Adolescent Sexual Behavior and Emergency Department Use

Area of Science:

• Adolescent Health
• Public Health
• Emergency Medicine

Background:

• Adolescents engaging in high-risk sexual behaviors represent a vulnerable population with unique healthcare needs.
• Access to consistent primary care is crucial for preventive health services and management of health risks in adolescents.
• Emergency departments (EDs) serve as a critical access point for healthcare for many adolescents, particularly those with limited access to primary care.

Purpose of the Study:

• To investigate the association between high-risk sexual behaviors in adolescents and their access to primary care providers (PCPs).
• To determine if adolescents reporting high-risk sexual behaviors are more likely to utilize emergency departments (EDs) for acute care compared to their sexually inexperienced peers.
• To identify potential missed opportunities for screening and preventive care within the ED setting for high-risk adolescents.

Main Methods:

• Secondary analysis of survey data from adolescents presenting to a pediatric ED with non-STI related complaints.
• Assessment of sexual behavior risk, primary care provider (PCP) identification, and patterns of emergency department (ED) utilization.
• Comparison of healthcare access and utilization between sexually experienced (high-risk) and sexually inexperienced adolescent groups.

Main Results:

• Adolescents reporting high-risk sexual behaviors were significantly less likely to identify a PCP (aOR=0.5).
• These adolescents demonstrated a higher preference for ED-based care for acute issues (aOR=1.6) and a greater number of ED visits (aRR=1.2).
• Clinician-documented sexual histories (10.9%) and STI testing (2.6%) were infrequent among high-risk adolescents.

Conclusions:

• High-risk sexual behavior in adolescents is linked to reduced PCP identification and increased ED utilization.
• Emergency departments present a critical, yet often underutilized, setting for identifying and screening high-risk adolescents for STIs and other preventive health needs.
• There is a significant gap in routine sexual history taking and STI screening for asymptomatic, high-risk adolescents within the ED setting, indicating a need for improved clinical protocols.