Effect of Forced Sexual Intercourse on Associations Between Early Sexual Debut and Other Health Risk Behaviors Among US High School Students

BACKGROUND: Previous research on associations between early sexual debut and other health risk behaviors has not examined the effect of forced sexual intercourse on those associations. METHODS: We analyzed data from a nationally representative sample of 19,240 high school students in the United States, age ≥16 years, to describe the effect of forced sexual intercourse on associations between early sexual debut and other health risk behaviors using adjusted prevalence ratios (APR). RESULTS: Early sexual debut and forced sexual intercourse were simultaneously and independently associated with sexual risk-taking, violence-related behaviors, and substance use. For example, even after controlling for forced sexual intercourse and race/ethnicity, students who experienced their first sexual intercourse before age 13 years were more likely than students who initiated sexual intercourse at age ≥16 years to have had ≥4 sexual partners during their lifetime (girls, APR = 4.55; boys, APR = 5.82) and to have not used a condom at last sexual intercourse (girls, APR = 1.74; boys, APR = 1.47). CONCLUSIONS: Associations between early sexual debut and other health risk behaviors occur independently of forced sexual intercourse. School-based sexual health education programs might appropriately include strategies that encourage delay of initiation of sexual intercourse, and coordinate with violence and substance use prevention programs.