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Abstract
INTRODUCTION: Adolescents are disproportionately affected by HIV and STIs, especially in the Southern United States, which can have a long-term impact on development and health outcomes. Co-occurring substance use during adolescence has been demonstrated to increase sexual risk behaviors, mental health issues, violence perpetration, and school dropout. Few studies, though, have assessed the health needs and behaviors of sexually active adolescent substance users in the South and evaluated opportunities for future risk reduction programming. METHODS: This study used a mixed methods longitudinal design to examine (1) the feasibility of recruiting this at-risk population online, (2) their unmet health needs and sexual risk and substance use behaviors, (3) relationship demographics, and (4) the acceptability of future intervention activities among youth 13-17 years residing in five Southern metropolitan areas who engaged in unprotected sex in the last 12 months and had a history of substance use. RESULTS: Online recruitment was successful via social networking sites, however challenges with duplicative and fraudulent enrollments were identified. The majority of youth (79.2%) reported at least one unmet medical or social service need. The most common unmet needs were dental, mental health, vision, employment assistance, and preventative care. On average, youth reported 2.2 (SD=1.7) barriers to care, including cost, lack of perceived urgency, and lack of time. High rates of engagement in sexual risk and substance use behaviors were found, with statistically significant differences by sex at birth, race, SES, and sexual and gender minority status. More than half of respondents (62.4%) had a current partner, however few associations were found between relational factors and recent substance use. Youth reported mHealth or online modalities most acceptable for future programming and most commonly requested the inclusion of direct services such as free access to condoms, modern contraceptive methods, and HIV/STI testing. CONCLUSIONS: Steps should be taken to address the number of unmet health needs reported among this at-risk population, especially among sexual and gender minorities. Efforts should also focus on improving awareness of local resources, increasing testing and preventative behaviors, and linking youth to quality affirmative care. Innovative methods and strategies using mHealth technologies should be considered.