A new study from the Bradley Hasbro Children's Research Center and Brown Medical School unveils profiles of adolescents at the greatest risk for HIV. Amongst a group of high-risk teens, researchers found that those at highest risk for the disease (those who engaged in the most unprotected sex acts) were mostly white males with mental health problems.

Prior studies have found that risky sexual behavior is often associated with mental health issues and other high-risk behaviors such as alcohol and drug use, school problems, delinquency and suicide attempts. However, this is one of the first studies to show that not all high-risk adolescents have the same types of risk behaviors, and therefore some are at higher risk for HIV than others. The authors found that there are subgroups within a high-risk population in which patterns of risks like unprotected sex, mental health crises and substance abuse exist at the same time, and also vary by gender.

"This study tells us that not all risky adolescents have the same risk behaviors and that the patterns seem to be different between boys and girls. It's also important because it suggests that programs designed for adolescents' specific risk profiles may be most useful in helping them change their behavior," says lead author, Christopher Houck, PhD, a psychologist with the Bradley Hasbro Children's Research Center.

The study appears in the July 2006 issue of the Journal of Pediatric Psychology.

Researchers identified three patterns of risk behavior among 1,153 high-risk boys and three patterns among high-risk girls ages 15-21 in Atlanta, Miami, and Providence. They found that the group of boys at highest risk for HIV (i.e., practiced the most unprotected sex) also had more mental health problems, such as psychiatric hospitalization or suicide attempts, than other study participants. By contrast, amongst the girls, two distinct profiles emerged: the cluster with the highest amount of unsafe sex reported only moderate substance abuse and low numbers of mental health issues, whereas the group of girls who reported only moderate amounts of unsafe sex acts had significantly higher levels of substance abuse and psychiatric crises.

"This may suggest that the influence of psychiatric problems, although certainly a risk factor for both males and females, may be more closely related to risky sexual decision making for males," the authors write.

Age and race were also factors in distinguishing the clusters of males, but in contrast to the authors' hypothesis, African Americans did not represent the greatest proportion of those at high sexual risk. In fact, more than half (52 percent) of the boys in the cluster reporting the most unprotected sex, and with the most mental health problems were white, and on average 20.46 years old; 27 percent were African American, and 27 percent were Latino. By contrast, the group of boys who reported only moderate numbers of unprotected sex acts, but with higher amounts of substance abuse were, on average, 20.90 years old; 43 percent were African American, 36 percent white, and 27 percent Latino. Those in the lowest-risk group were predominantly African-American (66 percent) (25 percent Latino and 14 percent White) and younger than the other two groups at 19.17 years old.

These patterns suggest that effective HIV prevention needs to target the association between mental health and substance abuse with sexual risk for some adolescents, the authors say.

There were also significant demographic differences between the groups of females. Girls in the group at highest risk for HIV (those reporting the most unprotected sex) were 38 percent African-American, 37 percent white, and 30 percent Latino. Females in the group reporting moderate numbers of unprotected sex acts, but high levels of substance use and mental health crises were less likely to identify themselves as heterosexual (57 percent identified themselves as heterosexual, 39 percent said they were bisexual, four percent were undecided) and were overwhelmingly white (72 percent). As with the boys, the girls in the lowest-risk group were 65 percent African American.

"Clinicians should be aware that adolescents with a history of mental health crises are likely to be at sexual risk and may benefit from prevention efforts. Also, our results demonstrate that separate interventions may be needed for males and females," says Houck. Unprotected sex places adolescents at great risk for contracting sexually transmitted infections (STIs). In fact, according to the Centers for Disease Control (CDC), approximately 50 percent of new HIV infections and two-thirds of new STIs each year are diagnosed among those 25 years or younger, and three million adolescents are infected yearly with STIs.

Determining factors associated with unprotected sexual intercourse among adolescents is therefore critical to the development of appropriate and successful primary HIV/STI prevention interventions, the authors conclude.

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Founded in 1931, Bradley Hospital (bradleyhospital/) was the nation's first psychiatric hospital operating exclusively for children. Today, it remains a premier medical institution devoted to the research and treatment of childhood psychiatric illnesses. Bradley Hospital, located in Providence, RI, is a teaching hospital for Brown Medical School and ranks in the top third of private hospitals receiving funding from the National Institutes of Health. Its research arm, the Bradley Hasbro Children's Research Center (BHCRC), brings together leading researchers in such topics as: autism, colic, childhood sleep patterns, HIV prevention, infant development, obesity, eating disorders, depression, obsessive-compulsive disorder (OCD) and juvenile firesetting. Bradley Hospital is a member of the Lifespan health system.

Contact: Carol L. Vieira
Lifespan