Problems associated with homelessness and young pregnant teenagers

Study Objective: Homelessness is a major complication to adolescent pregnancy. We hypothesized that homelessness was associated with an increased incidence of other psychosocial and health risk factors for young pregnant teens.

Design, Setting, Participants: We conducted a nationwide study of homeless young pregnant teens living in group residential facilities and of a control population of young pregnant teens living at home with their families. Clinical social workers involved in services for these patients were located by consulting a national directory of maternity homes and through contact with hospital-based social service departments randomly selected through long-distance telephone information. After a telephone conversation detailing the nature of the project, questionnaires were mailed to each social worker. They were to complete a questionnaire for each of the two youngest pregnant teens cared for at their facility in the previous 12 months. The data from the returned questionnaires were evaluated by chi-square analysis and Fisher's exact test.

Main Outcome Measures: We distributed 736 questionnaires and collected data on 509 subjects (278 homeless, 231 controls) from 191 cities throughout the United States. The return rates were 69.1% from each group. There were no significant differences between the two groups in median age (14 years), race (50 and 42% white, 32 and 39% black, 10 and 14% Hispanic), school grade level (8th), or dropout rates (19 and 18%).

Results: Findings included a greater likelihood for those in the homeless group to be under the guardianship of a social service agency (29 vs. 3%, p < .001), to be known to family court (54 vs. 13%, p < .001), to have been declared by the courts to be “a person in need of supervision” (43 vs. 7%, p < 0.001), and to have been convicted of a criminal offense (12 vs. 0%, p < .001). Homeless young pregnant teens were likely to have been victims of physical abuse (47 vs. 9%, p < .001), victims of sexual abuse (46 vs. 16%, p < .001), to have abused illicit drugs or alcohol (24 vs. 7%, p < .001), to have sold illicit drugs (3 vs. 0%, p < 0.01), to have exchanged sex for drugs (6 vs. 0%, p < .001), and to have exchanged sex for food and shelter (9 vs. 0%, p < .001).

Conclusions: Homelessness should alert prenatal care providers to the expected coexistence of numerous additional psychosocial and health risk factors in young pregnant teens.