Skip to main content

Advertisement

SpringerLink
Log in

Multi-City Assessment of Lifetime Pregnancy Involvement among Street Youth, Ukraine

  • Published:
Journal of Urban Health Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. United Nations Children’s Fund (UNICEF). The State of the World’s Children 2003. New York, NY: United Nations Children's Fund (UNICEF); 2002.

  2. United Nations Children’s Fund (UNICEF). The State of the World’s Children 2006: Excluded and Invisible. New York, NY: United Nations Children's Fund (UNICEF); 2006.

  3. Engelman R. The State of World Population 2009. New York, NY: United Nations Population Fund; 2009.

  4. Teltschik A. Children and Young People Living or Working on the Streets: the Missing Face of the HIV Epidemic in Ukraine. Kiev, Ukraine: United Nations Children's Fund (UNICEF); 2006.

  5. Boivin JF, Roy E, Haley N, du Galbaud FG. The health of street youth: a Canadian perspective. Can J Public Health. 2005; 96(6): 432–437.

    Google Scholar 

  6. Feldmann J, Middleman AB. Homeless adolescents: common clinical concerns. Semin Pediatr Infect Dis. 2003; 14(1): 6–11.

    Article  PubMed  Google Scholar 

  7. Roy E, Haley N, Boudreau JF, Leclerc P, Boivin JF. The challenge of understanding mortality changes among street youth. J Urban Health. 2010; 87(1): 95–101.

    Article  PubMed  Google Scholar 

  8. Kissin DM, Zapata L, Yorick R, et al. HIV seroprevalence in street youth, St. Petersburg, Russia. AIDS. 2007; 21(17): 2333–2340.

    Article  PubMed  Google Scholar 

  9. Ensign J, Santelli J. Health status and service use. Comparison of adolescents at a school-based health clinic with homeless adolescents. Arch Pediatr Adolesc Med. 1998; 152(1): 20–24.

    PubMed  CAS  Google Scholar 

  10. Hoffman SD, Maynard RA. Kids having kids: economic costs and social consequences of teen pregnancy. 2nd ed. Washington, DC: Urban Institute Press; 2008.

    Google Scholar 

  11. Stein JA, Lu MC, Gelberg L. Severity of homelessness and adverse birth outcomes. Health Psychol. 2000; 19(6): 524–534.

    Article  PubMed  CAS  Google Scholar 

  12. Quinlivan JA, Evans SF. The impact of continuing illegal drug use on teenage pregnancy outcomes—a prospective cohort study. BJOG. 2002; 109(10): 1148–1153.

    PubMed  Google Scholar 

  13. Busen NH, Engebretson JC. Facilitating risk reduction among homeless and street-involved youth. J Am Acad Nurse Pract. 2008; 20(11): 567–575.

    Article  PubMed  Google Scholar 

  14. O'Hara MW. Postpartum depression: what we know. J Clin Psychol. 2009; 65(12): 1258–1269.

    Article  PubMed  Google Scholar 

  15. Nair P, Black MM, Schuler M, et al. Risk factors for disruption in primary caregiving among infants of substance abusing women. Child Abuse Negl. 1997; 21(11): 1039–1051.

    Article  PubMed  CAS  Google Scholar 

  16. Williams-Petersen M, Myers B, Degen H, Knisely J, Elswick R Jr, Schnoll S. Drug-using and non-using women: potential for child abuse, child rearing attitudes, social support, and affection for expected baby. Int J Addict. 1994; 29: 1039–1051.

    Google Scholar 

  17. Olszyk M, Goodell M. Homelessness and our most vulnerable patients. Md Med. 2008; 9(4): 20–25.

    PubMed  Google Scholar 

  18. Ensign J, Gittelsohn J. Health and access to care: perspectives of homeless youth in Baltimore City, USA. Soc Sci Med. 1998; 47(12): 2087–2099.

    Article  PubMed  CAS  Google Scholar 

  19. Rew L, Chamber K, Kulkarni S. Planning a sexual health promotion intervention with homeless adolescents. Nurs Res. 2002; 51: 168–174.

    Article  PubMed  Google Scholar 

  20. Greene JM, Ringwalt CL. Pregnancy among three national samples of runaway and homeless youth. J Adolesc Health. 1998; 23(6): 370–377.

    Article  PubMed  CAS  Google Scholar 

  21. Solorio M, Milburn N, Rotheram-Borus M, Higgins C, Gelberg L. Predictors of sexually transmitted infection testing among sexually active homeless youth. AIDS Behav. 2006; 10(2): 179–184.

    Article  PubMed  Google Scholar 

  22. Haley N, Roy E, Leclerc P, Boudreau JF, Boivin JF. Characteristics of adolescent street youth with a history of pregnancy. J Pediatr Adolesc Gynecol. 2004; 17(5): 313–320.

    Article  PubMed  CAS  Google Scholar 

  23. Thompson SJ, Bender KA, Lewis CM, Watkins R. Runaway and pregnant: risk factors associated with pregnancy in a national sample of runaway/homeless female adolescents. J Adolesc Health. 2008; 43(2): 125–132.

    Article  PubMed  Google Scholar 

  24. Robbins CL, Zapata L, Kissin DM, et al. Multi-city HIV seroprevalence in street youth, Ukraine. Int J STD AIDS. 2010; 21(7): 489–196.

    Article  PubMed  CAS  Google Scholar 

  25. Muhib FB, Lin LS, Stueve A, et al. A venue-based method for sampling hard-to-reach populations. Public Health Rep. 2001; 116(Suppl 1): 216–222.

    Article  PubMed  Google Scholar 

  26. Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. 1998; 14(4): 245–258.

    Article  PubMed  CAS  Google Scholar 

  27. Hillis SD, Anda RF, Dube SR, Felitti VJ, Marchbanks PA, Marks JS. The association between adverse childhood experiences and adolescent pregnancy, long-term psychosocial consequences, and fetal death. Pediatrics. 2004; 113(2): 320–327.

    Article  PubMed  Google Scholar 

  28. Saewyc EM. Influential life contexts and environments for out-of-home pregnant adolescents. J Holist Nurs. 2003; 21(4): 343–367.

    Article  PubMed  Google Scholar 

  29. Rotheram-Borus MJ, Mahler KA, Koopman C, Langabeer K. Sexual abuse history and associated multiple risk behavior in adolescent runaways. Am J Orthopsychiatry. 1996; 66(3): 390–400.

    Article  PubMed  CAS  Google Scholar 

  30. Deardorff J, Gonzales NA, Christopher FS, Roosa MW, Millsap RE. Early puberty and adolescent pregnancy: the influence of alcohol use. Pediatrics. 2005; 116(6): 1451–1456.

    Article  PubMed  Google Scholar 

  31. Williams C, Vines SW. Broken past, fragile future: personal stories of high-risk adolescent mothers. J Soc Pediatr Nurs. 1999; 4(1): 15–23.

    Article  PubMed  CAS  Google Scholar 

  32. Rainey DY, Stevens-Simon C, Kaplan DW. Are adolescents who report prior sexual abuse at higher risk for pregnancy? Child Abuse Negl. 1995; 19(10): 1283–1288.

    Article  PubMed  CAS  Google Scholar 

  33. Hathazi D, Lankenau SE, Sanders B, Jackson BJ. Pregnancy and sexual health among homeless young injection drug users. J Adolesc. 2009; 32(2): 339–355.

    Article  PubMed  Google Scholar 

  34. Glasier A, Gulmezoglu AM, Schmid GP, Moreno CG, Van Look PF. Sexual and reproductive health: a matter of life and death. Lancet. 2006; 368(9547): 1595–1607.

    Article  PubMed  Google Scholar 

  35. World Health Organization. Medical Eligibility Criteria for Contraceptive Use. 3rd ed. Geneva, Switzerland: World Health Organization; 2004.

  36. World Health Organization. Medical Eligibility Criteria for Contraceptive Use: 2008 Update. http://www.who.int/reproductive-health/publications/mec/mec_update_2008.pdf. World Health Organization. Accessed 22 Jan 2009.

  37. American College of Obstetricians and Gynecologists Committee on Gynecologic Practice, Long-Acting Reversible Contraception Working Group. ACOG Committee Opinion no. 450: Increasing use of contraceptive implants and intrauterine devices to reduce unintended pregnancy. Obstet Gynecol. 2009; 114(6): 1434–1438.

    Google Scholar 

  38. Mavranezouli I, Larc Guideline Development Group. The cost-effectiveness of long-acting reversible contraceptive methods in the UK: analysis based on a decision-analytic model developed for a National Institute for Health and Clinical Excellence (NICE) clinical practice guideline. Hum Reprod. 2008; 23(6): 1338–1345.

    Article  PubMed  CAS  Google Scholar 

  39. Kidd S, Shahar G. Resilience in homeless youth: the key role of self-esteem. Am J Orthopsychiatry. 2008; 78(2): 163–172.

    Article  PubMed  Google Scholar 

  40. Spaulding AB, Brickley DB, Kennedy C, et al. Linking family planning with HIV/AIDS interventions: a systematic review of the evidence. AIDS. 2009; 23(Suppl 1): S79–88.

    Article  PubMed  Google Scholar 

  41. Zabina H, Kissin D, Pervysheva E, et al. Abandonment of infants by HIV-positive women in Russia and prevention measures. Reprod Health Matters. 2009; 17(33): 162–170.

    Article  PubMed  Google Scholar 

  42. Rew L, Fouladi RT, Land L, Wong YJ. Outcomes of a brief sexual health intervention for homeless youth. J Health Psychol. 2007; 12(5): 818–832.

    Article  PubMed  Google Scholar 

  43. Arnold EM, Rotheram-Borus MJ. Comparisons of prevention programs for homeless youth. Prev Sci. 2009; 10(1): 76–86.

    Article  PubMed  Google Scholar 

  44. Wethington HR, Hahn RA, Fuqua-Whitley DS, et al. The effectiveness of interventions to reduce psychological harm from traumatic events among children and adolescents: a systematic review. Am J Prev Med. 2008; 35(3): 287–313.

    Article  PubMed  Google Scholar 

Download references

Disclaimer

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Author information

Authors and Affiliations

  1. Division of Reproductive Health, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, USA

    Lauren B. Zapata, Dmitry M. Kissin, Cheryl L. Robbins, Denise J. Jamieson, Polly A. Marchbanks & Susan D. Hillis

  2. HealthRight International, Kyiv, Ukraine

    Halyna Skipalska

  3. HealthRight International, St. Petersburg, Russia

    Roman V. Yorick

Authors
  1. Lauren B. Zapata
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dmitry M. Kissin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cheryl L. Robbins
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Erin Finnerty
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Halyna Skipalska
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Roman V. Yorick
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Denise J. Jamieson
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Polly A. Marchbanks
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Susan D. Hillis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lauren B. Zapata.

Additional information

Project support provided by HealthRight International, Centers for Disease Control and Prevention Global AIDS Program, USAID/Ukraine and the International AIDS Alliance. At the time of the assessment, Finnerty was with HealthRight International, New York, NY, USA.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zapata, L.B., Kissin, D.M., Robbins, C.L. et al. Multi-City Assessment of Lifetime Pregnancy Involvement among Street Youth, Ukraine. J Urban Health 88, 779–792 (2011). https://doi.org/10.1007/s11524-011-9596-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11524-011-9596-z

Keywords

Search

Navigation