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Sexual risk-taking among at-risk alcohol and drug users presenting to emergency departmentsBackground: Alcohol use is linked to increased sexual risk-taking, including unprotected sexual contacts, and illegal drug use is associated with an increased likelihood of sexual risk-taking and at-risk alcohol use. Risky sexual behavior is co-morbid with anxiety, depression, and mood disorders. The purpose this study was to identify factors associated with sexual risk-taking among adult, at-risk alcohol or drug users presenting to emergency departments (EDs). Methods: Data were derived from self-report surveys conducted with a random sample of ED patients screening positive for at-risk alcohol or drug use. As part of an alcohol and drug assessment completed by a health education specialist, patients were asked questions about their sexual behaviors. If warranted, patients also received a brief intervention addressing their alcohol and/or drug use. A negative binomial regression was conducted to identify risk factors associated with sexual risk-taking, defined here as unprotected sexual contacts. Results: Six of nine factors included in the model were statistically significant. White race was associated with more unprotected sexual contacts relative to non-whites. Females had fewer unprotected sexual contacts relative to males. Both the frequency of drinking days and illegal drug use days in the last 30 days were associated with unprotected sexual contacts. As patient age increased, the number of unprotected sexual contacts decreased. Mental health problems, as measured by the Global Assessment of Individual Needs (GAIN) Internalizing subscale, were associated with more unprotected sexual contacts. Conclusions: Gender, race, age, frequency of drug and alcohol use, and mental health problems are risk factors associated with unprotected sexual contacts among at-risk alcohol users. In the ED, those administering brief interventions for unhealthy alcohol and drug use may consider including safe sex education and/or providing patients with preventive measures for sexually transmitted infections, particularly to those whose assessments indicate higher frequencies of alcohol and drug use or possible mental health problems.