The impact of running away on teen girls' sexual health

Relationship Between Sexual Activity, Contraceptive Utilization and Biopsychosocial Characteristics Among Homeless Shelter Adolescents

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.

Safer Sex Communication and Sexual Health Behaviors Among a Representative Statewide Sample of Homeless Adolescents

Homeless adolescents are at substantial risk of human immunodeficiency virus (HIV), other sexually transmitted infections (STIs), and unplanned pregnancy; however, little research has assessed factors, such as safer sex communication, that may protect homeless adolescents against these negative outcomes. Using the 2015 North Carolina Youth Risk Behavior Survey (YRBS; unweighted N = 5,486; ages 12 to 18; 5% homeless), we compared homeless adolescents' primary safer sex communication sources (i.e., health care providers, parents, teachers, peers, religious leaders) to housed adolescents' communication sources and assessed how these sources relate to sexual health behaviors, including condom use, HIV testing, and number of sexual partners. Most homeless adolescents (61%), and 46% of housed adolescents reported having questions about sex. Further, twice as many homeless adolescents communicated primarily with health care providers compared to housed adolescents. Importantly, among homeless adolescents, communicating primarily with health care providers or teachers was related to greater likelihood of condom use and communicating primarily with religious leaders was related to greater likelihood of HIV testing. Parent communication was unrelated to homeless adolescents' sexual health behaviors. Last, communicating primarily with peers was associated with reduced likelihood of HIV testing. Having nonparental adult communication sources, including health care providers, teachers, and religious leaders, may be critical for encouraging safer sex behaviors among homeless adolescents.

Runaway Youth: Caring for the Nation's Largest Segment of Missing Children

The largest segment of missing children in the United States includes runaways, children who run away from home, and thrownaways, children who are told to leave or stay away from home by a household adult. Although estimates vary, as many as 1 in 20 youth run away from home annually. These unaccompanied youth have unique health needs, including high rates of trauma, mental illness, substance use, pregnancy, and sexually transmitted infections. While away, youth who run away are at high risk for additional trauma, victimization, and violence. Runaway and thrownaway youth have high unmet health care needs and limited access to care. Several populations are at particular high risk for runaway episodes, including victims of abuse and neglect; lesbian, gay, bisexual, transgender, and questioning youth; and youth in protective custody. Pediatricians and other health care professionals have a critical role to play in supporting runaway youth, addressing their unique health needs, fostering positive relationships within their families and with other supportive adults, and connecting them with available community resources. This report provides clinical guidance for pediatricians and other health care professionals regarding (1) the identification of adolescents who are at risk for running away or being thrown away and (2) the management of the unique medical, mental health, and social needs of these youth. In partnership with national, state, and local resources, pediatricians can significantly reduce risk and improve long-term outcomes for runaway youth.

The Links Between Sexual Abuse Severity, Running Away, and Parental Connectedness Among Youth at a Hospital-Based Child Advocacy Center

PURPOSE

Runaway adolescents often have strained relationships with their parents. Given parental support is an important protective resource for traumatized young people, understanding differences in support within parent-adolescent relationships could aid in designing more effective interventions. We hypothesized (1) runaway adolescents seen at a Child Advocacy Center (CAC) would have poorer parental relationships than adolescents without a history of running away and (2) severity of diagnosed sexual violence would be associated with lower parental connectedness.

METHODS

Data were from 2,042 adolescents aged 10-19 years and their parents evaluated for any reason at our hospital-based CAC from 2008 to 2017. Parent-adolescent relationship scales were completed by adolescents and at least one parent/guardian (usually mothers). Sexual abuse was stratified at four levels, higher levels indicating increasingly severe forms of abuse. T-tests and analyses of variance to tested relationships between supportive and controlling parental behaviors by runaway status, and, among runaways, by the severity of sexual abuse.

RESULTS

Runaway adolescents comprised 58.3% of adolescents seen at the CAC; runaways reported lower parental support and higher parental controlling than patients without a history of running away. Those with the most severe forms of sexual abuse (including sexual exploitation and gang rape) reported the least supportive and most controlling relationships with parents, as did their parents.

CONCLUSIONS

Findings support our clinical observations that polyvictimization of adolescents who have spent significant time as runaways may further strain parent-adolescent relationships. Future clinical research should focus on developing interventions to promote parental connectedness after a runaway episode.

Intimate partner violence: a guide for primary care providers

Women, men, children, and adolescents who self-disclose exposures to or at risk for exposures to intimate partner violence or domestic violence may exhibit moderate-to-severe psycho-social-emotional, mental, and physical healthcare problems. Healthcare providers have a unique opportunity to assist this population in the primary care office.