Adolescent health behaviors in the time of COVID-19

ABSTRACT The COVID-19 pandemic and related public health policies (e.g., physical distancing, school closures, vaccine distribution) are likely impacting the short- and long-term sexual health behaviors of adolescents in the United States (US). Although essential to mitigate the effects of COVID-19 on population health, these necessary public health measures may be substantially disrupting the provision of and access to sexual health services (i.e., contraception, HIV/STI testing, pre-exposure prophylaxis [PrEP]). Further, emerging evidence underscores the drastic impact of physical distancing measures on sexual behaviors, as well as mental health and substance use. The nascent research in this area has been among adults. It is likely that these effects may be even more pronounced among adolescents given their developmental stage. Youth 13-17 years of age in the US are substantially burdened by sexually transmitted infections (STIs) and unintended pregnancies. Preliminary data suggest that the COVID-19 pandemic and related policies may be having both deleterious effects, including decreased access to STI testing, while also having potentially positive impacts, such as reduced opportunities for condomless sex acts on adolescent sexual health. The effects of COVID-19 and related policies on adolescent sexual health behaviors have yet to be systematically investigated, however. Further, COVID-19 may be amplifying existing sexual health disparities experienced by sexual and gender minority (SGM) and racial/ethnic minority youth. Given that COVID-19 is disproportionately impacting marginalized communities, it is particularly critical to understand how the pandemic is influencing the sexual health of youth facing health disparities. To investigate how the COVID-19 pandemic and related public health policies are impacting the sexual health behaviors of adolescents both in the short- and long-term, we propose to recruit via social media and survey online a longitudinal cohort of 2000 13-17-year-olds from across the US. SGM and racial/ethnic minority youth will be over-recruited. We will survey youth 12 times over the course of 3.5 years to: (1) Identify the immediate impact of COVID-19 on their sexual health behaviors (HIV/STI acquisition; unintended pregnancy; number of penile-vaginal and penile-anal sex acts, respectively; number of condom- and contraceptive-protected sex acts; HIV/STI testing; and PrEP uptake); (2) Identify longitudinal trends in sexual health behaviors as the COVID-19 pandemic and related public health policies change; and (3) Examine how trends vary by important subgroups of youth (i.e., by sex assigned at birth, gender, sexual identity, and racial/ethnic identity). The COVID-19 pandemic has drastically changed the lives of adolescents across the US in a very short amount of time. Understanding how this change relates to their sexual health behaviors will be critical to continuing to reduce health disparities among adolescents.