Sexual Health Behaviors, Preferences for Care, and Use of Health Services Among Adolescents in Pediatric Emergency Departments

Objectives: The objective of this study was to describe sexual health behaviors, as well as prior use of and preferences for sexual health services among adolescents in the pediatric emergency department (ED). Methods: In this cross-sectional study, subjects aged 14 to 19 years who presented to an urban or suburban ED from a single Midwestern hospital system completed a written survey. The survey included questions on previous sexual activity, high-risk behaviors (first sex before age 15 years, no condom at last sex, substance use at last sex, >3 partners in past 3 months, and >4 lifetime partners), and sexual health service use and preferences. Comparisons of responses between subgroups were analyzed using chi(2) test. Multiple logistic regression was used to identify factors associated with high-risk behaviors. Care preferences were scored using a 4-point Likert scale; mean scores were ranked. Results: Subjects included 306 adolescents (85% of approached). The mean age was 15.5 years. Almost half (45%) reported previous sexual activity, and of those, 63% reported 1 or more high-risk behaviors (most commonly first sex before age 15 years [43%] and no condom at last sex [29%]). Almost all wanted to prevent pregnancy, but only one third received birth control counseling before sexual debut, and 14% reported no contraception at last sex. Younger age was associated with 1 or more high-risk behaviors (odds ratio, 3.7; confidence interval, 1.39-9.84). Preferences for care included caring, knowledgeable providers, and low/no cost. Conclusions: Because of high prevalence of high-risk behaviors among adolescents presenting in the ED, strategies should be developed to link these patients to comprehensive sexual health care.