ArticleBMC public health2026
Opioid misuse and sexually transmitted infections among U.S. college students: a cross-sectional analysis of the ACHA-NCHA III.
Article in BMC public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundSexually transmitted infections (STIs) and opioid misuse are co-occurring concerns among U.S. young adults. We assessed the association between lifetime opioid misuse and past-year chlamydia/gonorrhea diagnosis among U.S. college students and described condom use and sexual partner number in relation to opioid misuse and STI diagnosis.
methodsWe analyzed American College Health Association-National College Health Assessment (ACHA-NCHA III) survey data from fall 2019 through fall 2022. The analytic sample included 138,757 students aged 18–24 years with data on lifetime opioid misuse and past-year clinician-diagnosed chlamydia or gonorrhea. Lifetime opioid misuse was defined as lifetime heroin use and/or nonmedical use of prescription opioid pain medications. We used multivariable Firth penalized logistic regression to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of past-year STI for opioid misuse while adjusting for race/ethnicity, gender identity, sexual orientation, attention deficit/hyperactivity disorder, depression, health insurance status, nonmedical cannabis use, and geographic region. Condom use and partner number were summarized descriptively among respondents with non-missing responses.
resultsOverall, 3.9% reported lifetime opioid misuse and 2.4% reported a past-year STI diagnosis. Lifetime opioid misuse was associated with higher odds of past-year STI (aOR 2.22, 95% confidence interval [CI] 1.97–2.51). STI prevalence was higher among students reporting more than one past-year sexual partner versus 0–1 partner (5.2% vs. 0.9%). Students reporting opioid misuse more often reported more than one partner than those without misuse (50.5% vs. 33.2%) and, among respondents with available vaginal condom/barrier data, lower “always” use during vaginal sex (14.6% vs. 29.4%).
conclusionsIn this multi-institution college sample, lifetime opioid misuse was associated with approximately twofold higher odds of recent chlamydia/gonorrhea diagnosis and co-occurred with higher-risk sexual behavior profiles. Because exposure, behaviors, and outcome were assessed over different recall windows in a cross-sectional survey, findings are associative and do not establish temporal ordering or causal pathways. Integrated campus strategies linking opioid misuse services with STI screening and sexual risk counseling may strengthen prevention. Longitudinal studies with time-aligned measurement are needed.
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