Are there risk factors for hepatitis B infection in inner-city adolescents that justify prevaccination screening?

Purpose: This study was undertaken to determine if homelessness could serve as a marker for previous hepatitis B infection (HBI), and thus justify prevaccination screening. Methods: One hundred sexually active 13-21-year-olds (mean = 17 years), 74% female, attending an inner-city hospital-based adolescent clinic (HOSP), and 48 sexually active 13-21-year-olds (mean = 19 years), 40% female, attending a clinic based at an urban drop-in center (UDC) for street youth were consecutively enrolled, screened for HBI serum markers and administered a structured interview about sexual practices, sexual abuse, prior sexually transmitted diseases (STDs), and injection drug use. Results: For the HOSP group, 7% were homeless and 4% were HBI positive. In the UDC group, 96% were homeless and 23% were HBI positive. Homelessness was significantly associated with HBI (p < 0.001), and this was corroborated by logistic regression analysis (p < 0.01). Other factors significantly associated with HBI in adolescents included a history of anal sex (p less than or equal to 0.002), anal-receptive sex (p less than or equal to 0.01), genital Chlamydia (p less than or equal to 0.03), prostitution (p less than or equal to 0.03), and sexual abuse (p less than or equal to 0.002). For both populations, gender, sexual orientation, intravenous drug use, and genital sex were not related to HBI. Conclusion: These data indicate that homelessness and associated high-risk sexual practices may be indications for prevaccination screening for HBI in adolescents. (C) Society for Adolescent Medicine, 1998.