title: Transactional sex involvement: exploring risk and promotive factors among substance-using youth in an urban emergency department.
abstract: OBJECTIVE
  The current study aims to evaluate individual, relational, and community-level risk and promotive factors for transactional sex involvement among substance-using youth.
  
  
  METHODS
  Youth (ages 14-24 years) presenting for care in an urban emergency department, who reported drug use within the past 6 months, were surveyed as part of a larger study assessing violence. Of the 600 youth enrolled in this study, 350 presented to the emergency department with violent injury. Based on youth presenting with violent injury, a proportionally selected (age and gender) comparison group of youth (n = 250) presenting without violent injury were enrolled. Participants were queried about both risk and promotive factors at the individual, relational, and community levels.
  
  
  RESULTS
  Of the sample, 7.3% reported involvement in transactional sex within the past month. Regression analyses indicated that being African American or other race (as compared with White), having more than one sexual partner, depressive symptoms, negative peer influence, and substance use treatment utilization were positively associated with transactional sex involvement. Increased school involvement was negatively related to involvement in transactional sex.
  
  
  CONCLUSIONS
  Drug-using youth who reported recent transactional sex involvement are more likely to experience increased HIV risk, depressive symptoms, and negative peer influence and are less likely to experience the promotive factors of school involvement. Future research is needed to better understand the bidirectional relationship between transactional sex involvement and both risk and promotive factors at multiple ecological levels.
authors.affiliation: Department of Counseling, University of Akron, Akron, Ohio.
authors.forename: Rikki A
authors.initials: RA
authors.lastname: Patton
authors.affiliation: Department of Psychiatry and Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Cunningham
authors.affiliation: Department of Psychiatry and Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Frederic C
authors.initials: FC
authors.lastname: Blow
authors.affiliation: Department of Psychiatry and Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Zimmerman
authors.affiliation: Department of Psychiatry, University of Arkansas, Little Rock, Arkansas.
authors.forename: Brenda M
authors.initials: BM
authors.lastname: Booth
authors.affiliation: Department of Psychiatry and Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Maureen A
authors.initials: MA
authors.lastname: Walton
mesh_terms: D000293:Adolescent; D003863:Depression / Q000453:epidemiology; D004636:Emergency Service, Hospital; D005260:Female; D015658:HIV Infections / Q000635:transmission; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010379:Peer Group; D044469:Racial Groups / Q000706:statistics & numerical data; D012044:Regression Analysis; D012309:Risk-Taking; D011477:Sex Work / Q000706:statistics & numerical data*; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000453:epidemiology*; D014505:Urban Population / Q000706:statistics & numerical data; D014754:Violence; D055815:Young Adult