Background Scotland has one of the highest rates of early sexual activity among 15-year-old girls compared with other countries in Europe and North America, and diagnosis of STDs in Scotland has increased over the last decade. As there are known socioeconomic and geographic inequalities in adult health, the aim of this study is to describe socioeconomic and urban-rural differences in sexual behaviour of 15-year old boys and girls in Scotland in 2010.

Methods Data from the 2010 Scotland Health Behaviour in School-Aged Children survey, boosted to provide a representative sample of rural and remote areas, were modelled using multilevel logistic modelling for outcome ‘has/has not had sexual intercourse’. Individual’s family affluence, type of school (state versus private) and area level deprivation (SIMD 2012 quintiles) were included in the analyses as measures of socioeconomic status. The Scottish Household Survey Rurality indicator was also included in the analyses.

Results Prevalence of having had sex was higher among girls (33% [95% CI 30, 36]) than boys (25% [22, 28]). Similarly, prevalence among those with low family affluence (FAS) was higher than those with high FAS. However, when modelled, adjusting for school type and area-level deprivation, FAS was no longer significant. Girls living in SIMD 1 and SIMD 2 (most deprived quintiles) had higher odds of having had sex (OR 1.74 [95% CI 0.99, 3.07] and 1.87 [1.19, 2.95] respectively) relative to those living in SIMD 5. This was also true for boys, although odds were lower, approximately 1.3 in the 2 most deprived quintiles, relative to SIMD 5. School type was significantly associated with sex among girls, with higher odds in state schools (1.96 [1.01, 3.82]). When rurality was added to the models, this was not significant in the boys’ model. However, girls living in Accessible and Remote Towns (i.e. towns of between 3,000 and 10,000 residents) had higher odds of having sexual intercourse (OR 1.73 and 1.61 respectively), as did those living in Accessible Rural areas (settlements of less than 3,000 people, less than 30 minute drive time from an urban centre) (OR 1.64) relative to those living in the 4 Cities.

Conclusion Area-level deprivation and school type were stronger predictors of having had sexual intercourse than family affluence. Although rurality was not associated with boy’s sexual behaviour, girls from Accessible and Remote Towns and Accessible Rural Scotland were more likely to have had sexual intercourse.