Larry K. Brown, M.D., Professor, Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, Rhode Island - presenting on the topic of Adolescent Sexual Behavior: What Does Reserch Say and What Can Clinicians Do? -- at the Sheppard Pratt Health System Wednesday Grand Rounds Series for Mental Health Professionals (in Towson, MD). Presentation delivered on January 20, 2010. Contact info@sheppardpratt.org for more information on CME presentations at Sheppard Pratt.

1. ADOLESCENT SEXUAL RISK BEHAVIOR: WHAT DOES RESEARCH SAY AND WHAT CAN CLINICIANS DO? Larry K. Brown, M.D. Bradley/Hasbro Children’s Research Center Professor of Psychiatry, The Warren Alpert Medical School of Brown University Providence, Rhode Island Research Supported by NIMH Grants: R01 MH 63008; R01 MH 66641; U01 MH 66785; T32 MH 07878 and Lifespan/Tufts/Brown Center for AIDS Research (CFAR)

4. Rhode Island Hospital Investigators Celia Lescano, Wendy Hadley, Christopher Houck, Marina Tolou-Shams, Christie Rizzo, Nancy Beausoleil & Laura Whiteley Co-Investigators Brown University : Christy Esposito, Ronald Seifer & Caron Zlotnick Emory University: Ralph DiClemente Syracuse University , Michael Carey University of Illinois, Chicago: Geri Donenberg University of Pennsylvania : Daniel Romer HIV Prevention Team

8. AIDS Risk Groups in the 1980s H emophiliacs H omosexuals H eroin Addicts H aitians

12. HIV – Related Risk Behaviors Percent Comparative Risk Profile Mental Health Treatments (n=795) & National Sample (YRBS) HIV Risk Behaviors

13. Adolescent HIV Prevention Cluster Analysis Among At-Risk Community Youth Girls (n=645) 62 Unprotected Sex (upper half) Marijuana ( past 30 days) Cocaine (ever) Suicide Attempt (ever) Arrest (ever) 38 13 42 2 75 12 54 14 54 Houck, Lescano, Brown, et al, J. Ped. Psych , 2006 PROPORTION

15. Safe Sexual Behavior Information Motivation Behavioral Skills Sexual Behavior IMB Model-Fisher & Fisher

16. Environmental Conditions Personal Attributes HIV Risk Family Context Peer & Partner Relations Donenberg & Pao, JAACAP , 2005. Social Personal Framework HIV risk among adolescents with psychiatric disorders is increased because of difficulties in the following areas (Brown, JAACAP , 1997)

25. HIV Behavior: Differences by Sexual Abuse Brown, American Journal of Psychiatry 2000 ; 157 : 1713-5

26. HIV Risk of Adolescents in Mental Health Treatment Self-Cutting and Sexual Risk (N= 196) 35% of sample were self-cutters; 40% > 3X Brown, et al, Psych Services , 2005 *Gender, race, age entered in MLR Variable Adj OR* p Self-cutting 3.6 .04 HIV self-efficacy 3.6 .04 Sexual abuse 3.0 .05

28. Condom Use Self-Efficacy During Distress and Risk Behaviors (n=133) Affective Arousal: High Self Efficacy Low Self Efficacy Lescano, C.M. & Brown, L.K., Journal of Prevention Intervention in the Community , 2007. PROPORTION

29. Triggers Feelings You Take Charge! Feelings Take Charge!

30. TAKING CHARGE OF FEELINGS Get Out Get away or get your mind off of Triggers. Let It Out Do something to keep your feelings from getting bottled up. Think It Out Look for other ways to think about Triggers.

32. D istract yourself R emember a plan B reathe deeply and relax A pply positive thinking L eave the situation A llow the feeling to pass N ame people who care about you C onsider other options E xpress yourself positively UNSAFE SAFE

44. Family Context & Adolescent HIV Risk Parent-teen condom discussion and condom use at last sex Hadley, Brown, et al., AIDS & Behavior , 2009.

49. Six Month Outcomes (n=354) PROPORTION

53. Attempted Calls to the CDC National AIDS Hotline January 1991-January 1992 Thousands Month

63. CDISC Diagnostic Data

64. Psychopathology and Sexual Risk (N=840) Unprotected Ever had Sex Last Sex 1 STIs 1 1 Among sexually active only 2 OR adjusted for age, gender, race, alcohol use, and psychiatric hospitalization. Diagnostic Category (#of participants) % Adj OR 2 % Adj OR 2 % Adj OR 2 Mania (153) 62 1.9 39 1.7 21 5.1 Internalizing (48) 44 1.0 30 1.2 6 0.7 Externalizing (282) 53 2.3 23 1.9 12 2.1 Comorbid (252) 56 1.8 32 2.4 10 2.0 None (105) 43 1.0 12 1.0 9 1.0