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Three quick hits today. All from JAMA Pediatrics. This is Healthcare Triage News.

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Three quick hits today, all from JAMA Pediatrics.  This is Healthcare Triage News.


First up, long acting reversible contraception.  It's great, because it really, really works to prevent pregnancy.  It doesn't, however, protect you from sexually transmitted diseases.  For that, you really need a condom.  A new study looked at how females using long acting reversible contraception, or LARC, compared to those who didn't in also using condoms.  Researchers examined data from Youth Risk Behavior survey in 2013.  They looked at what kinds of contraceptions females were using and whether they also used condoms.  Of the 2,288 sexually active females in grades 9-12, 1.8% used LARC.  Another 5.7% used Depo-Provera, a patch, or a ring.  22.4% used oral contraceptives, and 40.8% used condoms.  11.8% used the withdrawal or some other method, and only 15.7% used no contraception at all, and 19% weren't sure what they were using.  

After adjusting for other factors, LARC users were 60% less likely to use condoms compared to those who used oral contraceptives, but there weren't any real differences compared to Depo-Provera, the patch, or ring users.  Moreover, LARC users were more than twice as likely to have two or more sexual partners compared to oral contraceptives, Depo-Provera, patch, or ring users.

It seems like females who use LARC don't think they need to use condoms, and they really do!  It's not true they don't.  We need to message these things better.

Study #2 looked at what causes children and youth to become homeless in developed and developing countries.  It was a systematic review and meta-analysis of studies published between 1990 and about half of 2013.  To be eligible, studies had to look at people aged 24 years or younger.  49 studies met all the inclusion criteria.  The main measures of interest included poverty, abuse, family conflict, delinquency, psychosocial health, and other.

Data were included on more than 13,500 participants in 24 countries, most of which were considered developing nations.  The most common reason for homelessness was poverty, at 39%.  Following that was family conflict at 32%.  Abuse was present as a cause in 26%, and delinquency was the least common cause at 10%.

Kids aren't responsible for almost any of this.  We'd like to see child homelessness get to 0.  Poverty and family conflict are all too common.

And to end things today, as we've discussed before, homicide is one of the top causes of death in adolescents, but are there are any environmental factors associated with homicide?  Researchers wanted to know!  They conduced a case-control study in Philadelphia, Pennsylvania from 2008-2014.  They identified adolescents aged 13 to 20 years of age who died by homicide and then they matched them by sex and location and time of day to ones who did not die of homicide.
Then they obtained data on the environments of all these adolescents.  They even used photographic data to record where the events took place.  They looked at 143 cases and 155 match controls both inside and outside at the times of homicides, and here's what they found.

Street lighting was associated with a lower risk of homicide.  So were illuminated walk signs, crosswalks, public transportation, parks, and maintained vacant lots.  Some things were associated with an increased risk.  These included stop signs, security bars or gratings on houses, and private bushes or plantings.

Of course, this is just one study in one place and it's a case control study, so don't go all causal on me, but the results are still pretty interesting.  Worth following up on probably.

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