Young women, particularly racial and ethnic minority women, are particularly vulnerable to sexually transmitted infections (STIs), accounting for a disproportionate percentage of all newly acquired STIs in the United States [1]. Young women evince the highest incidence of chlamydia, gonorrhea, and human papillomavirus (HPV) infection [1]; and one-quarter of all 20 to 24-year-old women acquire HPV annually [2]. Despite representing only 13% of the U. S. population, African-American women account for 62% of new HIV infections among women and have 2-to-10 times the rates of reported chlamydia, syphilis, and gonorrhea cases compared to White women [3]. Although African-American young adults have the highest rates of these STIs of any racial/ethnic and age categories, Hispanic individuals also have elevated risk compared to non-Hispanic Whites [3]. Young women are also uniquely at risk for unintended pregnancy [4] and sexual assault [5]. Consequently, sexual and reproductive health care is especially important for this age group and for particular subgroups of women.

Perhaps because of their unique sexual health vulnerability, young women often consider their gynecologist to be their primary care provider and their most trusted medical professional [6]. Among women in the U. S. aged 15–24, the majority (59%) sought reproductive health services in the past year [7]. Given women’s reliance on and trust in sexual health providers, reproductive health centers are well-positioned to offer not only family planning, STI prevention and treatment, general gynecologic care and sexual assault triage, but also to address young women’s broader health needs. This is particularly important given that integrating STI prevention services with outpatient medical and behavioral health care is an effective way to reduce sexual risk intentions and behavior compared to traditional, “siloed” care [8, 9]. This may be especially important for minority women, as Hispanic and African-American adults have low rates of mental health service utilization despite equivalent or higher rates of mental health concerns [10].

Therefore, it is important to identify the needs of young adult women presenting for care in an effort to provide comprehensive services, and also to identify any racial/ethnic differences in these needs. Two important correlates of risky sexual behavior are alcohol use and depressive symptoms. For many young women, alcohol use often co-occurs with sexual behavior; research has documented alcohol use as an important correlate of sexual initiation, unprotected sex, and risky sexual behavior [11]. More than half of women aged 18 to 44 drink alcohol, and young women aged 18 to 24 have the highest rates of “binge drinking” (≥ 4 drinks during one drinking episode) relative to other age cohorts [12]. One in five sexually active high school females reported using alcohol during their last sexual encounter [13], and heavy drinking in particular is associated with having sexual intercourse [14]. Although research suggests that White women are more likely than Hispanic and African-American women to be current drinkers [15], other research suggests that there are no racial/ethnic differences in heavy drinking among women who drink [16]. Therefore, it is important to understand how substance use and sexual risk align among a diverse group of women. Similarly, rates of depressive symptoms are increasing among young women [17]. This is important for women seeking medical care at reproductive clinics, because depressive symptoms are associated with young women’s risky sexual behavior, such as a greater number of sexual partners and substance use prior to last sexual encounter [18, 19]. Further, it is important to note that although Hispanic, Non-Hispanic White, and Non-Hispanic Black women experience similar rates of depression [20], African-American and Hispanic adults are less likely to receive any treatment for depression [21].

In summary, young women are (a) at elevated risk for STIs and unintended pregnancies, (b) often use alcohol before sex, (c) evince concerning increases in depressive symptoms, (d) rely on reproductive health centers for their healthcare needs, and (e) benefit from integrated health services. Despite these facts, screening for substance use and misuse in reproductive health care settings remains uncommon. This is unfortunate because screening for substance use as well as sexual risk behavior in reproductive health care settings affords an opportunity to improve young women’s health, in line with recommendations for screening, brief interventions, and referral for substance use treatment within ambulatory health care settings [22]. Leading gynecological providers therefore recommend such screening become an integral part of women’s health visits [23].

With the goal of improving this aspect of young women’s care, we sought to better understand young women’s needs and preferences regarding behavioral health services. Therefore, the purpose of this study was threefold; in the context of a reproductive health setting, we describe young women’s sexual behavior, mental health, and substance use, associations between alcohol and risky sex, and interest in behavioral intervention to guide future health promotion services. Moreover, given racial and ethnic disparities in health (e.g., STIs, alcohol use) and health treatment, we examine these outcomes based on race and ethnicity. Although the overarching purpose of this study was exploratory to establish the needs of young women presenting for care, we hypothesized that Hispanic and African-American women would have higher rates of STIs and be less likely to engage in alcohol misuse compared to White women, given population-level disparities.