Purpose
To compare risk for teen pregnancies between children living in poverty with no Child Protection Services (CPS) report history, and those in poverty with a history of CPS report.
Methods
Children selected from families in poverty, both with and without CPS report histories were prospectively followed from 1993–2009 using electronic administrative records from agencies including child protective services, emergency departments, Medicaid services and juvenile courts. A total of 3281 adolescent females were followed until age 18.
Results
For teens with history of poverty only, 16.8% had been pregnant at least once by age 17. In teens with history of both poverty and report of child abuse or neglect, 28.9% had been pregnant at least once by age 17. While multivariate survival analyses revealed several other significant factors at the family and youth services levels, a report of maltreatment remained significant (about a 66% higher risk).
Conclusions
Maltreatment is a significant risk factor for teen pregnancy among low income youth even after controlling for neighborhood disadvantage, other caregiver risks and indicators of individual emotional and behavioral problems.
Purpose: The purpose of this study was to describe the prevalence of and relationships among disordered eating, food insecurity, and weight status among transgender and gender nonbinary youth and young adults. Methods: This cross-sectional study involved a screening protocol to assess disordered eating and food insecurity risk from September to December of 2019 at a gender clinic using five validated measures: (1) previous eating disorder diagnosis (yes/no); (2) Sick, Control, One Stone, Fat, Food Questionnaire (SCOFF); (3) Adolescent Binge Eating Disorder Questionnaire (ADO-BED); (4) Nine-Item Avoidant/Restrictive Food Intake Disorder Screen (NIAS); and (5) Hunger Vital Sign. Age, assigned sex at birth, gender identity, stage of medical transition, and body mass index were collected. Pearson's r correlation coefficients, between-groups t-tests, one-way analysis of variance tests, and Tukey's honest significant difference test were used to characterize the relationships between variables. Results: A total of 164 participants ages 12-23 years completed the screener. Using assigned sex at birth, 1.8% were underweight, 53% were a healthy weight, 17.1% were overweight, and 28.0% were obese. An estimated 8.7% reported a previous eating disorder diagnosis, 28.0% screened positive on the SCOFF, 9.1% on the ADO-BED, 75.0% on the NIAS, and 21.2% on the Hunger Vital Sign. Transgender males scored higher on the NIAS than transgender females ( p = 0.03). Those with a previous eating disorder diagnosis scored significantly higher on the Hunger Vital Sign ( p < 0.05). Conclusion: Gender clinics should routinely screen for disordered eating, food insecurity, overweight, and obesity to identify patients in need of further evaluation and referral.
Objectives
1) Define a nutrition screening protocol for transgender and nonbinary youth and adolescents, and 2) Identify the prevalence of disordered eating and food insecurity in transgender and nonbinary patients using multiple validated measures at a Midwestern transgender center.
Methods
Return patients at the Washington University in St. Louis Transgender Center at Children's Hospital were screened for disordered eating and food insecurity from 9/2019–12/2019. The screener included five sections: 1) Yes/no question regarding previous diagnosis of an eating disorder; 2) SCOFF Questionnaire; 3) Nine-Item Avoidant and Restrictive Food Intake Disorder Screen (NIAS); 4) Adolescent Binge Eating Disorder Questionnaire (ADO-BED); 5) Hunger Vital Sign. The completed screeners were collected weekly and scored by a registered dietitian. Positive screens for disordered eating and food insecurity were referred to adolescent medicine and case management, respectively.
Results
A total of 159 transgender and nonbinary adolescents and young adults completed the screener. Two major findings emerged: 1) Food insecurity was a potential concern for one in five patients. Of the n = 159 patients that completed the screener, n = 32 (20%) screened positive for food insecurity on the Hunger Vital Sign. Food insecurity and disordered eating were not mutually exclusive; over half (56%) of the patients that screened positive for food insecurity also screened positive on at least one disordered eating measure. 2) Disordered eating was a potential concern for the majority of patients. Of the 159 patients that completed the screener, n = 115 (72%) screened positive for disordered eating.
Conclusions
Disordered eating and food insecurity are prominent nutrition-related concerns for transgender and nonbinary adolescents and young adults. Providers working with this population may utilize a screening and referral protocol to address patient needs that may be otherwise unmet.
Funding Sources
This project was supported by a workload release awarded to the primary investigator through the Doisy College of Health Sciences at Saint Louis University.
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