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Health Status and Service Use
Comparison of Adolescents at a School-Based Health Clinic With Homeless Adolescents
Jo Ensign, FNP, DrPH;
John Santelli, MD, MPH
Arch Pediatr Adolesc Med. 1998;152:20-24.
Objective To examine the health status, risk-taking behaviors, and access-to-care issues of shelter-based homeless adolescents compared with a domiciled adolescent population from the same large US city.
Subjects The samples consisted of 109 youth (aged 12-17 years) in emergency shelters and 1010 youth using school-based inner-city clinics.
Interventions Adolescents completed a health history, which was followed by a physical examination.
Results Homeless youth began sexual activity at an earlier age (median, 12 vs 13 years for homeless vs school-based youth), were less likely to have used birth control at their first sexual experience, and were twice as likely to have ever been pregnant. Oral and anal sex, same-sex activities (boys only), multiple sex partners in the past 30 days, depression, and substance use behaviors were reported more often by the homeless sample. The homeless youth were twice as likely to have visited an emergency department in the past 12 months. After adjustment for other risk factors, homelessness was an independent predictor of depression (adjusted odds ratio [OR], 7.0; 95% confidence interval [CI], 3.9-12.6), emergency department use in the past 12 months (adjusted OR, 1.8; 95% CI, 1.2-2.7), and history of pregnancy (adjusted OR, 2.6; 95% CI, 1.3-5.2) in the final logistic regression models.
Conclusion This study confirms and extends past research indicating that homeless youth exhibit more risk-taking behaviors and suffer from poorer overall health than do nonhomeless youth.
From the Departments of International Health (Dr Ensign) and Maternal and Child Health (Dr Santelli), The Johns Hopkins School of Hygiene and Public Health, and the Baltimore City Department of Public Health (Dr Santelli), Baltimore, Md. Dr Ensign is now with the Department of Psychosocial and Community Health, University of Washington School of Nursing, Seattle.
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