TY - JOUR
T1 - Sex Without Contraceptives in a Multicenter Study of Adolescent Emergency Department Patients
AU - Pediatric Emergency Care Applied Research Network (PECARN)
AU - Chernick, Lauren S.
AU - Chun, Thomas H.
AU - Richards, Rachel
AU - Bromberg, Julie R.
AU - Ahmad, Fahd A.
AU - McAninch, Brett
AU - Mull, Colette
AU - Shenoi, Rohit
AU - Suffoletto, Brian
AU - Casper, Charlie
AU - Linakis, James
AU - Spirito, Anthony
N1 - Funding Information:
Sites were located in the Northeast, Middle Atlantic, West, Midwest, and Southwest regions of the United States, primarily in urban areas. All sites received institutional review board approval and a certificate of confidentiality was obtained. This study was funded by the National Institute of Alcohol Abuse and Alcoholism and the Health Resources and Services Administration. We performed a planned secondary analysis of data from an institutional review board–approved prospective observational cohort study designed to test the validity of a brief alcohol screen in 16 pediatric EDs within the Pediatric Emergency Care Applied Research Network (PECARN).
Funding Information:
We performed a planned secondary analysis of data from an institutional review board?approved prospective observational cohort study designed to test the validity of a brief alcohol screen in 16 pediatric EDs within the Pediatric Emergency Care Applied Research Network (PECARN). Sites were located in the Northeast, Middle Atlantic, West, Midwest, and Southwest regions of the United States, primarily in urban areas. All sites received institutional review board approval and a certificate of confidentiality was obtained. This study was funded by the National Institute of Alcohol Abuse and Alcoholism and the Health Resources and Services Administration. We performed a planned secondary analysis of data from an institutional review board?approved prospective observational cohort study designed to test the validity of a brief alcohol screen in 16 pediatric EDs within the Pediatric Emergency Care Applied Research Network (PECARN). Sites were located in the Northeast, Middle Atlantic, West, Midwest, and Southwest regions of the United States, primarily in urban areas. All sites received institutional review board approval and a certificate of confidentiality was obtained. This study was funded by the National Institute of Alcohol Abuse and Alcoholism and the Health Resources and Services Administration. Eligibility criteria included the following: 1) age 12 to 17?years; 2) seen in the ED for a non?life-threatening health condition; and 3) medically, cognitively, and behaviorally stable. Additional criteria excluded youth who 1) were in severe acute emotional distress (i.e., suicidal), 2) were cognitively impaired, 3) were unaccompanied by an adult or guardian, 4) were unable to read and speak English or Spanish or whose parents were unable to read and speak English or Spanish, and 5) were previously enrolled in this study or had neither a telephone nor an address of residence. For the purpose of this analysis, given the low rates of sexual activity among 12- and 13-year-old adolescents in the United States, we limited our results to participants age 14 to 17?years and to those who had a nonmissing response (n?=?3,247). Each of the 16 sites received a screening schedule based on research staff availability that included five 4-hour screening shifts per site each week. The shifts were randomly chosen with greater weight given to times when the age group of interest most frequently visits the participating EDs. However, times spanned morning to night and all days of the week. Patients were screened consecutively in the order of ED arrival to minimize selection bias. Research coordinators approached parents or guardians and explained the study in detail. Parents provided written informed consent; adolescents provided written informed assent. Adolescents then completed a criterion assessment battery self-administered on a tablet computer in English or Spanish in a private location to maintain confidentiality. This assessment battery included validated measures of substance use and risk behavior, including validated questions of alcohol use and misuse; tobacco, marijuana, and other drug use; violence; and other risky behaviors such as sex without contraceptives and/or with someone you did not know well. Participants had the option of using an audio computer-assisted self-interview. Participants received a $10 gift card for participation in the survey. Detailed procedural methodology is described elsewhere. Data for our primary outcome came from participants? answer to the Reckless Behavioral Questionnaire (RBQ) item, ?How many times in the past 12?months have you had sex without contraceptives (withdrawal and having sex at a 'safe' time on the menstrual cycle doesn't count as a contraceptive)?? The RBQ is a validated 10-item scale used to evaluate past-year risky behaviors among high school and college samples, namely, substance abuse patterns. Sex without contraceptives was reported as categories (0, 1, 2?5, 6?10, or>?10 times within the past year) and was dichotomized for the primary analysis. Individual questions about substance abuse over the past year were administered. The Diagnostic Interview Schedule for Children (DISC), adapted for a Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnosis, assessed substance use disorders. The Global Appraisal of Individual Needs (GAIN) screened for behavioral health disorders, including conduct disorder and peer aggression. The Mental Health Inventory (MHI-5) screened mood and is considered a general indicator of mental health status; a score of?<?70 is considered the cutoff for significant depressive symptoms. The lower the score, the higher the risk of depressed mood. Casual sex was defined as sex with someone the participant did not know well in the past 12?months. We used both unadjusted and mutually adjusted logistic regression models to investigate the association between adolescent characteristics and sex without contraceptives. We analyzed females and males separately because of differential contraceptive decision making based on gender. We evaluated the univariable association of sex without contraceptives by gender with each variable. Candidate variables included age; race; ethnicity; casual sex (sex with someone the participant did not know well in the past 12?months); DSM-5 alcohol use disorder; frequency of binge drinking, marijuana use, smoking, or drug use; MHI-5 score; and number of GAIN-reported conduct problems. Those variables significant at the p?<?0.2 level in the univariable analysis were considered in each of the two multivariable models. To arrive at parsimonious models, a stepwise variable selection method was utilized with a dropout p-value threshold of 0.05. The data were examined for potential outliers. Correlation between model variables was calculated and examined for collinearity. We looked for data points with excessive influence on the model results and inspected linearity of the logit. To examine model fit, we calculated c-statistics and performed the Hosmer and Lemeshow test. We also performed leave-one-out cross-validation. We used SAS, version 9.4, software for all analyses.
Publisher Copyright:
© 2019 by the Society for Academic Emergency Medicine
PY - 2020/4/1
Y1 - 2020/4/1
N2 - Objectives: In the United States, rates of teenage pregnancy and sexually transmitted infections (STIs) remain exceptionally high, and racial and ethnic disparities persist. Emergency departments (EDs) care for over 19 million adolescents each year, the majority being minority and low socioeconomic status. Single-center studies demonstrate infrequent use of contraceptives among adolescent ED patients and an association between risky sex and behaviors such as alcohol and drug use; however, no multicenter ED data exist. The objectives of this study were to 1) determine the prevalence of sex without contraceptives in a large multicenter adolescent ED study and 2) assess patient demographic and risky behaviors associated with sex without contraceptives. Methods: Participants aged 14 to 17 years (n = 3,247) in 16 pediatric EDs across the United States completed an electronic survey. Questions focused on validated measures of risky sex; use of alcohol, tobacco, marijuana, and other drugs; and depression and violence. In this secondary analysis, we constructed univariable and multivariable models to identify demographic and behavioral factors associated with sex without contraceptives (our primary outcome), separately for adolescent males and females. Results: In the prior year, 17.4% (236/1,356) of males and 15.8% (299/1,891) of females had sex without contraceptives. In the multivariable model, sex without contraceptives for both genders was more likely among teens who were black, with conduct problems and participated in casual sex, binge drinking, or cannabis use. Sex without contraceptives was also more likely among Hispanic and cigarette-smoking males, as well as depressed females. Conclusions: Adolescent ED patients across the United States are participating in risky sexual behaviors that increase their likelihood of pregnancy and STI acquisition. These adolescents report a number of problem behaviors, including substance use, which are strongly correlated with unprotected sex. The ED visit may be an opportunity to identify at-risk adolescent patients, address risky behaviors, and intervene to improve adolescent health.
AB - Objectives: In the United States, rates of teenage pregnancy and sexually transmitted infections (STIs) remain exceptionally high, and racial and ethnic disparities persist. Emergency departments (EDs) care for over 19 million adolescents each year, the majority being minority and low socioeconomic status. Single-center studies demonstrate infrequent use of contraceptives among adolescent ED patients and an association between risky sex and behaviors such as alcohol and drug use; however, no multicenter ED data exist. The objectives of this study were to 1) determine the prevalence of sex without contraceptives in a large multicenter adolescent ED study and 2) assess patient demographic and risky behaviors associated with sex without contraceptives. Methods: Participants aged 14 to 17 years (n = 3,247) in 16 pediatric EDs across the United States completed an electronic survey. Questions focused on validated measures of risky sex; use of alcohol, tobacco, marijuana, and other drugs; and depression and violence. In this secondary analysis, we constructed univariable and multivariable models to identify demographic and behavioral factors associated with sex without contraceptives (our primary outcome), separately for adolescent males and females. Results: In the prior year, 17.4% (236/1,356) of males and 15.8% (299/1,891) of females had sex without contraceptives. In the multivariable model, sex without contraceptives for both genders was more likely among teens who were black, with conduct problems and participated in casual sex, binge drinking, or cannabis use. Sex without contraceptives was also more likely among Hispanic and cigarette-smoking males, as well as depressed females. Conclusions: Adolescent ED patients across the United States are participating in risky sexual behaviors that increase their likelihood of pregnancy and STI acquisition. These adolescents report a number of problem behaviors, including substance use, which are strongly correlated with unprotected sex. The ED visit may be an opportunity to identify at-risk adolescent patients, address risky behaviors, and intervene to improve adolescent health.
UR - http://www.scopus.com/inward/record.url?scp=85075435697&partnerID=8YFLogxK
U2 - 10.1111/acem.13867
DO - 10.1111/acem.13867
M3 - Article
C2 - 31596987
AN - SCOPUS:85075435697
SN - 1069-6563
VL - 27
SP - 283
EP - 290
JO - Academic Emergency Medicine
JF - Academic Emergency Medicine
IS - 4
ER -