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
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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