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Adolescent Sexual Behavior and Emergency Department Use

Weisman, Julie, MD*; Chase, Alyse, BS*; Badolato, Gia M., MPH*; Teach, Stephen J., MD, MPH*; Trent, Maria E., MD, MPH; Chamberlain, James M., MD*; Goyal, Monika K., MD, MSCE*

doi: 10.1097/PEC.0000000000001456
Original Article: PDF Only

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.

From the *Department of Pediatrics, Children's National Health System Washington, DC; and †Department of Pediatrics, Johns Hopkins University, Baltimore, MD.

This study was funded by the Children's National Health System CTSI Pilot Grant UL1TR000075 (M.K.G.) and National Institute of Health NICHD K23 HD070910 (M.K.G.).

Disclosure: The authors declare no conflict of interest.

Reprints: Monika K. Goyal, MD, MSCE, Children's National Health System 111 Michigan Ave, NW Washington, DC 20010 (e-mail:

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