Abstract
Objective: To determine whether biopsychosocial factors are associated with sexual activity and contraceptive utilization among homeless shelter adolescents.Methods: A retrospective study of 440 adolescents at a shelter in Pennsylvania between February 2015 and September 2019 was conducted. The cohort was evaluated to determine what relationship age, gender identity, substance use, and trauma history have with sexual activity and contraceptive utilization.Results: Sexual activity was significantly related to age (mean 15.8+1.4 years in sexually active vs. 14.7+1.6 years in abstinent youth, p<0.001); remote history of self-harm behavior (relative risk ratio (RR) 1.23 [95% CI 1.03-1.46]; p=0.02), history of aggressive behavior (RR 1.21 [95% CI 1.01-1.46]; p=0.04), history of trauma (RR 1.24 [95% CI 1.04-1.48]; p=0.03), and substance use (RR 2.27 [95%CI 1.86-2.77]; p<0.001). There were 55.7% sexually active females vs. 42.50% males reporting contraception use (p=0.01). After adjustment, older age and substance use remained significantly associated with sexual activity (adjusted odds ratio (AOR) 1.58 [95% CI 1.36-1.83]; p<0.001 and AOR 5.18 [95% CI 3.28-8.18]; p<0.001, respectively).Conclusions: Females self-reported sexual activity using contraception more than males. After adjustment, older age and substance use were associated with sexual activity. By better understanding the impact these factors can have on contraceptive utilization, informed policy and practice interventions can be developed and implemented to help increase safe sex practices in spaces where homeless adolescents access healthcare.
Highlights
Every year in the United States, approximately 1.6 million youth under age 18 and nearly 3.5 million young adults between the ages of 18 and 25 experience housing insecurity [1,2]
Some reports have estimated that unsheltered adolescents are six times more likely to become infected with Human Immunodeficiency Virus (HIV) than those with access to secure housing [2]
After controlling for confounders, including age, history of suicidal thoughts, suicide attempts, and/or self-harm behaviors, aggressive or violent behavior, history of trauma, substance use, and anxiety or attentiondeficit/hyperactivity disorder (ADHD), older age and substance use remained significantly associated with sexual activity (AOR 1.58 [95% confidence intervals (CI) 1.36-1.84]; p
Summary
Every year in the United States, approximately 1.6 million youth under age 18 and nearly 3.5 million young adults between the ages of 18 and 25 experience housing insecurity [1,2]. Unsheltered adolescents face diverse disparities in health care access and outcomes which may be exacerbated by a lack of transportation, insurance, money, health literacy, and support systems [3]. Unhoused youth are at significantly higher risk for negative reproductive health outcomes, including sexually transmitted infections (STIs) and unplanned pregnancy, than their housed peers [4]. Some reports have estimated that unsheltered adolescents are six times more likely to become infected with Human Immunodeficiency Virus (HIV) than those with access to secure housing [2]. Young women facing homelessness are four to eight times more likely to become pregnant than non-homeless young women [8] Their risk of becoming pregnant is compounded by their risk of poor ante-, intra- and post-partum outcomes [9,10]. It is important to underscore that the risk of unwanted or unplanned
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