4 lifetime sexual partners and condomless last sex. Discriminatory sexual orientation content was associated with increased condomless last sex; associations for all HIV risk behaviors were stronger among sexual minority youth.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Increased HIV risk behaviors associated with state policies stressing abstinence or requiring discriminatory sexual orientation content support the need for comprehensive and inclusive HIV education.<\/jats:p><\/jats:sec>","DOI":"10.1111\/josh.13130","type":"journal-article","created":{"date-parts":[[2021,12,24]],"date-time":"2021-12-24T02:59:30Z","timestamp":1640314770000},"page":"316-324","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Associations between <scp>State\u2010Level<\/scp> High School <scp>HIV<\/scp> Education Policies and Adolescent <scp>HIV<\/scp> Risk Behaviors"],"prefix":"10.1111","volume":"92","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7190-4512","authenticated-orcid":false,"given":"Carrie T.","family":"Chan","sequence":"first","affiliation":[{"name":"Department of Epidemiology, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue  Boston MA 02115"},{"name":"Stanford Children's Health, 750 Welch Road Suite 212  Palo Alto CA 94304"},{"name":"Department of Family Health Care Nursing, University of California San Francisco, 2 Koret Way  San Francisco CA 94131."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brianne L.","family":"Olivieri\u2010Mui","sequence":"additional","affiliation":[{"name":"The Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, 1200 Centre Street  Roslindale MA 02131."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth H.","family":"Mayer","sequence":"additional","affiliation":[{"name":"The Fenway Institute, Fenway Health, 7 Haviland Street  Boston MA 02215"},{"name":"Department of Medicine, Beth Israel Deaconess Medical Center\/Harvard Medical School, 330 Brookline Avenue  Boston MA 02215"},{"name":"Department of Global Health and Population, Harvard School of Public Health, 9 Bow Street  Cambridge MA 02138."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,12,23]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"U.S. Department of Education National Center for Education Statistics.Digest of Education Statistics 2018. NCES 2020\u2010009. 2019. Available at:https:\/\/nces.ed.gov\/programs\/digest\/d18. Accessed January 24 2021."},{"key":"e_1_2_6_3_1","unstructured":"Centers for Disease Control and Prevention.HIV Surveillance Report 2018 (Preliminary); vol. 30. 2019. Available at:http:\/\/www.cdc.gov\/hiv\/library\/reports\/hiv\u2010surveillance.html. Accessed September 23 2020."},{"key":"e_1_2_6_4_1","unstructured":"Trends in the Prevalence of Sexual Behaviors and HIV Testing National YRBS: 1991\u20132019|YRBSS|Adolescent and School Health|CDC. Available at:https:\/\/www.cdc.gov\/healthyyouth\/data\/yrbs\/factsheets\/2019_sexual_trend_yrbs.htm. Accessed September 23 2020."},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.su6901a2"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/her\/cyt110"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1089\/lgbt.2017.0076"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11121-020-01153-z"},{"issue":"2","key":"e_1_2_6_9_1","first-page":"56","article-title":"Association of state\u2010mandated abstinence\u2010only sexuality education with rates of adolescent HIV infection and teenage pregnancy","volume":"169","author":"Elliot LM","year":"2017","journal-title":"J La State Med Soc"},{"key":"e_1_2_6_10_1","unstructured":"Sex and HIV Education|Guttmacher Institute.2020. Available at:https:\/\/www.guttmacher.org\/state\u2010policy\/explore\/sex\u2010and\u2010hiv\u2010education. 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