Sex-Related Knowledge, Attitudes, and Behaviors of U.S. Medical Students Erica Frank, MD, MPH, Steven S. Coughlin, PhD, and Lisa Elon, MS, MPH OBJECTIVE: To understand the personal and clinical safe-sex–related knowledge, attitudes, and practices of U.S. medical students. METHODS: Sixteen medical schools were selected to survey the class of 2003 based on their characteristics similar to the national average. Students were surveyed at freshman orientation, at entrance to wards, and during their senior year. The primary personal outcome was the response to the question, “Are you currently trying to practice safe sex when sexually involved? (no, not appli- cable/no, not trying/yes, low priority/yes, high priority).” The primary professional outcomes were answers to: 1) “How relevant do you think talking to patients about safe sex will be in your intended practice? (not at all/some- what/highly),” and 2) “With a typical general medicine patient, how often do you actually talk about safe sex? (never-rarely/sometimes/usually-always).” RESULTS: A total of 2,316 students provided data, and the response rate was 80%. Personally practicing safe-sex habits was a high priority for 75% of the sexually active, single medical students, especially for women, African Americans, and those earlier in their medical education. Among seniors, 41% reported extensive training in dis- cussing safe sex with patients, and 57% were highly confident about conducting such discussions. Overall, 55% of students believed it would be highly relevant to counsel patients about safe sex (59% of freshmen, 62% of those at entry to wards, and 41% of seniors); 73% answered all four true/false questions on human papillo- mavirus correctly. CONCLUSION: About half of U.S. medical students be- lieved that counseling their patients about safe sex will not be highly relevant to their practice. These findings should be considered by those trying to interest a new generation of physicians in helping patients have safe-sex practices. (Obstet Gynecol 2008;112:311–9) LEVEL OF EVIDENCE: III S exually transmitted diseases (STDs) account for a substantial burden of morbidity and mortality in the United States, including acute illness, long-term sequelae (such as acquired immunodeficiency syn- drome [AIDS], certain cancers, infertility, and other chronic conditions), and premature death. Clinical and public health measures against STDs include early detection and treatment as well as educational interventions aimed at reducing sexual risk. 1 Evi- dence-based guidelines, such as those developed by the United States Preventive Services Task Force, recommend that physicians counsel their patients about how they can reduce their risk of acquiring STDs including human immunodeficiency virus (HIV). 1 Recent guidelines on HIV also encourage primary care physicians to talk to their patients who are HIV positive about how they can help prevent secondary infections. 1 Thus, physicians are in an excellent position to help prevent STDs and to slow the spread of the HIV epidemic. 2 Despite the importance of physicians talking to patients about STDs, studies have shown that some physicians do not follow clinical practice guidelines for reducing STDs and that many practicing physi- cians and medical students do not feel comfortable assessing their patients’ risks of sexually acquired illness or talking to their patients about risk-reduction practices. 3–8 Thus, there is an ongoing need for train- From the University of British Columbia, Department of Health Care and Epidemiology, Vancouver, British Columbia, Canada; Emory University School of Medicine, Department of Family and Preventive Medicine, Atlanta, Georgia; the Centers for Disease Control and Prevention, Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Atlanta, Georgia; and Emory University Rollins School of Public Health, Department of Biosta- tistics and Bioinformatics, Atlanta, Georgia. Supported by the American Cancer Society Grant #RSG-01-073-01-PBP. The findings and conclusions in this article are those of the authors and do not necessarily represent the view of the U.S. Centers for Disease Control and Prevention. Corresponding author: Erica Frank, MD, MPH, University of British Colum- bia, Department of Health Care and Epidemiology, 5804 Fairview Avenue, Vancouver, BC, Canada V6T 1Z3; e-mail: erica.frank@ubc.ca. Financial Disclosure The authors have no potential conflicts of interest to disclose. © 2008 by The American College of Obstetricians and Gynecologists. Published by Lippincott Williams & Wilkins. ISSN: 0029-7844/08 VOL. 112, NO. 2, PART 1, AUGUST 2008 OBSTETRICS & GYNECOLOGY 311