Abstract
BACKGROUND: The COVID-19 pandemic and associated changes in school learning model reshaped students' lives and may have impacted sexual behaviors and healthcare access. METHODS: We used a difference-in-differences (DID) approach to compare changes in sexual behaviors, human immunodeficiency virus (HIV)/sexually transmitted infection (STI) testing, and STI diagnosis rates from 2019-2021 between jurisdictions where high school was primarily virtual versus in-person for the 2020-2021 school year. We used behavioral data from local jurisdictions administering Youth Risk Behavior Survey and reported chlamydia and gonorrhea diagnosis rates for 15- to 19-year-olds in corresponding counties from AtlasPlus. Learning model was defined using the COVID-19 School Data Hub, school/governmental policies, news, or other documentation. We used survey-weighted logistic regression for behavioral outcomes and Poisson regression for diagnosis rates. The DID estimates were parameterized as the interaction between year and learning model. RESULTS: Twenty-four local jurisdictions (16 virtual, 8 in-person) were included. Compared to in-person learning, virtual learning was significantly associated with a relative increase in condom use from 2019 to 2021 (DID odds ratio [DID-OR], 1.42; 95% confidence interval [95% CI], 1.12-1.79) and relative decreases in STI testing (DID-OR, 0.75; 95% CI, 0.59-0.96), chlamydia diagnoses (DID incidence rate ratio [DID-IRR], 0.86; 95% CI, 0.84-0.88), and gonorrhea diagnoses (DID-IRR, 0.83; 95% CI, 0.79-0.87). Learning model was not significantly associated with changes in sexual intercourse ever or in past 3 months, multiple sex partners in past 3 months, alcohol/drug use before last sex, or ever HIV testing. CONCLUSIONS: Efforts are needed to maintain access to sexual health services during and after public health emergencies involving schools and increase STI testing access for students, especially those who attended school virtually.