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Adolescents are at greater risk for acquiring human immunodeficiency virus (HIV) due to increased risk behaviors. Parental influence is known to reduce adolescent risk behaviors. We compared HIV risk behaviors reported by adolescents to parents' perception of adolescent risky behavior engagement. We also examined participants' knowledge of HIV transmission and testing preferences.Participants included English-speaking adolescents and parents presenting to a pediatric emergency department. Participants were interviewed separately in private. Modeled after existing instruments, “adolescent” and “parent” questionnaires included multiple choices items, Likert-type scales, and standard yes/no and true/false options. Data were analyzed using a κ statistic and observed agreement to measure discordance between adolescent and parent responses.Participants included 126 adolescents and 110 parents. Many adolescents reported ever having sex (61%), of which 32% reported always practicing safe sex. Comparative analysis revealed low agreement between adolescents' risk behaviors and parents' perception of risk behavior engagement by youth. Discordance concerning tobacco use was greatest (κ = 0.13), followed by drug use (κ = 0.19) and ever having sex (κ= 0.19), and alcohol use (κ= 0.22). There was also poor agreement regarding HIV transmission knowledge (ie, oral sex; κ = 0.16). Participants shared strong agreement regarding parental support for adolescent interest in HIV testing (95.5%).Parents are mostly unaware of adolescents' broad risk behaviors. Participants' knowledge of HIV transmission is limited. Adolescents and parents shared strong agreement regarding HIV testing preferences. Multidimensional HIV prevention strategies aiming to decrease adolescent risk behaviors, increase parental involvement, and improve adolescent and parental knowledge of HIV transmission are needed.