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Abstract Background Female sex workers (FSWs) in Mozambique face significant health risks, including high HIV prevalence, combination of factors, including inconsistent condom use, engagement in risky sexual behaviors, and various socio-ecological determinants of health. Understanding the determinants of these practices is crucial for developing targeted interventions. Methods This cross-sectional study analyzed data from the second round of Biobehavioral Survey (BBS) conducted from 2019 to 2020 in five urban areas to examine determinants of inconsistent condom use and risky sexual behaviors among FSWs. Modified Poisson regression models were used to assess the effect of various socio-demographic, economic, and behavioral factors on the outcomes, providing adjusted relative risk (aRR) with 95% confidence intervals (CI). Results Among the 2,565 FSWs who reported inconsistent condom use, younger FSWs (15–24 years old, 29.1%), single (27.3%), with secondary or higher education (26.1%), nationals (25.9%), and residents of Tete City (30.5%) had a higher prevalence of inconsistent condom use. Initiating sex work

Abstract Background Risky sexual behaviors refer to actions or practices that increase the likelihood engaging in sexual intercourse. Such behavior can lead to HIV infection/AIDS, sexually transmitted diseases, and unintended pregnancy. The impact of risky sexual behaviors is a growing public health concern. These issues pose significant challenges to public health, particularly among university students and younger age groups who may be more vulnerable to various factors. Thus, this research aimed to examine the factors and sexual health literacy associated with risky sexual behaviors among undergraduate students in the four major regions of Thailand. Method A cross-sectional study was conducted among 916 undergraduate students in their final semester of the 2023 academic year, from March to May 2024, at public, autonomous, and private universities across four regions: northern, central, southern, and northeastern of Thailand. The study employed multistage random sampling method. A self-administered structured questionnaire was used to assess risky sexual behaviors and the data were analyzed using multiple logistic regression. Results A total of 916 students participated in the study. The prevalence of risky sexual behavior was 46.84% (95% CI:43.56% to 50.12%) students engaged in risky sexual behaviors. Risky sexual behavior was significantly associated with grade point averages (GPA) between 2.00–3.00 could protective risky sexual behaviors was 42% as compared to GPA > 3.00 (AOR = 0.58, 95%CI:0.42 to 0.79), ex-substance use (AOR = 3.48, 95%CI:1.46 to 8.26), Current smoker (AOR = 2.90, 95%CI:1.90 to 4.43), negative attitudes toward risky sexual behaviors (AOR = 2.32, 95%CI:1.32 to 4.06), access to places of ill repute and access to sexual arousal stimuli (sometime) (AOR = 2.23, 95%CI:1.41 to 3.52), social influences (high level) (AOR = 0.29, 95%CI:0.15 to 0.55), and sufficient to excellent level of the application of information about sexual health (AOR = 0.48, 95%CI:0.26 to 0.87) of statistical significance at P

Abstract Adolescents represent 16% of the global population and they are identified as a critical demographic group for promoting sexual health. Adolescents are susceptible to engaging in risky sexual behaviors (RSB) such as early sexual initiation, having multiple sexual partners, substance use during sexual encounters and practicing unsafe sex. Adolescents represent 16% of the global population and they are identified as a critical demographic group for promoting sexual health. Adolescents are susceptible to engaging in risky sexual behaviors (RSB) such as early sexual initiation, having multiple sexual partners, substance use during sexual encounters and practicing unsafe sex. To assess risky Sexual behaviors and associated factors among adolescent in Gedeo Zone, Southern Ethiopia: A community based cross-sectional study. A community based cross-sectional study was conducted in Gedeo Zone among adolescents. A total of 2780 (99.3%) adolescents were participated in the study and gave the response rate of 99.3%. A pre-tested structured questionnaire was used to gather the data and analyzed by using SPSS version 23. During analysis initially bivariable logistic regression model was used then, those variables with a level of significant at a P-value ≤ 0.25 were considered as candidate for multivariable logistic regression model. A level of significant at a P-value ≤ 0.05 was considered as statistically significant in this study. Out of 428 sexually active adolescent 334 (78%) exposed to risky sexual practice. More than half 54.3% of adolescent was protestant in religion followed by Orthodox 34.2% and Muslim 11.5%. In terms of ethnicity, Gedeo 67.4% was the dominant ethnic group in the study area. Mean age at sexual initiation was 15 ± 1.8.Residence AOR 1.14 (1.36–5.25), Sex AOR 2.77 (1.31–5.86), Age AOR 2.01 (1.41–6.39), School attending AOR 1.93 (1.27–5.75), Watching Pornographies AOR 2.51 (1.36–4.62) and Parental monitoring AOR 2.10 (1.07–4.10) were independent predictor of risky sexual practice in this study. The prevalence of risky sexual behavior was found to be alarming among adolescents aged 14–19 years, mostly rural and female adolescents and those adolescent start sexual practice earlier exposed to risky sexual practice than their counter parts. Sexual urge, watching pornography and not attending school were the major factor for risky sexual behaviors of adolescent. Parental over all control can protect risky sexual behaviors among adolescent.

Abstract Background Males have accounted for a significant share of new HIV infections among young people in the recent years. This study aimed to identify the factors associated with risky sexual behaviors, including early sexual debut, multiple sexual partnership and condomless sex, among sexually active male college students and provide implications for tailored health interventions. Methods The cross-sectional study was conducted from December 2020 to December 2021 in 16 colleges that were located in Sichuan Province, one of the high-risk areas in China. Overall 1640 male college students who reported sexually experienced were analyzed in this study. Multivariable logistic regression analysis was applied to determine factors associated with early sexual debut, multiple sexual partnership and condomless sex. Results The average age of included male students was 19.95 ± 1.56. Of them, 27.74% initiated sexual behavior early, 48.60% reported multiple sexual partnership, and 16.52% did not use condoms at the latest sexual intercourse. Students who were younger (age ≤ 19, AOR = 7.60, 95%CI: 4.84–11.93; age20-21, AOR = 3.26, 95%CI: 2.04–5.21) and self-identified as sexual minorities (AOR = 2.38, 95%CI: 1.69–3.36) were more likely to have early sexual debut. The odds of having multiple sexual partners were higher among those who were ethnic minorities (AOR = 1.79, 95%CI: 1.33–2.41) and accepted extramarital sex (AOR = 1.33, 95%CI: 1.03–1.71). The likelihood of engaging in condomless sex at the latest sexual intercourse was lower among those who had sufficient knowledgeable about HIV (AOR = 0.63, 95%CI: 0.44–0.89), were very confident in condom use efficacy (AOR = 0.26, 95%CI: 0.16–0.43) and confident (AOR = 0.48, 95%CI: 0.34–0.69). Early sexual debut was positively associated with multiple sexual partnership (AOR = 3.64, 95%CI: 2.82–4.71) and condomless sex at the latest intercourse (AOR = 1.53, 95%CI: 1.07–2.20), respectively. Conclusion Early sexual debut, multiple sexual partnership and condomless sex were of considerable concern among male college students. Comprehensive sex education curricula were advised by developing customized information on HIV prevention, sexuality and empowering students with assertiveness and negotiation skills with regard to condom use during and before college.

Abstract Background Secondary school students are vulnerable to risky sexual behaviors (RSBs) which may lead to adverse health consequences, such as teenage pregnancies and sexually transmitted diseases (STDs), including HIV/AIDS. In Tanzania, the burden of teenage pregnancy was reported to be 27% in 2016. The integration of sexual and reproductive health (SRH) education into the school curriculum is one of the proven crucial interventions. However, there is limited information on the extent to which curriculum-based SRH education is relevant for fostering good practices for coping with RSBs. This study sought to describe students’ and teachers’ perceptions of the relevance of curriculum-based SRH education. Methods A qualitative study was conducted from May to June 2020 (involving 5 secondary schools in Ilemela district, Mwanza, Tanzania). In-depth interviews (30) were conducted among secondary school students and 10 interviews for teachers. The data were collected in Swahili and then transcribed and translated into English after which thematic content analysis was performed. Results The majority (56%) of secondary school students were revealed to have a limited understanding of curriculum-based SRH education, which was limited to a few aspects of health that involved married people and pregnant women. Teachers of different subjects had different perceptions about the relevance of curriculum-based SRH education. Civics teachers had the perception that it was relevant and enough, while Biology teachers thought that it was not enough. Students reported utilizing the information taught in class to manage and navigate RSBs. Moreover, they expressed a need for additional delivery strategies to be used for a comprehensive understanding of sexual and reproductive health. Conclusion Despite the identified gaps in providing a comprehensive knowledge that builds on the appropriate attitudes and skills, the existing curriculum-based SRH education in secondary schools was utilized to help students in addressing and managing RSBs. However, there is a need for more comprehensive information and an improved delivery approach for SRH to equip students with the necessary skills when faced with RSBs.

Abstract Background Sexually transmitted infections (STIs) and food insecurity are public health concerns in the United States (US) due to their growing prevalence and incidence among young people, and particularly in college students. Studies have reported that college students are at higher risk of STIs due to the high rates of risky sexual behavior (RSB). Most studies report a food insecurity prevalence of more than 30% among college students, which was more than twice the overall national food insecurity rate of 10.5% in 2020. This study aims to assess the relationship between food insecurity and RSB among college students during the early-stages of the COVID-19 pandemic. Methods This was a cross-sectional study from a convenience sample of 320 students enrolled at the University of Nevada, Las Vegas during the 2020 Fall semester. Data was collected using an online survey. Univariate and multivariate logistic regression analyses were conducted. Results Food insecure students were 2.9 times more likely to report receiving or giving fellatio without using a condom at least once in the past 6 months (P

Introduction: Adolescent pregnancy remains a contentious issue despite improvements in quality of life and increased access to sexual education. The average age of first pregnancy has shifted due to financial instability among young people, leading to delayed pregnancies until financial stability is achieved. Teenage mothers face social stigma, and early sexual initiation not only increases the risk of pregnancy but also sexually transmitted infections (STIs). Often, adolescent pregnancies are unwanted, resulting in delayed medical consultation due to fear or ignorance. Aim of the Study: This study aims to investigate the medical and social implications of adolescent pregnancy, emphasizing the importance of early sexual education and comprehensive healthcare support. Description of the State of Knowledge: Adolescent pregnancy, defined as pregnancy between ages 10 and 19, is a global concern with millions of cases annually. It poses significant health risks, including premature birth, low birth weight, and intrauterine growth restriction. Socially, it affects educational attainment and financial stability, with adolescents from lower socioeconomic backgrounds facing greater challenges. Early sexual initiation and risky sexual behaviors further compound the issue, increasing the risk of STIs. Lack of comprehensive sexual education exacerbates these risks, highlighting the need for multidisciplinary support from healthcare professionals. Conclusions: Adolescent pregnancy requires a holistic approach encompassing medical, social, and legal dimensions. Effective sexual education programs, involving gynecologists, pediatricians, and educators, are essential for prevention. Legal frameworks must protect adolescents and address issues of consent and sexual health. Additionally, access to comprehensive healthcare services, including prenatal care and contraception, is crucial for mitigating the adverse effects of adolescent pregnancy on both individuals and society.

Abstract Background Young women in Haiti remain vulnerable to sexually transmitted infections and unintended pregnancy. However, little is known about condom use among this population. This study examined the prevalence and the factors associated with condom use among sexually active young women in Haiti. Methods Data from the 2016/17 Haiti demographic and health survey were used. The prevalence and the factors associated with condom use among sexually active young women in Haiti were assessed using descriptive statistics and binary logistic regression model. Results The prevalence of condom use was 15.4% (95% CI 14.0–16.8). Being teenage (AOR = 1.34; 95% CI: 1.04–1.74), living in urban areas (AOR = 1.41; 95% CI = 1.04–1.90), having higher education level (AOR = 2.39; 95% CI: 1.44–4.00), being in the middle or rich category of household wealth index (AOR = 2.32; 95% CI: 1.53–3.53 and AOR = 2.93; 95% CI: 1.90–4.52), having correct knowledge of ovulatory cycle (AOR = 1.65; 95% CI: 1.30–2.10), having 2–3 lifetime sexual partners and one lifetime sexual partner (AOR = 2.04; 95% CI: 1.36–3.06 and AOR = 2.07; 95% CI: 1.35–3.17) had significantly higher odds of using condom. In addition, sexually active young women whose last partner was their boyfriend (AOR = 4.38; 95% CI: 2.82–6.81), and those whose last partner was a friend/casual acquaintance/commercial sex worker (AOR = 5.29; 95% CI: 2.18–12.85) were associated with increased likelihood of using condom compared with their counterparts whose partner was their spouse. Conclusion The Haitian government as well as institutions involved in sexual health should consider these factors when designing sexual and reproductive health interventions targeting young women. More specifically, to increase condom use and reduce risky sexual behaviors, they should combine efforts to raise awareness and induce sexual behavioral changes at two levels. In the education system, they should reinforce sexual education in primary and secondary schools while paying special attention to rural areas. In the whole society, it is important to deepen efforts toward increased awareness on family planning and condom use, through mass media and local organizations including religious ones. Priority should be given to the poorer households, young people and women, and rural areas, in order to maximize reduction in early and unintended pregnancy, and sexually transmitted infections. Interventions should include a condom price subsidy and a campaign to destigmatize condom use which is actually a “male affair”.

BackgroundWorldwide, it is estimated that 38 million people are HIV-positive and that over 36 million people have died from the virus. In South Africa, the prevalence of HIV was reported to be 20.6% with Limpopo Province having 17% HIV. Given the high rate of new HIV infection in Limpopo, there is therefore a need to assess factors promoting risky sexual behavior among people living with HIV in order to help design and develop behavioral interventions aimed at reducing risky behaviors among people living with HIV.MethodsThis was a quantitative cross-sectional prospective study, conducted in Mankweng Hospital. The study consisted of 116 participants of which 40 were males and 76 were females aged 18 years and above. The participants were selected using purposive sampling. The data was analyzed using Statistical Package for Social Sciences version 27. A comparison of proportions was performed using Chi-Square. The association between risky sexual practice and sociodemographic factors was analyzed using multivariate logistic regression.ResultsThe proportion of risky sexual practices in the total population was 48.3%. Participants who were married, those aged 35–44, and those with tertiary qualifications were more likely to engage in risky sexual practices. Multivariate logistic regression showed widowed participants were less likely to practice risky sexual practices.ConclusionThe present study reported a high prevalence of risky sexual practices of 48.3%. Risky sexual behavior was determined by age, marital status, and level of education. The proportion of married participants was higher in risky sexual behavior. Based on the findings of the present study, it is recommended that targeted interventions and educational programs should be implemented to reduce risky sexual behavior among married individuals, individuals aged 35–44, and individuals with tertiary qualifications.

IntroductionAssessing the likelihood of engaging in high-risk sexual behavior can assist in delivering tailored educational interventions. The objective of this study was to identify the most effective algorithm and assess high-risk sexual behaviors within the last six months through the utilization of machine-learning models.MethodsThe survey conducted in the Longhua District CDC, Shenzhen, involved 2023 participants who were employees of 16 different factories. The data was collected through questionnaires administered between October 2019 and November 2019. We evaluated the model's overall predictive classification performance using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. All analyses were performed using the open-source Python version 3.9.12.ResultsAbout a quarter of the factory workers had engaged in risky sexual behavior in the past 6 months. Most of them were Han Chinese (84.53%), hukou in foreign provinces (85.12%), or rural areas (83.19%), with junior high school education (55.37%), personal monthly income between RMB3,000 (US$417.54) and RMB4,999 (US$695.76; 64.71%), and were workers (80.67%). The random forest model (RF) outperformed all other models in assessing risky sexual behavior in the past 6 months and provided acceptable performance (accuracy 78%; sensitivity 11%; specificity 98%; PPV 63%; ROC 84%).DiscussionMachine learning has aided in evaluating risky sexual behavior within the last six months. Our assessment models can be integrated into government or public health departments to guide sexual health promotion and follow-up services.

Abstract Background In China, men who have sex with men (MSM) face a high risk of HIV infection. Intimate partner violence (IPV) is common in this population and leads to various adverse consequences, including risky sexual behaviors, substance abuse, and poor mental health, which pose huge challenges to HIV prevention and control. Methods An anonymous cross-sectional study was conducted to investigate the lifetime prevalence of IPV and prevalence of risky sexual behaviors during the previous 6 months in a convenience sample of 578 MSM from 15 cities covering seven geographical divisions in mainland China. The associations between IPV and risky sexual behaviors and the moderating effect of self-efficacy on these associations were explored through univariate and multivariate regression analyses. Results The prevalence rates of IPV perpetration and victimization were 32.5% and 32.7%, respectively. The proportions of participants who reported inconsistent condom use with regular or casual partners and multiple regular or casual sexual partners were 25.8%, 8.3%, 22.2%, and 37.4%, respectively. Multiple IPV experiences were positively associated with risky sexual behaviors; for example, any IPV victimization was positively associated with multiple regular partners, adjusted odds ratio (ORa) = 1.54, 95% CI [1.02,2.32], and multiple casual partners, ORa = 1.93, 95% CI [1.33, 2.80]. Any IPV perpetration was positively associated with inconsistent condom use with regular partners, ORa = 1.58, 95% CI [1.04, 2.40], and multiple casual partners, ORa = 2.11, 95% CI [1.45, 3.06]. Self-efficacy was identified as a significant moderator of the association between multiple casual sexual partnership and emotional IPV. Conclusions In conclusion, given the high prevalence of both IPV and risky sexual behaviors among Chinese MSM in this study, the inclusion of self-efficacy in interventions targeting IPV and risky sexual behaviors should be considered.

Frequent involvement in risky sexual behaviors among members of society is a threat to their health. It’s also a social problem, as it increases the risk of spreading STDs and unwanted pregnancies. The aim of the study was to check the susceptibility to risky sexual behaviors in the Polish population aged 15-63. The research method was an original online questionnaire. A total of 294 responses were obtained from people of different gender, age, place of residence and level of education. The results were then statistically analyzed. 84% of respondents had undergone sexual initiation. The remaining respondents were excluded from further study. The average age of initiation was 18.2 years. 73% of respondents claim to never use condoms during oral sex. 22% of respondents use other methods instead of condoms. In the past 12 months, 21% of respondents had more than 1 sexual partner and 36% often had sex after drinking alcohol. 60% of respondents have never tested for STDs, and only 5% do it regularly when changing sexual partners. Subjects of concern are: large proportion of respondents who do not protect themselves during oral sex, a small number of respondents who regularly get tested for STDs, and a significant group of people who declare that they frequently have sex under the influence of alkohol.

The increase in sexually transmitted infections (STIs) in young people is a public health concern. Among those in university and out of school, different contextual factors contribute to their risky sexual behavior and increased susceptibility to STIs and HIV. There are limited comparative studies examining risky sexual behavior and partner notification (PN) between these two groups, particularly in South Africa. We investigated sexual behaviors, self-reported STI diagnosis, health seeking behavior, and preferred PN methods of university students and out of school youth. A descriptive cross-sectional survey was used using convenient sampling to select 917 students across five health sciences universities and through periodic sampling 699 out of school youth were selected from two main local shopping centers in South Africa. Descriptive statistics, bivariate and multivariable logistic analysis were performed using Stata IC version 14. More university students (71.7%) than out of school youth were in casual relationships (28.3%), with half of out of school youth being in steady relations (50.2%). Moreover, university students (65.7%) used a condom in the past 6 months compared to their counterparts (34.3%). Of the 124 youth who were diagnosed with STI in the past 12 months, majority (n = 106, 85%) were out of school youth. The probability of notifying a partner about a STI infection was 82% among university students compared to their counterparts (p = >0.05). The odds of notifying a partner was 1.79 times more for those having multiple sexual partners than those who had only one partner. Both groups preferred a face-to-face STI disclosure with partner; however, more university students (67%) preferred SMS notification than PN referral slips as compared to out of school youth (42%). Both the university students and the out of school youth engaged in risky sexual behaviors. Both groups preferred face-to-face and clinic SMS partner notifications, even though university students were in the majority. There is a need for developing health promotion scripts on disclosing STIs to sexual partners to empower the majority of the youth who prefer face-to-face PN over the prescribed methods.

Risky sexual behaviors are associated with a wide range of the physical and social health problems in young people. The role of emotional self-efficacy in preventing risky sexual behaviors is important. The aim of this study was to investigate the psychometric properties of the Emotional Self-Efficacy Questionnaire. In addition, this study examined the relationships between the emotional self-efficacy and risky sexual behaviors. The statistical population of the study included all male and female undergraduate students of Islamic Azad University, Bandar Abbas Branch, Iran. In total, 270 students were selected by stratified random sampling. The final analysis was performed on 260 questionnaires. The research method was descriptive and correlational. Data were collected using two questionnaires of emotional self-efficacy and risky sexual behaviors. Results indicated that the emotional self-efficacy questionnaire has good validity and reliability for implementation on the Iranian sample. The results also revealed a negative and significant relationship (-0.79) between the emotional self-efficacy and high-risk sexual behaviors (p

Adolescence and young adulthood are peak periods for risky sexual behaviors (RSB) and borderline personality disorder (BPD) features. RSB is a major public health concern and adolescents with BPD may be particularly vulnerable to RSB, but this is understudied. The aim of this study was to identify distinct RSB profiles in youth and determine whether a specific profile was associated with BPD features. Participants were 220 adolescents and young adults (age 14–21) recruited from the community. To identify groups of adolescents and young adults who engage in similar RSB, a latent profile analysis (LPA) was conducted on sexually active youth (57%). Next ANOVA was used to identify how profiles differed in terms RSB dimensions and BPD features. We identified three distinct RSB profiles: (1) a Low RSB profile that was manifested by the majority (77.7%) of youth; (2) an Unprotected Sex in Relationships profile (13.3%) and; (3) an Impulsive Sex Outside Relationships profile (12%) which was manifested by youth with significantly higher BPD features. The findings shed light on the difficulties youth with BPD manifest around integrating sexuality, intimacy, fidelity, and love. This contrasts with the majority of youth who are sexually active in the context of relationships and engage in little or no RSB. The findings have important clinical implications. Adolescent sexuality is frequently in the blind spot of clinicians. To address the elevated risk of RSB in adolescents with BPD, interventions are needed to help adolescents navigate this period and improve their understanding of the reasons for RSB while addressing difficulties in establishing sexual and attachment relationships.

Background: Youths in colleges have special and complex needs, with extremely high rates of sexual behaviors, mental health problems, and drug misuse. Despite this, the causal relations remain to be elucidated. Objective: The aim of this study was to assess the association between risky sexual behaviors (RSBs) and substance use among Jimma University students, Ethiopia, 2016. Materials and Methods: A quantitative cross-sectional study was conducted among 700 sampled students. Participants were drawn using a multistage stratified random sampling technique. Data were collected using a pretested, self-administered questionnaire. Alcohol use disorder identification test tool was used to assess alcohol use and for RSBs, and Khat uses questionnaires that were developed after an extensive review of the literature. Data were entered into Epi-data data management software and exported to SPSS version 20 for statistical analysis. Multivariable logistic regression was used for analysis and Variables at P < 0.05, and a 95% confidence level was used to declare statistical association. Results: The prevalence of RSB among students was found 30.2%. The odds of RSB were nearly three times higher among those who had probable alcohol use disorder than their counterpart (adjusted odds ratio [AOR] 2.9, 95% confidence interval [CI]: 1.4–6.1); similarly, the odds of RSB were nearly three times higher among those who had to chew Khat 2–4 times a month than never chewed counterpart (AOR 2.8, 95% CI: 1.1–7.7). Conclusion: The prevalence of RSB and substance use among Jimma University students was high and positively associated.

Abstract Background Risky sexual behaviors of adolescents in Mexico are a public health problem; 33.4 % of adolescent girls and 14.7 % of boys report not having used any protection at their first intercourse. The fertility rate is 77 births/1000 girls aged 15–19 years. The infrequent contact of adolescents with health services and the limited extent of school sex and reproductive health education require the support of innovative strategies. The objective of this paper is to present the design of an internet-based educational strategy to prevent risky sexual behaviors in Mexican adolescents. Methods A field trial with intervention and comparison group and with ex-ante and ex-post measurements will be conducted in two public secondary schools. Adolescents between 14 and 15 years of age will participate. The intervention will be conducted in one school and the second school will serve as a comparison group where the investigators will observe the usual sex education provided by the school. The intervention will be delivered using an internet web page that includes four educational sessions provided during a 4 week period. Follow-up will last 3 months. Information on the study variables will be obtained through an Internet-based self-applied questionnaire and collected on three occasions: 1) when the adolescents enter the study (baseline), 2) once the intervention is completed (at 1 month) and 3) after 3 months of follow-up (at the fourth month). There will be three outcome variables: 1) knowledge in regard to sexually transmitted infections, 2) attitudes regarding condom use, and 3) self-efficacy toward consistent condom use. The generalized linear model will be used to assess changes in each outcome variable controlling for baseline measures and for study covariates. Discussion The design and evaluation of an Internet-based educational strategy to prevent risky sexual behaviors in Mexican adolescents is important in order to provide a new, large-scale, easily implemented preventive tool. Trial registration The study was registered at the ClinicalTrials.gov ID: NCT02686736 .

Introduction: We examine the association between self-reported alcohol misuse and alcohol usewithin 2 hours of having sex and the number of sexual partners among a sample of African-Americanand Latino emergency department (ED) patients.Methods: Cross-sectional data were collected prospectively from a randomized sample of all EDpatients during a 5-week period. In face-to-face interviews, subjects were asked to report their alcoholuse and number of sexual partners in the past 12 months. Data were analyzed using multiple variablenegative binomial regression models, and effect modification was assessed through inclusion ofinteraction terms.Results: The 395 study participants reported an average of 1.4 (standard error¼0.11) sexual partnersin the past 12 months, 23% reported misusing alcohol, and 28% reported consuming alcohol beforesex. There was no statistically significant association between alcohol misuse and the number ofsexual partners; however, alcohol before sex was associated with a larger number of sexual partners inthe past year. Moreover, among those who misused alcohol, participants who reported alcohol beforesex were 3 times more likely to report a higher number of sexual partners (risk ratio¼3.2; confidenceinterval [CI]¼1.9–5.6). The association between alcohol use before sex and number of sexual partnersis dependent upon whether a person has attributes of harmful drinking over the past 12 months.Overall, alcohol use before sex increases the number of sexual partners, but the magnitude of thiseffect is significantly increased among alcohol misusers.Conclusion: Alcohol misusers and those who reported having more than 1 sexual partner were morelikely to cluster in the same group, ie, those who used alcohol before sex. Efforts to reduce the burdenof sexually transmitted diseases, including human immunodeficiency virus, and other consequences ofrisky sexual behavior in the ED population should be cognizant of the interplay of alcohol and riskysexual behaviors. EDs should strive to institute a system for regular screening, brief intervention, andreferral of at-risk patients to reduce negative consequences of alcohol misuse, including those of riskysexual behaviors.