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Learn more. 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.

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 outcomeseparately for adolescent males and females. In the prior year, 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. Adolescent ED patients across the United States are participating in risky sexual behaviors that increase their likelihood of pregnancy and STI acquisition.

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These adolescents report a 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. In the United States, reducing disparities in unintended teenage pregnancy and sexually transmitted infections STIs is a public policy priority. Emergency departments EDs care for over 19 million adolescents each year, the majority being ethnic and racial minorities. Very little is known about how demographics and risky behaviors link to high-risk sex among adolescents who present for care in EDs across the United States.

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Understanding how contraceptive use is associated with other risky health behaviors is important to better identify these at-risk youths in the acute care setting and de clinical interventions that address a constellation of risky adolescent behaviors. Therefore, it was the objective of this secondary analysis to assess the demographics and risky behaviors associated with the variable use of contraceptives among adolescents presenting to the ED for medical care. We performed a planned secondary analysis of data from an institutional review board—approved prospective observational cohort study deed to test the validity of a brief alcohol screen in 16 pediatric EDs within the Pediatric Emergency Care Applied Research Network PECARN.

All sites received institutional review board approval and a certificate of confidentiality was obtained. 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. 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.

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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. Participants had the option of using an audio computer-assisted self-interview. Detailed procedural methodology is described elsewhere. Individual questions about substance abuse over the past year were administered. 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. 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 of GAIN-reported conduct problems. To arrive at parsimonious models, a stepwise variable selection method was utilized with a dropout p-value threshold of 0.

The data were examined for potential outliers. Correlation between model variables was calculated and examined for collinearity.

Casual Sex Q\u0026A: The Fake Intimacy of Bodies

We looked for data points with excessive influence on the model 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. Of 7, adolescents who were screened, eligible, and approached for participation, baseline surveys were completed by 5, Of these, 4, answered the RBQ question on sex without contraceptives, with 3, between the ages of 14 to 17 years included in the analyses. Sex without contraceptives was reported one time by 5. Table 1 displays the proportion of participants having sex without contraceptives by sociodemographic and substance use characteristics.

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Overall, Table 1 also indicates that rates of sex without contraception increase steadily for both males and females from age 14 to Table 2 displays from logistic regression analysis. In the univariable regression model, all variables were ificantly associated with sex without contraceptives. In the multivariable logistic regression model, for both genders, sex without contraceptives was more likely among black vs.

Among males, sex without contraceptives was more likely among Hispanic vs. Leave-one-out cross-validation resulted in a drop in AUC from 0. This is largest study to date to examine high-risk sex patterns among an ED adolescent population. In this multicenter study, we found that almost one in five adolescent ED patients age 14 to 17 had sex without contraceptives in the past year. That increased with age, with one in four teens aged 17 years having sex without contraceptives in the past year.

This risk was similar for males and females. Although we cannot assume that the partners with which these adolescents are not using contraceptives are the casual partners, having sex without contraceptives in our study was ificantly associated for both males and females with having had casual sex over the past year. Thus, a subset of adolescent ED patients are having sex without contraceptives and casual sex, escalating their risk of teenage pregnancy and STIs. Sex without contraceptives was also associated with being black vs.

This finding strengthens single-center data. Certain risky behaviors were associated with sex without contraceptives such as binge drinking, marijuana use, and conduct problems. This is important because it suggests that adolescent ED patients who present with the latter problems should be evaluated for the former and vice versa.

For example, ED visits for depression and suicidality are rising in the United States. Given this finding, ED providers should consider, when evaluating adolescents presenting for such psychiatric complaints, further assessments for unprotected sex and the resulting need for STI and pregnancy testing as well as emergency contraception provision. Our findings are consistent with prior national surveys that highlighted high-risk sex among adolescents.

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Although our findings are difficult to compare to national survey data, given differences in the phrasing of survey questions, the prevalence of sex without contraceptives in our cohort was high. First, our primary outcome was sex without contraceptives over the past year. Other surveys ask about contraceptive use at last or first intercourse to minimize recall bias.

Second, the RBQ question does not specifically identify condoms as a contraceptive, which might have resulted in inaccurate responding.

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Also, the way the RBQ asks about last contraceptive use only s for the one-sided perspective of the surveyed participant. Particularly males may not be aware of the hormonal contraceptives used by their sexual partners, especially if these sexual partners are casual; this may have falsely increased the prevalence of sex without contraceptives among male adolescents.

In addition, we must assume that a proportion of sexual encounters involved hormonal contraceptives alone and no condoms. This increases our populations risk of STIs. Fourth, although we used validated measures, we must also appreciate the complex social contexts and decision making that influence adolescent sexual behaviors that may not have been captured by our question set. Fifth, certain issues such as partner violence, reproductive coercion, and sex trafficking, which are important to consider when considering adolescent risky sexual patterns, were not addressed in our data set.

When considering future sexual health ED-based interventions, we should consider the complicated context within which risky sexual behaviors occur and address directly with the adolescent. Finally, our models were only internally cross-validated. While the remain stable, the findings require further validation to become more definitive. This multicenter study indicates that about one in five adolescent ED patients engage in sex without contraceptives. These adolescents also report a of problem behaviors, including conduct problems and substance use, which are strongly correlated with sex without contraceptives.

A study such as this one pushes us to think about the broad context of our role as ED providers. While we recognize the ED is busy with limited resources, our current standards of care often do not address these behaviors, putting our patients at risk for a multitude of unintended consequences, such as pregnancy and sexually transmitted infections. The ED visit may be an opportunity for medical providers to screen and identify adolescents who are at risk for unintended teenage pregancy and sexually transmitted infections and intervene to improve their sexual health.

The ED may provide a unique opportunity for adolescents to ask questions about sexual health because of the relative anonymity of the ED compared to primary care. These interventions should also consider the high probability of other cooccurring risk factors in this population, such as substance use, and how they affect sexual risk behavior. The ED visit may be an opportunity to address other risky adolescent behaviors.

The ED can play a ificant role in the health outcomes of our adolescent patients, but more research is needed to understand the best practices to do so. Volume 27Issue 4. The full text of this article hosted at iucr.

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