Think Inside the Box: the Heterogeneity of “in Risk” Among “at Risk” Female African American Adolescents in North Carolina


Focus Areas: Health & Wellness

INTRODUCTION: An abundance of research investigates the health of often referred to as “at risk” or “high risk” youth from underserved communities and usually racial/ethnic minorities. These ubiquitous terms relate to poverty, violence, and unsafe behaviors (e.g., sex without condoms, alcohol, and drug use).

METHODS: This analysis distinguished the heterogeneity of risks among African American female adolescents recruited for an intervention study from underserved communities in North Carolina. Eligibility included: ages 16-19, considered or dropped out of school, never completed high school, and during the past 3 months had sex with a male partner and used drugs or alcohol. A variable was created to represent the continuum of risk comprised of history of homelessness, or trading sex, or current heavy alcohol and marijuana use. Participants fell into 0, 1, or 2-3 categories. Ordinal logistic regression estimated the odds of adverse poor outcomes by category. Linear regression estimated reduction in material and emotional support by category.

RESULTS: Of the 237 participants, 59.5%, 27.8%, and 12.7% were in 0, 1, or 2-3 categories, respectively. Relative to adolescents in 0 categories, participants in other categories were more likely to report food insecurity (OR = 3.27, 95%CI [1.8, 5.94]); past arrest (OR = 3.56 [2.08, 6.09]); run away (OR = 3.30 [1.79, 6.10]); multiple sex partners (2.97 [1.61, 5.48]); and vaginal/anal sexual abuse (OR = 3.21[1.73, 5.96]). Material and emotional support was significantly lower for participants in 2-3 risk categories.

CONCLUSIONS: Vague use of “at risk” fails to recognize the heterogeneity of experiences and needs of underserved African American youth.

Doherty, I. A., F. A. Browne and W. M. Wechsberg (2020). "Think Inside the Box: the Heterogeneity of "in Risk" Among "at Risk" Female African American Adolescents in North Carolina." J Racial Ethn Health Disparities.


Wendee Wechsberg

“We must listen to the communities, the local people, to understand culturally what is going to fit and what is going to be the language of the research, and not just say we know what to do here.”

Felicia Browne

"I am so grateful to have the opportunity to work on applied, gender-focused projects in the community in which I grew up, in hopes of having an impact on HIV, STIs and other health outcomes among African-American adolescent girls and young women."