Purpose: This study aimed to provide basic data for the future development of school-based sexuality
education and school nurse placement policies by examining the sexuality education experience in
middle schools according to levels of school nurse placement and identifying factors influencing on
adolescent sexual risk behaviors.
Methods: This study examined data from the 2018 14th Korean Youth Risk Behavior Survey. The raw data
from 30,229 middle school students enrolled in 400 schools were analyzed using descriptive statistics,
Chi-square test, independent t test, and complex sample logistic regression analysis.
Results: It is found that, in Korea, school nurse placement rates varied by region from 37.9% to 114.8%,
resulting in different levels of sexuality and alcohol prevention education (p < .001). Sexuality and
alcohol prevention education lowered the likelihood of sexual risk behaviors by 0.54 and 0.87 times,
respectively. The experience of drinking alcohol increased a student's likelihood of committing sexual
risk behaviors by 4.40 and 3.57 times, respectively, whereas the experience of using a drug increased the
risk by 9.42 and 5.00 times, respectively. Personal factors (e.g., gender and academic achievement) and
socioenvironmental factors (e.g., school type and perceived economic status) were also found to influence
on the sexual risk behaviors of adolescents, although, not to the same degree as sexuality education
or health risk behaviors.
Conclusion: To protect students' sex-related health equity, more elaborate support policies are needed to
ensure adequate placement of school nurses able to provide professional sexuality and related health
education.