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Objective: To determine whether biopsychosocial factors are associated with sexual activity and contraceptive utilization among homeless shelter adolescents. Methods: A retrospective study of 440 adolescents at a shelter in Pennsylvania between February 2015 and September 2019 was conducted. The cohort was evaluated to determine what relationship age, gender identity, substance use, and trauma history have with sexual activity and contraceptive utilization. Results: Sexual activity was significantly related to age (mean 15.8+1.4 years in sexually active vs. 14.7+1.6 years in abstinent youth, p<0.001); remote history of self-harm behavior (relative risk ratio (RR) 1.23 [95% CI 1.03-1.46]; p=0.02), history of aggressive behavior (RR 1.21 [95% CI 1.01-1.46]; p=0.04), history of trauma (RR 1.24 [95% CI 1.04-1.48]; p=0.03), and substance use (RR 2.27 [95%CI 1.86-2.77]; p<0.001). There were 55.7% sexually active females vs. 42.50% males reporting contraception use (p=0.01). After adjustment, older age and substance use remained significantly associated with sexual activity (adjusted odds ratio (AOR) 1.58 [95% CI 1.36-1.83]; p<0.001 and AOR 5.18 [95% CI 3.28-8.18]; p<0.001, respectively). Conclusions: Females self-reported sexual activity using contraception more than males. After adjustment, older age and substance use were associated with sexual activity. By better understanding the impact these factors can have on contraceptive utilization, informed policy and practice interventions can be developed and implemented to help increase safe sex practices in spaces where homeless adolescents access healthcare.
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Introduction Homeless youth are a vulnerable population. A volunteer clinic supported by medical students in northeastern Pennsylvania provides shelter and healthcare to adolescents seeking refuge. We set out to determine the immunization status of youth in the shelter and evaluate for associations of immunization deficiency with demographics or biopsychosocial factors. Methods After IRB approval, a retrospective cohort study was performed from existing clinical records at the shelter 2/2015-9/2019. Chart abstraction included variables such as demographics (including age, sex, and race/ethnicity), biopsychosocial factors (including childhood trauma/abuse history, substance abuse history, and sexual activity), and immunization history. Results A total of 440 charts were analyzed. When comparing demographics of patients that had complete vaccine regimens versus those who did not, the race was statistically significant (p=.006). The most prominent difference in race was seen for Black/African American patients; only 19.57% had a completed vaccine regimen documented. Regarding immunization history, vaccine schedules of hepatitis B, measles mumps rubella (MMR), inactivated polio vaccine (IPV), and varicella were most likely to be complete; pneumococcal conjugate vaccine (PCV) 13, rotavirus, influenza, and human papillomavirus vaccine (HPV) were least likely. There was no association found between a completed vaccine regimen and biopsychosocial variables. A larger portion of females (37.35%) completed the HPV vaccine compared to males (23.14%) (p=.009). Conclusions In this single-site study, this vulnerable, at-risk population of sheltered adolescents lacked the vaccinations recommended by the Centers for Disease Control and Prevention. Racial disparities further compounded this vulnerability for Black/African American teens. Additionally, a significantly greater number of female patients received the HPV vaccine compared to males.
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Introduction There are more than 6,000 international medical mission trips that are conducted annually by United States medical teams. Successfully planning a medical mission trip relies on careful preparation. The objective of this study is to elucidate common chief concerns, diagnoses, and prescription patterns so that medical mission trip teams can effectively prepare for future medical mission trips in Jarabacoa, Dominican Republic, or similar international sites. Methods A retrospective chart review of 940 patient charts was conducted from two University of South Florida Latino Medical Student Association medical mission trips to Jarabacoa, Dominican Republic (DR) that took place during October 2017 and 2018. A coding system was utilized to categorize the data. The most common chief concerns, diagnoses, and medications prescribed were revealed. Findings were stratified further by age (<18 vs ≥18 years old) and sex. Results Our study reveals that 68.6% (n=597/870) of the patients were female and 59.2% (n=161/870) of males were under 18. The most common chief concerns were "cold/flu" (33.2%,n=289/870), gastrointestinal problems (20.3%, n=177/870), headache (20.0%, n=174/870), and musculoskeletal problems (12.0%, n=104/870). The most common diagnoses were viral syndrome (25.4%, n=221/870), presumed parasitic infection (16.9%, n=147/870), hypertension (12.6%, n=110/870), headache (10.6%, n=92/870), and musculoskeletal disorder (8.5%, n=74/870). The most frequently prescribed medications were acetaminophen (18.3%, n=291/1,587), albendazole (15.2%, n=241/1,587), nonsteroidal anti-inflammatory drugs (NSAIDs) (10.5%, n=166/1,587), antihistamines (6.1%, n=97/1,587), and antibiotics (5.9%, n=93/1,587). Conclusions Our study reveals potential areas for improvement of an annual, medical student-run medical mission trip to Jarabacoa, DR. Dedicated efforts should be made to address long-term management of chronic conditions identified or treated on medical mission trips. Community partnerships should be established to facilitate this. We hope this will encourage other medical mission trip teams to analyze their data in order to be more prepared for their trips.
