1. Increases in Oral and Anal Sexual Exposure among Adolescents Attending STD Clinics in Baltimore Renee M Gindi, MPH, Khalil G Ghanem MD, Emily J Erbelding, MD MPH CDC STD Prevention Conference Jacksonville, Florida May 10, 2006

3. Background Surveys suggest increase in oral sex among teens and young adults –2002 National Survey of Family Growth –1995 National Survey of Adolescent Males Accurate risk assessment is essential –Appropriate clinical exam, diagnostic tests –Tailored preventive messages Do trends among adolescents attending the Baltimore STD clinics reflect changes suggested by national surveys?

4. Methods Clients age 12-25 seen at 2 public STD clinics in 1994 or 2004 were eligible for inclusion Electronic medical record review of patients –Demographic information –Sexual exposure –Sexual preference Chi-squared tests, t-tests, and multivariate logistic regression were used

5. Characteristics of the Study Population * All changes are significant at p<.0001

6. Changes in Behavior – Males (%) 0% genital oral rectal 77% 0% 15% 1% 0% genital oral rectal 66% 0% 30% 3% 1994 N=1610 2004 N=3274 7% none 0% none

7. Changes in Behavior – Females (%) 0% 2% 0% genital oral rectal 74% 0% 11% 2% 0% 1% 0% genital oral rectal 59% 0% 34% 6% 1994 N=988 2004 N=3164 11% none 0% none

8. Changes in Oral and Anal Sexual Exposure among Heterosexual Adolescents, 2004 vs. 1994 OR (CI)adjOR (CI) Oral Sex Exposure3.00 (2.63 – 3.36)2.55 (2.30 – 2.91) Anal Sex Exposure2.00 (1.45 – 2.77)1.51 (1.05 – 2.16) Same Sex Preference9.51 (5.84 – 15.48)10.4 (6.1 – 17.8) * Adjusted for gender, race, and age of patient

9. Conclusions Increasing rates of: –Oral sexual exposure –Anal sexual exposure –Same-sex behavior Changes in behavior among high-risk populations mirror trends suggested by national population-based surveys

10. Strengths Samples a high-risk population Clinical setting reduces social desirability bias Standard form has had comparable variables for ten years Assessment of STD risk behaviors rather than “ever/never” Retrospective chart review Not generalizable Reporting behavior vs. engaging in behavior Limitations

11. Thank you. Renee M Gindi, MPH rgindi@jhsph.edu