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 ≤ 0.002), anal-receptive sex (p ≤ 0.01), genital Chlamydia (p ≤ 0.03), prostitution (p ≤ 0.03), and sexual abuse (p ≤ 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.