High Risk Health Behavior 

Development of a Harm Reduction Program

This artifact is from my High-Risk Health Behavior and Harm Reduction course. In this project, I applied harm-reduction principles to address a real public health issue by designing a program to reduce unintended pregnancies and sexually transmitted infections among adolescents. I used epidemiological data, evidence-based strategies, and practical planning to develop a school-based intervention that improves access to confidential sexual health services, education, and support. This work demonstrates my abilities in program development, health communication, and the use of harm-reduction approaches with high-risk youth. (PBHL-H315, High Risk Health Behavior). 

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Harm reduction program for sexually active high school students at risk for unintended pregnancies and STIs. Avery Utterback, Sydni Zebrauskas, Griffin Carnagua, Michael Kuhn High Risk Health Behavior And Harm Reduction, PBHL-H 315, 24482 Fall, 2025.

Introduction/ Background (Griffin Carnagua)

There is an ongoing health issue of unintended pregnancies and sexually transmitted infections among high school students, where prevention and harm reduction strategies are needed. Our program will address unprotected sex among those high schoolers who are sexually active, which will include sexual contact with the proper barriers to stop pregnancies and the spread of STIs. These behaviors suggest inconsistent and incorrect use or just no use at all. This type of sexual encounter is a link to the program's target, which is to stop unintended pregnancies and STIs.

To address this health issue, we will create an approach that tries to decrease the negative impacts of social, economic, and health issues associated with sexual activity in youth. The goal is to realize that not every youth will stop sexual activity, but it can still have a positive change in lowering the risks associated with sexual activity among high school students. This program is creating a health office on campus just for sexual education, but consulting, sexual health materials, and testing will aim to lower the risks that promote safe sex and increase access to preventative care. This kind of program can help to alleviate the stigma that high school students face when accessing sexual health care.

The target population for the reduction program is sexually active high school students, normally aged around 15 to 19 years old. This age group makes up approximately 13% of the population; they make up roughly half of reported sexually transmitted infections. Many factors pose a risk to this age group. Biologically, females can contract certain infections more easily at that age due to their bodies not being fully developed. Adolescents also face obstacles when trying to access healthcare. High school students can consent even as a minor to STI care; however, patient privacy is a massive deterrent to getting care. Most of the time, physicians do not have to notify the minor’s parents. The issue is that insurance companies usually must send a statement to the primary holder, which breaches confidentiality. This is seconded by the social stigma with sexual activity largely prevents youth who are most vulnerable from seeking care. The harm reduction program must confidentially overcome these barriers to be successful.

There are many consequences associated with high-risk sexual behavior among high school students. Those consequences include health, social, and economic burdens for the individual students. Going without treatment for sexually transmitted infections can lead to long-term health conditions and complications. Some of those conditions could be irreversible, like taking the risk of catching Human Immunodeficiency Virus (HIV) or potentially cancer. There is a significant chance of contracting a virus or disease, and not even knowing about it, and being sexually active with multiple partners means spreading the disease or virus. Those who become pregnant are especially at high risk of mortality, pre-eclampsia, and other health risks. Their fetus has a higher health risk of being premature and potentially ending up in the neonatal intensive care unit.

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The socioeconomic status of an adolescent who becomes pregnant can contribute to high intergenerational poverty. Three out of ten girls drop out of high school because they have become pregnant. Not having that, education shows that there are higher unemployment rates and an increase in violence. This can create challenges not just for themselves but for their children as well.

Sexually transmitted infections like HIV and HPV can cost the healthcare system millions in medical costs, and sometimes those costs are for a person's lifetime. This does not include other expenses and costs that are non-medically related to these young adolescent high school students. Spending money on programs to prevent unintended pregnancies and the spread of sexually transmitted infections is not only better for society but also for the individuals themselves. This can help to keep costs down for the healthcare system.

There are some reasons for concern on this matter, as research has been done to show that federal programs have not been effective. They have not lowered the number of adolescents who become pregnant, and have not lowered the incidence of sexually transmitted infections. Those programs do not help adolescents prepare for real decision-making and the risks associated with having sex. Some of those programs either do not mention or stigmatize adolescents who are usually a part of the LGBTQ+ community. This can lead to an increase in negative health outcomes. We hope to use a harm reduction program to create positive change in high school students to think more carefully and be smart about their actions.

Data and Statistics (Avery Utterback)

The issue of unprotected sexual activity among adolescents is an important public health concern in the United States. Despite decades of prevention efforts, including improvements in sexual education and access to contraception, recent national data indicate that high school students continue to experience significant rates of unintended pregnancies and sexually transmitted infections (STIs).

While the 2023 Youth Risk Behavior Survey (YRBS) reported a decline in overall adolescent sexual activity since 2013, this positive trend is undermined by simultaneous findings of declines in condom use and the number of adolescents getting tested for STIs and human immunodeficiency virus (OASH, 2024). Even though teen birth rates are reaching a record low in 2021 (CDC, 2024), the persistence of unprotected sex and high rates of STIs shows that teenagers are still engaging in risky behaviors. These statistics show the ongoing need for evidence-based interventions. To address this persistent gap in safe-sex practices, the implementation of a dedicated school-based health clinic—the SafeSpace Sexual Health Initiative (SSHI)—presents a promising solution.

Despite decades of prevention efforts, a substantial risk associated with unprotected sexual activity continues among high school students, characterized by notable regional disparities in protective behaviors. The Youth Risk Behavior Surveillance System (YRBSS), which conducts a biannual survey among U.S. students in grades 9–12, offers a critical look at these trends. According to the 2019 YRBSS findings, 54% of sexually active high school students nationally reported using a condom at last sexual intercourse (YRBSS, 2020).

While this figure represents more than half of the sexually active population, the remaining percentage (46%) constitutes a large group that is still at high risk for unintended pregnancies and STIs. Furthermore, the data shows significant geographic variation, underscoring ongoing disparities in sexual health education and access to contraceptives. For example, condom use at last sex ranged from a high of 63% in New Jersey to a low of 45% in Ohio, with 6 of the 10 states with the lowest reported condom use rates located in the South (YRBSS, 2020). These lower rates observed in specific states indicate that regional and cultural barriers may continue to limit access to essential sexual health resources or comprehensive education programs, reinforcing the urgent need for targeted, localized interventions like the SSHI.

To address the persistent gap in safe-sex practices among adolescents, the implementation of a dedicated school-based health clinic—the SafeSpace Sexual Health Initiative (SSHI)—presents an evidence-based solution. Research consistently shows that School-Based Health Centers (SBHCs) offering comprehensive reproductive health services can significantly increase contraceptive use and reduce teen pregnancy rates.

According to the County Health Ranking and Roadmaps, SBHCs provide a variety of healthcare services to students, with those serving adolescents often including reproductive services such as abstinence and contraception counseling, pregnancy and STI testing, and contraceptive distribution (County Health Ranking and Roadmaps, 2024). The expected benefits of this model are substantial and multidimensional. They include increased use of contraception and reduced teen births, increased preventive care and STI testing, improved student attendance, and increased high school completion. Building on these proven benefits, the SSHI will apply these evidence-based strategies within a local school setting to directly address the ongoing risks of unintended pregnancies and STIs among adolescents. The SSHI is designed to ensure all students have access to confidential, judgment-free sexual health services without financial or social barriers.

Despite the recent decline in adolescent sexual activity and teen birth rates, public health concerns remain due to the risk of unprotected sex and the decline in safe practices like condom use and STI testing. The national and regional disparities highlighted by the YRBSS data underscore the critical need for locally tailored interventions. The SafeSpace Sexual Health 5 Initiative (SSHI), structured as an evidence-based School-Based Health Center, is strategically positioned to fill this gap. By offering available and confidential reproductive health services, the SSHI would promote informed decision-making, increase protective behaviors, and ultimately could play an important role in decreasing the risk of unintended pregnancies and STIs among high school students.

Program Description (Sydni Zebrauskas)

The SafeSpace Sexual Health Initiative (SSHI) is a school-based harm reduction program designed to reduce the number of unintended pregnancies and sexually transmitted infections (STIs) among high school students aged 15–19. Instead of promoting abstinence alone, SSHI will take a practical and compassionate approach that understands that some adolescents will engage in sexual activity and they deserve access to accurate information, confidential care, and safe practices. The program’s goal is to reduce the number of negative health, social, and economic consequences of unprotected sex through SSHI, providing education, access, and support.

Our on-campus sexual health office, SafeSpace Clinic, is dedicated to confidential sexual health services. Our clinic will be staffed by a nurse practitioner as well as a trained health educator. SafeSpace Clinic will provide several things, such as: free or low-cost STI and pregnancy preventative materials, offer STI testing and treatment referrals in a private, accessible setting, ensuring confidentiality through an opt-in consent policy to avoid any parental contact regarding STI testing and treatment, and allow walk-in consultations for any sexual health questions or guidance. According to the Centers for Disease Control and Prevention, high school students who are more informed regarding sexual health are more likely to have fewer sex partners, have fewer experiences of unprotected sex, and increase their use of protection, specifically condoms (CDC, 2024). This shows that students being educated plays a large role in positive outcomes and reduced risk.

SafeSpace Clinic will be led by our SafeSpace Ambassadors. These ambassadors will be a cohort of upperclassmen each semester who have been trained as peer mentors and will lead discussions, workshops, and awareness campaigns. All of which will include topics related to consent, contraception use, healthy relationships, and LGBTQ+ inclusivity. Our ambassadors will complete a short training in communication, HIPAA confidentiality, and sexual health information, all of which will help them to communicate better and provide better information to the students in need. They will also host interactive, judgment-free group sessions that will take place during lunch periods or advisory times. Lastly, having peer education will help normalize discussions about sexual health and reduce stigma (NIH, 2023). An article from ScienceDirect suggests that people are more likely to change attitudes and or behaviors if they believe the messenger is similar to them and faces the same concerns(ScienceDirect, 2014). With this 6 information, having Peer Ambassadors would be beneficial and help students feel more comfortable and be more open-minded to the idea of our SafeSpace Clinic.

To ensure privacy and engagement in our clinic, our program includes a digital app and website where students can have convenient access that provides confidentiality and comfort. On our digital app and website, you can do several things, such as: schedule confidential appointments at our SafeSpace Clinic, access information about birth control methods, STI prevention, and consent, submit anonymous questions answered by healthcare staff or peer ambassadors, and receive reminders for follow-up testing or convenient preventative material access. Research from National Library of Medicine suggests that, digital health interventions can reach those that may lack access to traditional healthcare services due to geographical convenience, financial costs, or cultural constraints, digital health interventions can help to address inequalities in sexual health outcomes among 15-19 year olds by providing online access that includes evidence-based sexual health information and services (NIH, 2024). Their research supports exactly what our clinic is aiming to do: help those who are misinformed, underserved, or just needing guidance.

Our program will include community outreach nights to reduce stigma. We will also host optional parent workshops to promote open communication and build trust and understanding between parents and students. While hosting these, we will continue to ensure student confidentiality while aiming to educate families about adolescent sexual health and the importance of safety and having a supportive environment. When programs increased parent-child communication, several resulted in reduced sexual risk behaviors of adolescence. Suggesting that delivering a clinic-based program that includes effective communication about reproductive health is beneficial (NIH, 2023).

SafeSpace Sexual Health Initiative (SSHI) accepts that sexual activity is a part of adolescent development, and rather than enforcing abstinence, we are focusing on minimizing harm. SSHI promotes making informed decisions, having access to resources and support that is nonjudgmental. SSHI wants to meet students where they are and give them the power to take control of their health and futures.

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Program Implementation: Michael Kuhn

The hard part about this exact subject is, in fact, the implementation of programs. Currently in the United States, the very subject has been met with either much support or a very strong opposition. There will be a number of steps taken to implement our program, including support and backing from the local children’s hospital, support from the police department, as well as local shelters, and other public health groups from the state. Getting the support from the community is what we feel is the most important step in order to see this be successful.  Following that, we will use evidence-based information based on statistics gathered from the schools within the region.

We will be taking a mobile approach to our implementation, meaning we will travel between the high schools within the 5-county district. Our initial setup will be offering open forums to the whole school, with information, statistics, and general open conversations, then for the following week, we will have the clinic set up on campus with the assistance of the school's first aid office. We believe that by offering the initial contact followed by the week of open clinic time, students will have time to make the decisions they want without feeling forced or coerced into it. With our current range we have set up, we will revisit schools every 6 weeks. This does not mean students won’t be able to have the support; we simply will not be in-house. However, via the app, they can log in and get support, and supplies will be left with the student health office at each school. So when a student comes to us, we will take their information strictly for our own record-keeping purposes. They will enter the portal on the app if they don’t have a phone, and we will offer a computer for them to sign in free of charge. So if support is needed when we are not in-house, they can use an iPad left in the health office, a phone, or a computer to have a live video visit with one of our educators or psychiatrists. Following that video visit, they can receive the needed supplies from the health office at their school. We will offer sex education tools and one-on-one counseling with students whenever they choose to come in.

Having studied other similar projects, we have found that we will likely follow a similar setup to that of PREP ( Personal Responsibility and Education Program ),2, designed and started in 2010, and TPP (Teen Pregnancy Prevention). We will also apply for federal grants to support our program. Since 2014, Congress has awarded over one hundred million dollars to evidence-based educational programs such as these and ours. We believe that using the evidence-based education approach, gathering support from local pediatricians, the public health office in each county and the schools themselves we have a solid base to back up our work. We plan to finance with the aid of grants such as those used for the PREP and TPP programs.

The biggest hurdle we expect will be that of the parents. We understand there will be parents that are against it, our hope is that by inviting them in to see our set-up, read our information, ask questions and clarify anything they might not understand we can gain their trust. In the end our mission is about safety and wise decisions with these teenagers, and we wish to work alongside the schools on the education side, but we also hope to be a good influence and a positive experience for those who are not sure what to do, where to go, or are simply in need. We view this as a great opportunity to serve this population and address the lack of these resources thereby aiding public health in a large area.

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