Division of Reproductive Health, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, USA.
J Urban Health. 2011 Aug;88(4):779-92. doi: 10.1007/s11524-011-9596-z.
Although street youth are at increased risk of lifetime pregnancy involvement (LPI), or ever becoming or getting someone pregnant, no reports to date describe the epidemiology of LPI among systematically sampled street youth from multiple cities outside of North America. The purpose of our assessment was to describe the prevalence of and risk factors associated with LPI among street youth from three Ukrainian cities. We used modified time-location sampling to conduct a cross-sectional assessment in Odesa, Kyiv, and Donetsk that included citywide mapping of 91 public venue locations frequented by street youth, random selection of 74 sites, and interviewing all eligible and consenting street youth aged 15-24 years found at sampled sites (n = 929). Characteristics of youth and prevalence of LPI overall and by demographic, social, sexual, and substance use risk factors, were estimated separately for males and females. Adjusted odds ratios (AORs) were calculated with multivariable logistic regression and effect modification by gender was examined. Most (96.6%) eligible youth consented to participate. LPI was reported for 41.7% of females (93/223) and 23.5% of males (166/706). For females, LPI was significantly elevated and highest (>70%) among those initiating sexual activity at ≤12 years and for those reporting lifetime anal sex and exchanging sex for goods. For males, LPI was significantly elevated and highest (>40%) among those who reported lifetime anal sex and history of a sexually transmitted infection. Overall, risk factors associated with LPI were similar for females and males. Among the total sample (females and males combined), significant independent risk factors with AORs ≥2.5 included female gender, being aged 20-24 years, having five to six total adverse childhood experiences, initiating sex at age ≤12 or 13-14 years, lifetime anal sex, most recent sex act unprotected, and lifetime exchange of sex for goods. Among street youth with LPI (n = 259), the most recent LPI event was reported to be unintended by 63.3% and to have ended in abortion by 43.2%. In conclusion, our assessment documented high rates of LPI among Ukrainian street youth who, given the potential for negative outcomes and the challenges of raising a child on the streets, are in need of community-based pregnancy prevention programs and services. Promising preventive strategies are discussed, which are likely applicable to other urban populations of street-based youth as well.
尽管街头青年一生中怀孕的风险（LPI）或曾经怀孕或使他人怀孕的风险增加，但迄今为止尚无报告描述来自北美的多个城市以外的系统抽样街头青年的 LPI 流行病学。我们评估的目的是描述来自乌克兰三个城市的街头青年的 LPI 的流行率和相关风险因素。我们使用改良的时间位置抽样法在敖德萨，基辅和顿涅茨克进行了横断面评估，该评估包括对街头青年常去的 91 个公共场所进行全市范围的制图，随机选择 74 个场所，并对在抽样场所发现的所有符合条件并同意参加的 15-24 岁街头青年（n = 929）进行访谈。分别针对男性和女性，估算了青年特征和总体 LPI 以及按人口统计学，社会，性和药物使用风险因素的流行率。对于女性（93/223）和男性（166/706），分别计算了调整后的优势比（AOR），并通过性别检查了效果修饰。大多数（96.6％）合格的青年同意参加。报告的女性 LPI 为 41.7％（93/223），男性为 23.5％（166/706）。对于女性，首次性行为发生在 12 岁或以下，以及有过终身肛交和用性换取物品的女性，LPI 明显升高，最高（> 70％）。对于男性，有过终身肛交和性传播感染史的男性，LPI 明显升高，最高（> 40％）。总体而言，与 LPI 相关的风险因素在女性和男性中相似。在总样本中（女性和男性合并），与 AOR≥2.5 相关的重要独立风险因素包括女性，年龄在 20-24 岁，有五到六个总的不良童年经历，12 岁或 13-14 岁开始性行为，有过终身肛交，最近的性行为没有保护措施，以及终身用性换取物品。在有 LPI 的街头青年中（n = 259），最近的 LPI 事件有 63.3％的人报告是意外的，有 43.2％的人报告是堕胎结束的。总之，我们的评估记录了乌克兰街头青年中 LPI 的高发生率，鉴于可能会出现负面后果以及在街头养育孩子的挑战，这些青年需要基于社区的怀孕预防计划和服务。讨论了有前途的预防策略，这些策略可能也适用于其他城市街头青年人群。
