Original Studies
Characteristics of adolescent street youth with a history of pregnancy

https://doi.org/10.1016/j.jpag.2004.06.006Get rights and content

Abstract

This study examines characteristics of adolescent street youth with histories of pregnancy and documents important factors that merit consideration when providing global sexual health care.

Study objective

To determine social and behavioral factors associated with a history of pregnancy among adolescent street youth.

Design, setting, participants

In a prospective cohort study, female adolescent street youth (14–19 years) ever pregnant (AEP) were compared with adolescents never pregnant (ANP) using data from baseline questionnaires.

Results

Among the 225 participants, 41.8% were ever pregnant. Both groups were similar with respect to age (mean 17.8 years) and other socio-economic characteristics. However, AEP were more likely to have been kicked out of home (62.8% vs. 47.3%, P = 0.022) and to have run away (78.7% vs. 64.9%, P = 0.025) and were homeless younger (mean age: 13.9 vs. 14.7 years, P = 0.011) and since a longer period (mean: 4.0 vs. 3.0 years, P = 0.001). Both groups had problematic alcohol and drug use: 31.3% had a CAGE score >2; 72.2% had a DAST score >6. Almost half (44.0%) had ever injected drugs and AEP were younger at initiation into drug injection (15.2 years vs. 16.0 years, P = 0.049). More AEP had experienced intra-familial or extra-familial sexual abuse (71.3% vs. 56.5%, P = 0.024), and had had more than one abuser (71.6% vs. 50.0%, P = 0.009). Among those abused by family members, abuse occurred at an earlier age for AEP (mean age: 7.4 vs. 8.9 years, P = 0.090) and more AEP reported severe abuse: vaginal penetration (62.2% vs. 26.7%, P = 0.004) and anal penetration (29.7% vs. 3.3%, P = 0.005).

Conclusions

Histories of severe sexual abuse and early injection drug use are extremely frequent in ever pregnant street adolescents. These factors need to be addressed when planning global health care and sexual health education.

Introduction

Thousands of youth live on the streets of urban centers in North America. In Canada, there are an estimated 45,000 to 150,000 street youth1 and in United States estimates range from 500,000 to 2 million.2, 3, 4 Many youth run away because of experiences of emotional, sexual, and physical abuse and neglect. Others leave their homes in search of adventure or self-actualization, or are forced out of home over conflicts about drug use and sexual orientation.5, 6, 7, 8 The social and economic hardships of street life can seriously jeopardize the mental and physical health of these adolescents and often predispose them to increased risk behaviors.8, 9, 10, 11 Many articles have reported on the extreme vulnerability of homeless youth.8, 9, 10, 11, 12, 13, 14 Their high rates of substance abuse, mental health problems, victimization, and risky sexual behaviors lead to many health problems while their access to both mental and physical health services is often limited and untimely.15, 16, 17 Adolescent girls living on the streets are especially vulnerable for sexual health problems such as sexually transmitted infections and pregnancy.5, 18, 19, 20, 21 In fact, studies on health issues important to street youth report that pregnancy is one of the most common youth-identified problems.16, 22

In industrialized nations, adolescent pregnancy is considered a major public health concern because of the serious social, economic, and health consequences for both teenagers and the children born to these young mothers.23, 24, 25, 26 Even though teenage pregnancy rates have fallen over the last decade in North America, pregnancies still occur in 4% of teenagers in Canada and in almost 10% in the United States.27, 28

Certain groups of adolescents are at higher risk of pregnancy, such as youth in shelters, runaways, and homeless youth.9, 20, 21 Among these groups, adolescents living on the streets have the highest risk of teen pregnancy. In the U.S., a 1992 multi-city survey among 14–17 year olds reported lifetime pregnancy rates of 48% among girls currently living on the streets (n = 85) compared with 33% among girls living in shelters (n = 169) and less than 10% among adolescents living at home (n = 379) 20. Other studies have reported lifetime rates of pregnancy on a wider age range of young women living on the street. In a survey of street youth aged 13–23 years old in Hollywood, CA, Anderson documented that 60% of the 263 young women had ever been pregnant.9 A cross-sectional study carried out in Montreal in 1999 among street youth aged 14–25 reported a 44% rate of lifetime pregnancy among the 78 female participants and among those ever pregnant, 42% had been pregnant at least twice.19

Two studies comparing pregnant homeless youth with pregnant teens living at home provide information on the characteristics of homeless pregnant teens.29, 30 Yordan reported that almost half of the homeless pregnant teens had a history of physical abuse (47%) and sexual abuse (46%), a quarter (24%) had used illicit drugs or alcohol, and 15% had exchanged sex for drugs, food or shelter.29 A clinic-based study by Pennbridge et al30 noted that 30% of homeless adolescents were depressed or had previously attempted suicide, 48% were diagnosed as having a major mental disorder or as drug abusing, and 33% reported histories of sexual and/or physical abuse.

These studies highlight the increased vulnerability of homeless pregnant adolescents and document several important psychosocial and behavioral risk factors among adolescents living on the streets. However, the reasons why some of these girls are more likely to become pregnant than their peers living in the same conditions remain unclear. The objective of this study is to determine the social and behavioral factors associated with a history of pregnancy among adolescent street youth and compare these adolescents with their never pregnant peers in order to better understand factors that may influence pregnancy rates in this vulnerable population.

Section snippets

Methods

A prospective cohort study on risk behaviors for HIV infection took place among Montreal street youth between January 1995 and September 2000. The study method has been fully detailed in a previous paper.31 Briefly the entry criteria for this cohort were: being “street-active”; being between 14 and 25 years old; English or French speaking; and being able to provide informed consent and to complete an interviewer-administered questionnaire. Youth were considered “street-active” if they had, in

Statistical methods

Analyses for this paper were based solely on the information from the entry questionnaires of female street youth between 14 and 19 years of age (inclusively). Socio-demographic and behavioral variables were compared among two groups of youth, adolescents ever pregnant (AEP) and adolescents never pregnant (ANP) based on the question “Have you ever been pregnant?” Subjects answering “not sure” to this question were not included in the analysis.

Pregnancy history prevalence rate was calculated

Results

A total of 1013 youth were recruited in the Montreal Street Youth Cohort from January 1995 to September 2000. The refusal rate of participation was estimated at approximately 12%. Almost one third of participants (32.6%, n = 330) were females and 70.3% (n = 232) of them were between 14 and 19 years of age. Seven girls reported not being sure if they had ever been pregnant and were excluded from the final analyses, which were based on the 225 remaining female teenagers.

Among the 225 selected

Discussion

The lifetime rate of pregnancy among adolescents living in the streets of Montreal is very high despite the availability of sexual health education through outreach community workers and free reproductive health care in local community clinics. The past histories of the girls who had a pregnancy is very disturbing even in comparison with their street peers. The characteristic that most differentiates the two groups of girls is certainly the experience of sexual abuse.

A greater proportion of

Limitations

Limitations of this study must be taken into consideration in the interpretation of the results. One area of concern may be the generalizability of the results to other homeless adolescents. Given the entry definition and recruitment strategy we used, we are confident that youth in our study are representative of the larger Montreal street youth population. Subjects were recruited in all major non-governmental organizations offering services to street youth. A previous study showed that over

Conclusions

In conclusion, our results show that pregnancy is a common reality among adolescent street youth in Montreal. This study has allowed us to clarify the amplitude of the problem and to describe two important characteristics that distinguish girls with a history of pregnancy from their never pregnant peers. Past history of sexual abuse, and especially severe intra-familial abuse, is significantly associated with pregnancy among street involved girls. As well, early initiation into injection drug

Acknowledgments

The authors would like to thank the street youth and street youth community organizations that collaborated in this study, the research interviewers that gathered the information, and Manon Hudson for her secretarial support. This study was supported by a grant from the Medical Research Council of Canada, Health Canada, the Fonds de recherche en santé du Québec, and the Ministère de la Santé et des Services sociaux du Québec. The study was conducted in Montreal, Quebec, Canada.

References (42)

  • D.Y. Rainey et al.

    Are adolescents who report prior sexual abuse at higher risk for pregnancy?

    Child Abuse Negl

    (1995)
  • L.S. Bensley et al.

    Self-reported childhood sexual and physical abuse and adult HIV-risk behaviors and heavy drinking

    Am J Prev Med

    (2000)
  • Canadian Paediatric Society: Bringing street youth out of the shadows. CPS News...
  • C.L. Ringwalt et al.

    The prevalence of homelessness among adolescents in the United States

    Am J Public Health

    (1998)
  • D. Finkelhor et al.

    Missing, abducted, runaway, and throw-away children in America: First Report: Numbers and Characteristics: National Incidence Studies

    (1990)
  • B.N. Cochran et al.

    Challenges faced by homeless sexual minorities: Comparison of gay, lesbian, bisexual, and transgender homeless adolescents with their heterosexual counterparts

    Am J Public Health

    (2002)
  • L. Rew et al.

    Sexual abuse, alcohol and other drug use, and suicidal behaviors in homeless adolescents

    Issues Compr Pediatr Nurs

    (2001)
  • J.M. Greene et al.

    Substance use among runaway and homeless youth in three national samples

    Am J Public Health

    (1997)
  • J.E. Anderson et al.

    Sexual risk behavior and condom use among street youth in Hollywood

    Fam Plann Perspect

    (1994)
  • É. Roy et al.

    Prevalence of HIV infection and risk behaviours among Montreal street youth

    Int J STD AIDS

    (2000)
  • J.B. Uner et al.

    Homeless youths and young adults in Los Angeles: Prevalence of mental health problems and the relationship between mental health and substance abuse disorders

    Am J Community Psychol

    (1997)
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