Incidence and prevalence of chlamydia, herpes, and viral hepatitis in a homeless adolescent population

The health of street youth: a Canadian perspective

OBJECTIVE

To review epidemiologic studies of the health of street youth in industrialized countries, with a special focus on Canadian youth.

METHODS

We identified 52 peer-reviewed studies from searches of the MEDLINE database and bibliographies of published papers, for data on blood-borne and sexually transmitted infections, mental health problems, pregnancy, violence and mortality.

RESULTS

Rates of hepatitis B, hepatitis C, and HIV infection are much higher among street youth than among their non-street peers. Likewise, the prevalence of all mental health problems assessed in street youth is greater than that in non-street youth. Pregnancy is more frequent among street than household youth. Street youth also experience high levels of violence: a large proportion report physical abuse or assault. Finally, mortality is about 11 times the expected rate based on age and sex and is mainly caused by suicide and drug overdose.

CONCLUSION

Current research results are useful to orient public health interventions for street youth, but further epidemiologic research is needed. The need for Canadian data is particularly acute in specific areas including mental health, violence, pregnancy, and sexually transmitted infections such as, for example, herpes infection and syphilis.

Seroprevalence of hepatitis B and C in juvenile detention entrants, Oregon, 1994-1996

We tested sera originally collected from 1335 juvenile detention entrants for an HIV study in 1994-1996 for hepatitis B virus (HBV) and hepatitis C virus (HCV) antibodies; we found that the seroprevalence of HBV and HCV antibody was 2% and 1%, respectively. HBV was associated with Asian race, whereas HCV infection was associated with injection drug use and female gender.

Hepatitis C virus infection, substance use and mental illness among homeless youth: a review

OBJECTIVES

Homeless youth are at a high risk of substance abuse, mental illness and blood-borne infections, such as hepatitis C. In this paper, we review the implications of these conditions, discuss the unique challenges faced by homeless youth, and explore potential strategies for harm reduction and intervention in this vulnerable population.

RESULTS

Interventions that combine youth-centered, service-based care, street outreach, case management, and motivational interviewing with integrated health services such as hepatitis A/B vaccination, and mental health and substance abuse programmes, are presented as innovative approaches to address the healthcare needs of homeless youth.

CONCLUSION

Recommendations for age-appropriate interventions and further research are made.

The epidemiology of sexually transmitted infections in adolescents

This article addresses the epidemiology of several common sexually transmitted infections (STIs) in adolescents. Chlamydia is a common occurrence in adolescents, more so than is gonorrhea, but both are of particular concern because they may cause pelvic inflammatory disease. Many experts recommend screening for chlamydia in sexually active adolescents, particularly females. Trichomonas vaginalis is significant as a marker for risk of contracting other STIs and because of its association with pregnancy complications and with increased risk of transmission of HIV. Genital herpes simplex virus (HSV) infection, which usually has been caused by HSV-2, is a common finding in adolescents, and it now is caused also by HSV-1 in some populations. Human papillomavirus (HPV), though widespread in adolescents, usually is a self-limited infection, and malignancy resulting from HPV is a rare occurrence in this age group. The least common of the diseases discussed below is syphilis, but a recent sharp increase in incidence has occurred in men who have sex with men.

Epidemiology of hepatitis B and hepatitis B virus infection in United States children

Before the era of routine hepatitis B vaccination, an estimated 24,000 children acquired hepatitis B virus (HBV) infection each year in the United States. Childhood hepatitis B immunization has led to significant declines in the incidence and prevalence of HBV infection in U.S. children. Because the greatest burden of hepatitis B is caused by complications of hepatocellular carcinoma and cirrhosis in adults who were infected with HBV as children, most of the benefits of vaccination have yet to be realized. Reaching the goal of eliminating HBV transmission to children likely will require increasing vaccination coverage, ensuring timely administration of postexposure immunoprophylaxis to prevent more perinatal infections, and continued evaluation of the impact of immunization recommendations.

Hepatitis B vaccination rate of homeless children in Baltimore

OBJECTIVE

To investigate the hepatitis B vaccination rate in homeless children 2 to 18 years old living in Baltimore City.

METHODS

During a 21-month period, 250 children from homeless shelters were enrolled.

RESULTS

The percent of children who had received 3 or more doses of hepatitis B vaccine was inversely related to age; 90% in 2- to 5-year-olds and 29% in 13- to 18-year-olds (P<0.0001). Seventy percent of 2- to 5-year-olds had at least some of their vaccine history recorded in the Baltimore Immunization Registry Program but the history was complete in only half. Forty-two percent of 13- to 18-year-olds had no hepatitis B vaccine doses recorded in any source; 49 per cent of 10- to 18-year-olds were either not immunized or had received only one hepatitis B vaccine dose.

CONCLUSIONS

Hepatitis B vaccine coverage is high in homeless children up to 9 years of age, whereas the majority of homeless children 10 years of age and older are unprotected against hepatitis B virus infection. Tracking the vaccine records in homeless children is labor intensive. Better public health strategies to deliver hepatitis B vaccine to older homeless children are urgently needed.

Is There an Association Between Alcohol Consumption and Sexually Transmitted Diseases? A Systematic Review

OBJECTIVE/GOAL

The objective of this study was to conduct a systematic review of published literature on the association between problematic alcohol consumption and sexually transmitted diseases (STDs).

DESIGN

Using a MEDLINE search (1995-2003) and article references, we identified articles that described measures of alcohol consumption and STDs and presented data on their association. For each eligible study, we classified the alcohol consumption measure as specific (problem drinking) or general, and examined study designs, study populations, STD measures, and results.

RESULTS

Of 42 eligible studies, 11 included specific measures of problem drinking, of which 8 found a significant association between alcohol consumption and at least 1 STD. The relationship did not appear to vary according to gender or pattern of alcohol consumption assessed.

CONCLUSIONS

The literature supports an overall association between problematic alcohol consumption and STDs, although their causal relationship cannot be determined with certainty from these observational studies. The findings have implications for prevention planners, clinicians, and individual patients at risk of STDs.

Genital herpes in adolescents

Herpes simplex virus (HSV) infections occur commonly among adolescents. Most HSV-2 infections are genital, but genital herpes can be caused by either HSV-1 or HSV-2. Weighted means were calculated based on published seroprevalence data on adolescents from the United States and found HSV-1 rates of 53.1 percent for adolescent males and 49.4 percent for adolescent females. The weighted means for HSV-2 was 15 percent for adolescent females and 12 percent for adolescent males. Most individuals who are infected with HSV-2 are unaware of their infection. Healthcare providers of adolescents should consider genital herpes even when an adolescent presents with nonspecific genital symptoms. In this article, we review current recommendations for diagnosis and management and review the psychological sequelae that can be associated with having genital herpes. Finally, we discuss biomedical interventions that are being developed to help reduce the epidemic of HSV and the challenges that these interventions face with regard to implementation.

Screening for Chlamydia and gonorrhea by strand displacement amplification in homeless adolescents attending youth shelters in Korea

We conducted the screening of sexually transmitted infections to define the prevalence of genital Chlamydia trachomatis and Neisseria gonorrhoeae infections and status of sexual risk behavior among homeless adolescents (10-19 yr old) in Korea. Adolescents who ran away from home and are under the care of youth shelters in ten cities in Korea served as the study population. Participants filled out a self-administered questionnaire related to sexuality. First-void urine was analyzed for chlamydial and gonococcal infection by strand displacement amplification (BDProbTec ET, BD Diagnostic Systems, MD, U.S.A.). A total of 175 adolescents from 15 youth shelters took part in the study. Their median age was 16 yr, and 54.9% of them reported having sexual intercourse at least once. The prevalence of C. trachomatis and N. gonorrhoeae among homeless adolescents was 12.6% and 15.4%, respectively. Factors significantly associated with the infections were number of sexual partners during the past year and lifetime. This is the first community-based sexually transmitted infection (STI) screening among adolescent in Korea. Screening programs targeting sexually active adolescents are important for detection of STIs. They should be considered an alternative population-based surveillance system in order to control STIs nationally.

Sexual and demographic risk factors for herpes simplex virus type 2 according to schooling level among Mexican youths

BACKGROUND

Herpes simplex virus type 2 (HSV-2), the agent causing one of the most common sexually transmitted infections in sexually active individuals, is currently considered a public health problem. In Mexico, there have been no population-based studies of the prevalence and factors associated with HSV-2 infection among young students.

GOAL

The goal was to measure HSV-2 seroprevalence and identify possible associated factors among students in the state of Morelos, Mexico.

STUDY DESIGN

Through a cross-sectional population-based study involving students at 92 schools in the state of Morelos, Mexico, 898 students aged 11 to 24 years old were identified. All of them reported they had already initiated sexual activity and provided a blood sample to detect the presence of anti-HSV-2 antibodies through the Western blot technique. The association between risk factors and HSV-2 was evaluated through multiple logistic regression analysis with stratification by sex and schooling level.

RESULTS

In the population under study, the prevalence of HSV-2 seropositivity was 5.7% (51/898), and the ratio of females to males was 2:1. The prevalence of consistent condom use overall was 22.6% among the 898 students. For students in Morelos State, Mexico, the HSV-2 seroprevalence was higher among the youngest female students (9.5% among junior high school versus 3.3% among university students; P<0.001). The main factors associated with HSV-2 infection were sex (for females the risk was 2.2 times higher than for males; 95% CI, 1.2-3.9); junior high school status (2.5 times higher risk than university students (95% CI, 1.1-6.0); and having had same-sex sexual intercourse (3.5 times higher risk; 95% CI, 1.4-8.9).

CONCLUSION

In contrast with other reports, the HSV-2 seroprevalence was higher among younger people. This finding can be explained by a cohort effect of more exposition to behavioral risks, particularly an earlier age at first intercourse and very low use of condoms among youngest students. Longitudinal surveys about serological responses to HSV-2 infection in different age groups are warranted.

HIV incidence among street youth in Montreal, Canada

OBJECTIVES

To estimate HIV incidence and identify predictors of seroconversion among Montreal street youth.

METHODS

From 1995 to 2000, street youth aged 14-25 years were recruited in a prospective cohort study. Interviews were conducted semiannually and included anti-HIV antibody testing. Among subjects who tested HIV negative at study entry and were interviewed at least twice, predictors of HIV seroconversion were identified using Cox regression. Variables considered as potential predictors were age, sex, injection drug use, being a male reporting male sexual partners, and survival sex.

RESULTS

Overall, 1013 youth were recruited in the study. HIV prevalence at study entry was 1.4% [95% confidence interval (CI) 0.8-2.4] and was stable over the 6 recruitment years. Among the 863 subjects selected for the incidence analysis, 66.7% were boys, 47.2% had ever injected drugs at study entry, and 25.7% had ever engaged in survival sex. The selected participants cumulated 2327 person-years of follow-up and 16 HIV seroconversions were observed, for an incidence rate of 0.69 per 100 person-years (95% CI 0.39-1.11). In univariate analysis, injection drug use [hazard ratio (HR), 7.0] and involvement in survival sex (HR, 4.0) were associated with HIV incidence. In the multivariate analysis, only injection drug use was retained.

CONCLUSIONS

Among Montreal street youth, injection drug use was the strongest predictor of HIV seroconversion. Prevention of initiation into injection drug use must become a public health priority.

Hepatitis C virus infection in children coinfected with HIV: epidemiology and management

Mothers with hepatitis C virus (HCV) and HIV coinfection are the major source of HCV/HIV coinfection in infancy and childhood. There is no known intervention capable of interrupting HCV spread from mother to child, while the majority of infant HIV infections occurring in the developed world can be prevented by antiretroviral prophylaxis in the mother and child, elective caesarean section, and formula-feeding. In the era preceding treatment of HIV infection with highly active antiretroviral therapy, HCV coinfection was of little concern because the short-term survival of patients with HIV infection prevented the slowly developing consequences of chronic hepatitis C. As the life expectancy of patients with HIV infection increased with therapy, HCV has emerged as a significant pathogen. Several lines of evidence in adult patients suggest that liver disease may be more severe in patients coinfected with HIV and that progression of HIV disease may be accelerated by HCV coinfection. Whether coinfected children may share these clinical patterns remains a matter of speculation. Chronic hepatitis C in otherwise healthy children is usually a mild disease; liver damage may be sustained and fibrosis may increase over the years, suggesting slow progression of the disease. Interferon-alpha has been the only drug used in the past decade to treat hepatitis C in children and adolescents, with average response rates of 20%. Preliminary results of treatment with interferon-alpha and ribavirin suggest that the efficacy would be greater with combined therapy. These treatment protocols have not yet been applied to children coinfected with HIV, but the increasing number of long-term survivors will probably prompt further investigation in the near future. At present, treating HIV disease and monitoring HCV infection and hepatotoxicity induced by antiretroviral drugs seem to be the more reasonable approach to HCV/HIV coinfection in childhood.

Boston HAPPENS Program: HIV-positive, homeless, and at-risk youth can access care through youth-oriented HIV services

The Boston HAPPENS Program is a collaborative network of care consisting of multiservice outreach agencies; community health centers; and hospitals for HIV-positive, homeless, and hard-to-reach youth. In four years of data collection, the program served more than 2,000 youth, including 54 HIV-positive youth. The youth were 19.9 +/- 2.9 years old; 64 percent female; 45 percent youth of color; 11 percent gay/lesbian, bisexual, or undecided; and 13 percent homeless or runaway. Homeless youth were much more likely to have been involved with a mental health system (47% vs. 12%, P < 0.001), the criminal justice system (20% vs. 2%, P < 0.001), high-risk sexual behaviors (21% vs. 3%, P < 0.001), and substance abuse (25% vs. 6%, P < 0.001) than were other youth served by the program. Comprehensive networks of care offering a continuum of services and a variety of entry routes and types of care sites are needed to connect under-served youth to health care. Outreach and human immunodeficiency virus (HIV) counseling and testing services can offer important portals of entry into health services for at-risk youth. Support services such as outreach, case management, and mental health services are needed to complement medical services by all youth at-risk for contracting HIV. Support services are necessary for the initiation and retention of youth in care so that early case identification and complex treatment regimens can be initiated and tailored to the individual.

Human immunodeficiency syndrome and hepatitis B and C infections among homeless adolescents

The lifestyle of homeless adolescents places them at high risk for contracting a variety of serious illnesses. The purpose of this cross-sectional study was to determine the predictors of human immunodeficiency virus (HIV) and hepatitis infections among homeless youth. Anonymous and confidential interviewer-administered psychosocial surveys were conducted with 150 homeless youth (ages 14 to 23 years; 70% male). Venous blood samples were collected as well. Most respondents (95%) had engaged in sexual intercourse, with 13 years as the median age at first coitus. Approximately 36 percent indicated they had exchanged sex for food, shelter, or drugs. Although youth reported a high rate of consistent condom use, 16 percent of the sample tested positive for HIV, 17 percent tested positive for hepatitis B (HBV), and 12 percent tested positive for hepatitis C (HCV). Homeless youth should be considered a high-risk group for contracting HIV, HBV, and HCV infections. The positive rates for HIV, HBV, and HCV observed in this study are higher than those of many previous reports among street youth. Because HIV prevention and hepatitis B vaccination programs have been targeted at school-based youth, most homeless youth are missed by these efforts. Targeted programs are needed to reach this high-risk group. Suggested guidelines for clinicians involved in the provision of medical care to homeless children and adolescents are provided.

Homeless adolescents: common clinical concerns

Homeless youth are at alarmingly high risk for a myriad of physical and psychological problems as a result of both the circumstances that prededed their homelessness, and as a direct consequence of life on the streets. Sexually transmitted infections (STIs), pregnancy, trauma, tuberculosis, uncontrolled asthma, and dermatologic infestations are a few of the health problems with which these youth commonly present. These somatic problems are compounded by high rates of drug and alcohol abuse as well as depression and suicide. Despite the obvious need for medical services, homeless youth often do not receive appropriate medical care due to numerous individual and systems barriers impeding health care access by this population. In addition to the barriers experienced by the adult homeless population, homeless adolescents confront further hurdles stemming from their age and developmental stage. Some of these impediments include a lack of knowledge of clinic sites, fear of not being taken seriously, concerns about confidentiality, and fears of police or social services involvement. Improved access to appropriate health care is necessary if we are to better support and care for this population of young people. To effectively manage and treat homeless youth, individual providers must be aware of the diagnoses associated with homelessness, as well as the community resources available to these youth. Finally, providers need to be the voices advocating for improved services for this disadvantaged and silent population.

Prevalence of hepatitis C virus infection and risk factors in an incarcerated juvenile population: a pilot study

OBJECTIVE

Hepatitis C virus (HCV) infection is the leading cause of liver failure in adulthood. Although the prevalence of HCV is reportedly as high as 80% in incarcerated adult populations, little is known about the prevalence of HCV in incarcerated juvenile populations. The purpose of this study was to determine the prevalence of HCV and high-risk behaviors in a population of incarcerated youths.

METHODS

We conducted a cross-sectional prevalence study of HCV infection in youths who were admitted to a juvenile detention center between September 1999 and January 2001. Subjects were asked questions regarding behaviors that might put them at risk for acquiring HCV, and blood was drawn for HCV antibody testing. Qualitative HCV RNA testing was performed on antibody-positive subjects.

RESULTS

Seventy-four percent (n = 305) of youths consented to participate in the seroprevalence study. HCV risk behaviors were common in this population: sexual activity (70%), intravenous drug use (6%), intranasal drug use (32%), body piercing (53%), and tattoos (33%). Six study youths (2%) were HCV antibody positive; 4 of these subjects were also HCV RNA positive. HCV-positive status was significantly associated with history of intravenous drug use and having had a sexually transmitted disease. Only 17% of study participants could correctly identify behaviors that might put them at risk for HCV.

CONCLUSIONS

The prevalence of HCV in incarcerated youths is higher than in the general pediatric population but not yet at adult levels of prevalence. Given the high prevalence of risk factors in this population, future studies should address the need for targeted HCV screening and education of incarcerated youths regarding risks for HCV.

Genital herpes simplex virus infection in the adolescent: special considerations for management

Genital herpes simplex virus (HSV) infections are increasingly common among adolescents. In developed countries, during the 1990s, adolescent HSV type 2 seroprevalence rates ranged from 4 to 30% depending on the population studied. The clinical diagnosis of genital herpes may be unreliable and laboratory testing is recommended. Aciclovir, valaciclovir, and famciclovir are three antiviral drugs that have proven efficacy in the treatment of genital herpes. These drugs can be used in the treatment of the first episode or for recurrent infections, or can be used long term to suppress recurrent infections. Once or twice daily administration regimens are preferable for adolescents for reasons of adherence, and because it avoids the need to take medication at school. Unproven remedies are used commonly and can be harmful. In addition to antiviral therapy, proper management of the adolescent with genital herpes should also include developmentally appropriate explanations of the diagnosis, treatment and potential complications, recommendations for symptomatic relief, screening for other sexually transmitted infections, and discussion of safer sexual practices. All adolescents should have follow-up visits to complete education and counseling and to assess compliance with antiviral therapy.

Age-specific prevalence of infection with herpes simplex virus types 2 and 1: a global review

Information on age- and sex-specific prevalence of herpes simplex virus (HSV) types 2 and 1 infections is essential to optimize genital herpes control strategies, which increase in importance because accumulating data indicate that HSV-2 infection may increase acquisition and transmission of human immunodeficiency virus. This review summarizes data from peer-reviewed publications of type-specific HSV seroepidemiologic surveys. HSV-2 prevalence is, in general, highest in Africa and the Americas, lower in western and southern Europe than in northern Europe and North America, and lowest in Asia. HSV-2 and -1 prevalence, overall and by age, varies markedly by country, region within country, and population subgroup. Age-specific HSV-2 prevalence is usually higher in women than men and in populations with higher risk sexual behavior. HSV-2 prevalence has increased in the United States but national data from other countries are unavailable. HSV-1 infection is acquired during childhood and adolescence and is markedly more widespread than HSV-2 infection. Further studies are needed in many geographic areas.

Reaching homeless youths for Chlamydia trachomatis and Neisseria gonorrhoeae screening in Denver, Colorado

BACKGROUND AND RATIONALE

The availability of urine based testing for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) provides a unique opportunity to screen for these pathogens outside traditional clinical settings. The researchers investigated the feasibility of street based CT/GC screening in the context of an outreach programme among street/homeless adolescents in Denver.

OBJECTIVES

To describe the integration of urine based CT/GC screening into an existing outreach programme among street/homeless youths and the yield of CT/GC testing in this setting.

METHODS

The Denver Department of Public Health (DPH) collaborated with outreach staff from Urban Peak (a community based organisation serving street/homeless youths in Denver) to offer urine based CT/GC testing to males and females in street settings. Tests were conducted on the street in areas where street/homeless youths congregate.

RESULTS

Urban Peak outreach staff were trained by DPH staff to conduct CT testing, process urine specimens, and provide test results to participating youths. DPH remained responsible for treatment of people with CT or GC infection as well as CT/GC case reporting. CT testing started in January 2000; GC testing was added in July 2000. Throughout April 2002 a total of 414 CT and 302 GC tests were conducted, respectively 11.6% and 2.7% of which were positive. Among first testers, 13.0% were positive for CT and 3.7% for GC.

CONCLUSIONS

CT/GC urine testing can be incorporated into existing outreach programmes without considerable extra effort. Overall CT rates were high and suggest the need for ongoing screening in this manner.

LEARNING OBJECTIVE

To understand the role of CT/GC screening in the context of services provided to street/homeless youths in outreach settings.

Telephone vs. face-to-face notification of HIV results in high-risk youth

PURPOSE

To increase the number of high-risk and homeless youth who receive human immunodeficiency virus (HIV) test results and posttest counseling.

METHODS

Oral HIV testing and counseling were offered to high-risk and homeless youth at sites at which youth congregate throughout Portland, Oregon. Subjects were randomized to receive test results and posttest counseling either in a face-to-face manner or with the option of telephone notification. Self-reported demographic and risk-behavior information was collected prior to HIV testing. The differences in the proportion of youth who received their test results were analyzed according to the notification method and demographic characteristics using SPSS.

RESULTS

Among the 351 youth who were tested, 48% followed up to receive test results and posttest counseling. Adolescents most likely to receive their results were female, older (19-24 years), and white and those who reported high-risk behaviors. Those given the option of telephone notification were significantly more likely to receive their results than those required to have face-to-face notification (odds ratio = 2.301, 95% confidence interval of 1.499, 3.534). This was true regardless of age, race, history of previous HIV testing, or presence of high-risk behaviors. Two youths tested positive for HIV corroborating previous reports of low HIV prevalence in this population. Both were assigned to the face-to-face notification group and, therefore, no HIV positive results were given by telephone.

CONCLUSIONS

The option of telephone notification significantly increased the proportion of youth who received posttest counseling and results following community-based testing.

Infections in the homeless

Homeless people in developed countries have specific problems predisposing them to infectious diseases. Respiratory infections and outbreaks of tuberculosis and other aerosol transmitted infections have been reported. Homeless intravenous drug users are at an increased risk of contracting HIV, and hepatitis B and C infections. Skin problems are the main reason the homeless seek medical attention, and these commonly include scabies, pediculosis, tinea infections, and impetigo. Many foot disorders are more prevalent in the homeless including ulcers, cellulitis, erysipelas, and gas gangrene. The louse transmitted bacteria Bartonella quintana has recently been found to cause clinical conditions in the homeless such as urban trench fever, bacillary angiomatosis, endocarditis, and chronic afebrile bacteraemia. Treatment of homeless people is complicated by financial constraints, self-neglect, and lack of adherence. Patients with serious and contagious illnesses should be hospitalised. Physicians should be aware of these specific issues to enhance care.

Relationship of sexual orientation to substance use, suicidal ideation, suicide attempts, and other factors in a population of homeless adolescents

PURPOSE

To explore the relationship of sexual orientation and gender to four sets of factors: (a) family history, (b) incarceration, (c) substance use, and (d) depression and suicide, in a population of homeless adolescents.

METHODS

A sample of homeless adolescents was recruited in Portland, Oregon and assessed using semi-structured interviews at baseline, three months and six months. A total of 532 youths (216 females and 316 males) provided data on sexual orientation and other variables. Heterosexual (n = 391) and non-heterosexual youths (n = 141) were compared on all sets of factors, primarily using logistic regressions.

RESULTS

44.9% of females identified as lesbian or bisexual, while only 13.9% of males identified as gay or bisexual. Gay, lesbian, bisexual, and "unsure" (GLBU) youths were less likely to have been in foster care or arrested, but were more likely to have spent time in a locked mental health treatment facility. More than one-third of all participants reported use of injection drugs. GLBU youths were more likely to have recently used amphetamines and to have injected drugs, however, gay-bisexual males were less likely to have recently used marijuana. GLBU status was associated with recent measures of depression and suicidal ideation, but not with lifetime measures. Associations of sexual orientation with several lifetime measures were different than with prospective measures, demonstrating the limitations of using lifetime measures rather than recent or prospective measures.

CONCLUSIONS

This population of homeless adolescents appears to be higher in its high rate of injection drug use and the large proportion of females who identify as lesbian or bisexual than found in other studies. The high rates of depression and suicidal ideation, especially among GLBU youth, are of great concern.