1. STD/HIV Risk from Adolescence to Adulthood: Longitudinal Risk Behavior Patterns and Infection Status Denise Hallfors, Bonita Iritani, Daniel Bauer, Carolyn Halpern, Martha Waller Funded by NIH-NIDA, Denise Hallfors, PI

2. National Longitudinal Study of Adolescent Health (Add Health) Nationally representative sample Survey of adolescents in Grades 7-12 (Wave I,1995) Wave II conducted about 1 year later Wave III conducted in 2002 HIV, chlamydia, gonorrhea, trichomoniasis bio- assays collected at Wave 3 10,776 youth were included in all three waves, had valid sample weights, and data on key variables

3. Purpose Examine the persistence (Wave I-II) of sex and drug behaviors among adolescents Describe the prevalence of HIV and other STDs among young adults (Wave III), by behavior pattern Trace the modal behavior pathways associated with HIV/STD infection, from young adulthood (Wave III) to adolescence (Wave II).

4. Risk Behavior Clusters (K-Means) Clustered individuals by sex and drug behavior patterns Used 12 Variables: type, frequency, risk 4 a priori clusters (Abstainers, IV Drug Users, MSM, Sex for Drugs or Money) Derived 12 clusters analytically, using K-Means Assigned each adolescent to one cluster only Compared 4- to 16-cluster solutions within and across sex, race, and age groups About 80% of variance accounted for by 16 clusters Clusters replicated at Wave II

6. MSM IV Drug Users High Marijuana & Sex Sex for Drugs or Money Heavy Dabblers Alcohol & Sex Dabblers Sex & Drugs Combined Marijuana Users Marijuana & Other Drugs Sex Dabblers Smokers Binge Drinkers Drinkers Light Substance Dabblers Abstainers Multiple Partners WAVE1WAVE1 WAVE2WAVE2. 20. 65. 62. 51. 38. 42. 30. 20. 24. 29. 26. 02. 09. 27. 10. 17 MSM IV Drug Users High Marijuana & Sex Sex for Drugs or Money Heavy Dabblers Alcohol & Sex Dabblers Sex & Drugs Combined Marijuana Users Marijuana & Other Drugs Binge Drinkers Multiple Partners Sex Dabblers Smokers Drinkers Light Substance Dabblers Abstainers Grade 7-12 Grade 8-12

7. . 19. 13. 12. 14 MSM IV Drug Users High Marijuana & Sex Sex for Drugs or Money Heavy Dabblers Alcohol & Sex Dabblers Sex & Drugs Combined Marijuana Users Marijuana & Other Drugs Sex Dabblers Smokers Binge Drinkers Drinkers Light Substance Dabblers Abstainers Multiple Partners. 14 MSM IV Drug Users High Marijuana & Sex Sex for Drugs or Money Heavy Dabblers Alcohol & Sex Dabblers Sex & Drugs Combined Marijuana Users Marijuana & Other Drugs Binge Drinkers Multiple Partners Sex Dabblers Smokers Drinkers Light Substance Dabblers Abstainers WAVE1WAVE1 WAVE2WAVE2

8. MSM IV Drug Users High Marijuana & Sex Sex for Drugs or Money Heavy Dabblers Alcohol & Sex Dabblers Sex & Drugs Combined Marijuana Users Marijuana & Other Drugs Sex Dabblers Smokers Binge Drinkers Drinkers Light Substance Dabblers Abstainers Multiple Partners. 19. 18. 23. 15. 23. 21. 36. 10. 17. 21. 22 MSM IV Drug Users High Marijuana & Sex Sex for Drugs or Money Heavy Dabblers Alcohol & Sex Dabblers Sex & Drugs Combined Marijuana Users Marijuana & Other Drugs Binge Drinkers Multiple Partners Sex Dabblers Smokers Drinkers Light Substance Dabblers Abstainers WAVE1WAVE1 WAVE2WAVE2

9. WAVE3 Marijuana Users STI/HIV Infection Sexually Active, Few Partners, Low ATOD Light Alcohol & Sex Smokers Regret AOD w/ Sex, Mod. AOD Regret AOD w/ Sex, High AOD Heavy Dabblers Multiple Partners Sex for Money High Marijuana & Sex Marijuana & Other Drugs IV Drug Users MSM. 11. 06. 09. 07. 06. 05. 17. 07. 09. 11. 13 (Ages 18-26)

10. STI/HIV Infection WAVE3WAVE3 WAVE2WAVE2 Sexually Active, Few Partners, Low ATOD (19%) Drinkers Sex for Money IV Drug Users MSM Abstainers Light Substance Dabblers Sex Dabblers Smokers Marijuana Users MSM. 11. 17. 13. 11. 19. 22. 31

11. STI/HIV Infection WAVE3WAVE3 WAVE2WAVE2 Sexually Active, Few Partners, Low ATOD Drinkers Sex for Money (2%) IV Drug Users MSM Abstainers Light Substance Dabblers Sex Dabblers Smokers Marijuana Users MSM. 11. 17. 13. 11. 22

12. STI/HIV Infection WAVE3WAVE3 WAVE2WAVE2 Sexually Active, Few Partners, Low ATOD Drinkers Sex for Money IV Drug Users (1%)MSM Abstainers Light Substance Dabblers Sex Dabblers Smokers Marijuana Users MSM. 11. 17. 13. 11. 10. 12. 25

13. STI/HIV Infection WAVE3WAVE3 WAVE2WAVE2 Sexually Active, Few Partners, Low ATOD Drinkers Sex for Money IV Drug Users MSM (1%) Abstainers Light Substance Dabblers Sex Dabblers Smokers Marijuana Users MSM. 11. 17. 13. 11. 17. 13. 21

14. Conclusions Most adolescents engage in no, or low levels, of sex and drug behaviors Adolescents who engage in risky behavior rarely persist in a set behavior pattern. Rather, they tend to move back towards more normative behavior patterns. In young adulthood, both normative and high risk groups are susceptible to HIV/STD infections.