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Journal of Pediatric Psychology Advance Access originally published online on August 24, 2005
Journal of Pediatric Psychology 2006 31(6):619-629; doi:10.1093/jpepsy/jsj067
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© The Author 2005. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oupjournals.org

"Islands of Risk": Subgroups of Adolescents at Risk for HIV

Christopher D. Houck, PhD1, Celia M. Lescano, PhD1, Larry K. Brown, MD1, Marina Tolou-Shams, PhD1, Jonathon Thompson, BA1, Ralph DiClemente, PhD2, M. Isabel Fernandez, PhD3, David Pugatch, MD1, William E. Schlenger, PhD4, Barbara J. Silver, PhD5 and Project SHIELD Study Group*

1 Rhode Island Hospital and Brown Medical School, 2 Emory University, 3 University of Miami, 4 Research Triangle Institute, and 5 Substance Abuse and Mental Health Services Administration

All correspondence concerning this article should be addressed to Christopher D. Houck, PhD, Bradley/Hasbro Children’s Research Center, One Hoppin Street, Suite 204, Providence, Rhode Island 02903. E-mail: chouck{at}lifespan.org.

Received December 2, 2004; revisions received March 28, 2005 and July 6, 2005; accepted July 22, 2005

Objective To use cluster analysis to determine profiles of adolescents at risk for HIV. Methods Adolescents 15–21 years old (N = 1153) with a history of unprotected sex were assessed in five domains of risk (unprotected sex, alcohol/marijuana use, other drug use, mental health crises, and arrest/school dropout) as well as demographic, contextual, and behavioral variables. Results Cluster analysis revealed separate three-cluster solutions for males and females. Among males, clusters were characterized by (a) mental health crises and unprotected sex, (b) alcohol/marijuana use and unprotected sex, and (c) lower risk. Among females, clusters were distinguished by (a) unprotected sex, (b) substance use and mental health crises, and (c) lower risk. Cluster membership was associated with secondary variables related to sexual risk. Conclusions Even within populations of high-risk adolescents, subgroups exist for which specific risk factors co-occur, particularly unprotected sex, mental health crises, and substance use. These patterns suggest that effective HIV prevention interventions may need to target the association between mental health and/or substance abuse with sexual risk for some adolescents.

Key words: adolescents; HIV; sexual risk.


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