Adolescent Sexual Behavior and Emergency Department Use. Issue 7 (July 2020)

• Record Type: Journal Article
• Authors: Weisman, Julie; Chase, Alyse; Badolato, Gia M.; Teach, Stephen J.; Trent, Maria E.; Chamberlain, James M.; Goyal, Monika K.
• Is Part Of: Pediatric emergency care. Volume 36:Issue 7(2020)
• Publication Date: 2020-07
• Subjects: adolescent -- sexually transmitted infections -- health care access; Pediatric emergencies -- Periodicals; 618.92002505
• DOI: 10.1097/PEC.0000000000001456
• Languages: English
• ISSNs: 0749-5161

Abstract

Abstract : Objectives: The objective of this study was to determine whether adolescents in emergency departments (EDs) who report engaging in high-risk sexual behaviors are less likely to identify a primary care provider (PCP) and more likely to access the ED than their sexually inexperienced peers. Methods: This was a secondary analysis of adolescents presenting to a pediatric ED with non–sexually transmitted infection (STI)–related complaints who completed surveys to assess sexual behavior risk and health care access. We measured differences in self-reported PCP identification, preferential use of the ED, and number of ED visits over a 12-month period by sexual experience. Secondary outcomes included clinician documented sexual histories and STI testing. Results: Of 758 patients meeting inclusion criteria, 341 (44.9%) were sexually experienced, and of those, 129 (37.8%) reported engaging in high-risk behavior. Participants disclosing high-risk behavior were less likely to identify a PCP (adjusted odds ratio, 0.5; 95% confidence interval [CI], 0.3–0.9), more likely to prefer the ED for acute care issues (adjusted odds ratio, 1.6; 95% CI, 1.0–2.6), and had a higher rate of ED visits (adjusted relative risk, 1.2; 95% CI, 1.0–1.3) compared with sexually inexperienced peers. Among patients disclosing high-risk behavior, 10.9% had clinician-documented sexual histories and 2.6% underwent STI testing. Conclusion: Adolescents who reported engaging in high-risk sexual behaviors were less likely to identify a PCP, as well as more likely to prefer ED-based care and make more ED visits. However, ED clinicians infrequently obtained sexual histories and performed STI testing in asymptomatic youth, thereby missing opportunities to screen high-risk adolescents who may lack access to preventive care.