Increases in Oral and Anal Sexual Exposure among

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

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?

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

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

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

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

Changes in Oral and Anal Sexual Exposure among Heterosexual Adolescents, 2004 vs. 1994 Oral Sex Exposure OR (CI) 3. 00 (2. 63 – 3. 36) adj. OR (CI) 2. 55 (2. 30 – 2. 91) Anal Sex Exposure 2. 00 (1. 45 – 2. 77) 1. 51 (1. 05 – 2. 16) Same Sex Preference 9. 51 (5. 84 – 15. 48) * Adjusted for gender, race, and age of patient 10. 4 (6. 1 – 17. 8)

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

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” Limitations • Retrospective chart review • Not generalizable • Reporting behavior vs. engaging in behavior

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