Risk factors for attempted suicide in gay and bisexual youth.

Studies of human sexuality have noted high rates of suicidality among homosexual youth, but the problem has not been systematically examined. This work was undertaken to identify risk factors for suicide attempts among bisexual and homosexual male youth. Subjects were 137 gay and bisexual males, 14 through 21 years of age, from the upper Midwest and Pacific Northwest. Forty-one subjects (41/137) reported a suicide attempt; and almost half of them described multiple attempts. Twenty-one percent of all attempts resulted in medical or psychiatric admissions. Compared with non-attempters, attempters had more feminine gender roles and adopted a bisexual or homosexual identity at younger ages. Attempters were more likely than peers to report sexual abuse, drug abuse, and arrests for misconduct. The findings parallel previous studies' results and also introduce novel suicide risk factors related to gender nonconformity and sexual milestones.

The medical care of street youth.

Our clinical contacts with street youth support the view that their numbers are growing and that their medical needs are largely neglected. We describe our experience in providing medical care to street youth in Seattle, with attention to their medical presentations and patterns of health care utilization. We address aspects of adolescent street life that are unique to that particular mode of living or importantly formative in the lives of persons drawn to it.

Birth outcomes of prostituting adolescents.

In 1989, researchers at the University of Washington, Division of Adolescent Medicine, described the multifactorial risks of pregnancy for adolescents engaged in prostitution activities. Factors identified as placing this population at particular risk were transience, substance abuse, violence, sexually transmitted diseases, inadequate (or no) medical care, and poor nutrition. The relationship between such risks in the pregnant adolescent and poor birth outcome has been widely demonstrated. In this follow-up study, we describe the birth outcomes of 54 of the original sample of 61 prostituting adolescents who delivered infants between November 1987 and November 1989 in Seattle, Washington. The data were collected by retrospective chart review. Maternal factors evaluated were 1) age 2) ethnic group 3) substance abuse history 4) number of prenatal visits 5) maternal complications and 6) parity. The infant inpatient charts were reviewed for the following characteristics: 1) birth weight 2) occipitofrontal head circumference 3) length 4) Apgar scores and 5) neonatal complications. Results indicated high rates of maternal and infant complications with respect to: preterm birth (22%), precipitous delivery (15%), pregnancy-induced hypertension (16%), positive toxicology screens (28%), meconium staining (30%), infant hypertonicity (30%), and small for gestational age infants (14.5%).

Maltreatment of adolescents: the relationship to a predisposition toward violent behavior and delinquency.

This discussion reviews the literature concerning the association between the maltreatment, abuse and exploitation of adolescents and the predisposition to violent and other offending behavior. We review the importance and family dynamics of abuse which bear a relationship to antisocial behavior. The distinction is made between child abuse and adolescent abuse, and controversies regarding the sequelae of various maltreatments are discussed. Recent work in sexual abuse and its relationship to male sexual offenders and male prostitutes is detailed. Adolescents who commit various offenses or are in contact with juvenile justice system may be or have been the victims of various forms of maltreatment and exploitation. Helping professionals caring for these youths should have an understanding of these factors and the underlying dynamics.

Runaways: a growing social and family problem.

The problem of the juvenile runaway is one of increasing magnitude, and it is causing considerable alarm among lay and professional people. As the age of the runaway becomes younger and the harmful consequences of being away from home increase, public attention has focused on the problem. Family physicians are in a unique position to provide both preventive and remedial help to runaways and their families. Some of the ways in which physicians may play a significant role in this serious problem include individual and family counseling to anticipate and prevent such episodes and counseling to strengthen the adolescent-parent relationship following a running away episode.

Community college health services. Are they necessary?

A preliminary study was undertaken to assess the potential predictors of the medical care needs of the students attending a community college. No definite medical-social-economic parameters were useful predictors. The self-assessed primary health needs were documented. These were generally in areas not traditionally managed by college health services, particularly the visual, dental, and preventive health care concerns. Based on our data, colleges with limited resources may need to reassess their medical care priorities for students.

The pregnant adolescent prostitute.

The issue of teenage pregnancy is one of paramount concern and has been covered extensively in the professional literature. Teenage prostitution, as well, has drawn attention from medical and social science researchers. An increasing number of teenage prostitutes are becoming pregnant and delivering infants. These young women constitute a high-risk group that merits professional investigation and requires sensitive clinical approaches. We describe the pregnancy and early postpartum outcomes of 61 teenage prostitutes (age range, 13 to 18 years) in Seattle, Wash, during the period from January 1987 to February 1988. The subjects' environment, prenatal care, drug use, contraceptive practices, repeated pregnancies, and risk for sexually transmitted diseases (including acquired immunodeficiency syndrome) are discussed. Two case examples are used for illustration.

Adolescent sexual offense behavior: the role of the physician.

This article explores the more common adolescent sexual behavior problems that have legal ramifications, and the role of the physician in approaching such problems. Various presenting sexual offense behaviors are described, as well as the implications for the patient as offender, and finally the parental and physician attitudes necessary to facilitate successful treatment outcomes. Intervention approaches are discussed, and two cases are presented from a group of 83 adolescent male sexual offenders referred to our Juvenile Sexual Offender Project. The discussion and cases illustrate abnormal sexual behaviors which may come to the attention of physicians and other health care professionals.