Current Trends HIV-Related Beliefs, Knowledge, and Behaviors among High School Students

In 1987, CDC began to assist state and local departments of education in assessing human immunodeficiency virus (HIV)-related beliefs, knowledge, and behaviors among high school students in states and cities with the highest cumulative incidence of acquired immunodeficiency syndrome (AIDS) (1,2). Departments of education will use the results of these surveys to plan school HIV education programs and to monitor temporal changes in HIV-related beliefs, knowledge, and behaviors among high school students. This report presents selected baseline data from surveys conducted during the spring of 1988. A questionnaire for anonymous self-administration was developed collaboratively by representatives of 24 state and local departments of education, with technical assistance from CDC. The questionnaire contained 49 core questions: four to assess demographic characteristics of respondents, 33 to assess HIV-related beliefs and knowledge, and 12 to assess behaviors associated with HIV transmission. Each department of education that conducted the survey first completed the appropriate state or local survey review and approval process. The survey included samples of students in grades 9-12 (ages 13-18 years) in each of six cities (Chicago, Los Angeles, New Orleans, New York City, San Francisco, and Seattle) and in each of nine states (California, District of Columbia*, Kentucky, Michigan, New Jersey, New York, Ohio, Pennsylvania, and Washington). Samples from California, New York, and Washington excluded students in Los Angeles, San Francisco, New York City, and Seattle; data from these four cities were collected and analyzed separately. Each site chose which of the 49 questions to administer; nearly every site obtained information using all the questions regarding demographic characteristics and HIV-related beliefs and knowledge. Four sites (California, District of Columbia, Michigan, and San Francisco) used the 12 questions to assess the extent to which students engage in behaviors that may result in HIV infection. Sampling strategies were designed to obtain a representative sample of students and varied among sites. Most sites used a geographically stratified cluster sample, randomly selecting schools within strata, then selecting classes within each selected school. Other sites used a random sample of schools, then randomly selected students at each school. Using standardized procedures, classroom teachers or department heads administered questionnaires in required classes, e.g., health education or homeroom. Sample sizes in each site ranged from 778 to 7013 students, and the response rate of schools from each site ranged from 52% to 100% (Table 1). Because response rates of schools from some sites were less than 100%, results cannot be generalized, and comparison of the results among sites should be made with caution. Results are presented by site as unweighted crude rates. Almost all respondents believed students their age should be taught about AIDS** in school (range, 89.0% to 96.8%). Knowledge about sources for correct information about AIDS varied greatly among sites (range, 41.1% to 70.5%). The range of students who knew that AIDS is not transmitted through shaking hands was 85.5% to 95.6%; through giving blood, 27.8% to 53.3%; from mosquito or other insect bites, 28.9% to 46.8%; from using public toilets, 41.8% to 64.6%; and from having a blood test, 49.6% to 75.4% (Table 2). A range of 83.8% to 98.4% of students knew that AIDS is transmitted by sharing needles or syringes used to inject drugs; 88.3% to 98.1% knew that AIDS is transmitted through sexual intercourse. High school students from four sites reported variable rates of intravenous (IV)-drug use and sexual intercourse (Table 3): 2.8% to 6.3% reported ever injecting cocaine, heroin, or other illegal drugs; 28.6% to 76.4% reported having had sexual intercourse at least once. At each site, more male than female students and more older than younger students reported ever injecting illegal drugs or ever having had sexual intercourse. The percentage of students who reported having had three or more sex partners ranged from 15.1% to 42.6%. At each site, more male than female students (range for males, 24.2% to 67.3%; for females, 8.3% to 25.6%) and more older than younger students reported three or more sex partners (range for 13- and 14-year-olds, 7.5% to 45.5%; for 15- and 16-year-olds, 13.0% to 39.4%; and for 17- and 18-year-olds, 29.9% to 47.7%). Reported by: R Rich, Office of Instruction, Los Angeles Unified School District; J Haskin, Health Programs, San Francisco Unified School District; B Bradley, Office of Critical Health Initiatives, California State Dept of Education. BJ Biehr, Dept of Curriculum, Chicago Public Schools. J Sadler, Office of Instruction, District of Columbia Public Schools. G Fitzhugh, Curriculum and Staff Development, Kentucky Dept of Education. W Jubb, Instructional Specialists Program, Michigan Dept of Education. C Turner, Div of General Academic Education, New Jersey State Dept of Education. C Dolese, Instructional Support Svcs, Orleans Parish School Board, Louisiana. G Abelson, Office of Health and Physical Education, New York City Board of Education; A Sheffield, Bur of Health and Drug Education and Svcs, New York State Education Dept. K Stofsick, Div of Elementary and Secondary Education, Ohio Dept of Education. M Sutter, Bur of Curriculum and Instruction, Pennsylvania Dept of Education. D Danner, Basic Education Svcs, Seattle Public Schools; JA Maire, Special Svcs and Professional Programs, Washington State Education Dept. Div of Adolescent and School Health, Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: In the fall of 1987, CDC began providing fiscal and technical assistance to 15 state and 12 local departments of education that serve areas with the highest cumulative incidence of AIDS. The purpose of this assistance was to help schools implement effective HIV education programs. In the fall of 1988, this assistance was extended to departments of education in the remaining states and territories and in four other local departments of education. Some state and local departments of education are initiating a unique school-based system to assess whether important HIV-related beliefs, knowledge, and behaviors of high school students in their respective states and cities change over time. In ensuing years, department of education staff plan to improve the representativeness and response rate of samples and to begin assessing changes in other important health behaviors (e.g., drinking and driving, cigarette smoking, exercise) among high school students. Baseline data reported here suggest that HIV-related beliefs, knowledge, and behaviors among the adolescents surveyed in 15 states and cities are generally similar. Many students incorrectly thought that HIV infection may be acquired from giving blood, using public toilets, or having a blood test or from mosquito and other insect bites. Most students knew sexual intercourse and IV-drug use can result in HIV infection. Students who reported using IV drugs or having sexual intercourse, particularly with multiple partners, are at risk for HIV infection. Departments of education should implement programs to correct misperceptions about HIV transmission, to reduce behaviors resulting in HIV infection, and to assess periodically whether these misperceptions and behaviors change among high school students over time (3).

References

1. Kolbe L, Jones J, Nelson G, et al. School health education to prevent the spread of AIDS: overview of a national program. Hygie 1988;7(3):10-3. 2.Kann L, Nelson GD, Jones JT, Kolbe L. Establishing a system of complementary school-based surveys to periodically assess AIDS-related knowledge, beliefs, and behaviors among adolescents. J Sch Health 1989 (in press). 3.CDC. Guidelines for effective school health education to prevent the spread of AIDS. MMWR 1988;37(suppl S-2). *District of Columbia is categorized as a state for funding purposes. **When the questionnaire was developed in 1987, representatives of state and local departments of education believed students would not understand the term "HIV infection"; thus, the term "AIDS" was used.

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