Reproductive health education intervention trial

Objective: To measure the effectiveness of a reproductive health education package in improving the knowledge of adolescent girls aged 15–19 years in Chandigarh (India).Methods: A reproductive health education package, developed in consultation with parents, teachers and adolescents, was delivered to randomly sampled classes of two senior secondary schools and one school was selected as control. In one school, a nurse conducted 15 sessions for 94 students in three batches using conventional education approach. In another school she conducted sessions for a selected group of 20 adolescents who later disseminated the messages informally to their 84 classmates (peer education). Using a 70-item structured questionnaire the knowledge of 95 adolescents from conventional, 84 from peer, and 94 from control school were assessed before and one month after the last session. Change in the score in intervention and control groups was tested by ANOVA taking age and socio-economic status as covariates.Results: Teachers, parents and students overwhelmingly (88%, 95.5% and 93% respectively) favoured reproductive health education program. Five percent of the respondents reported that someone in their class is having sexual relations, and 13% of the girls approved of pre-marital sexual relations. Reproductive health knowledge scores improved significantly after intervention in conventional education (27.28) and peer education group (20.77) in comparison to the controls (3.64). Post-test scores were not significantly different between peer education group and conventional education group (43.65 and 40.52 respectively) though the time consumed in delivering the peer education intervention was almost one third of the time taken to implement conventional education.Conclusion: Peer education and conventional education strategies were effective in improving the reproductive health knowledge of adolescent girls but peer strategy was less time consuming     

Teen Club: a nursing intervention for reducing risk-taking behavior and improving well-being in female African American adolescents.

This article describes a nursing intervention called Teen Club that was designed to reduce risk-taking behavior and improve well-being in female African American adolescents. Participants were referred to Teen Club by their nurse practitioners, physicians, and a community health nurse who were working at an urban neighborhood health center's teen clinic. Referrals were based on factors such as parental substance abuse, lack of social and family support, and other characteristics thought to increase vulnerability to risk-taking behavior. The 2-year intervention included weekly group meetings co-led by a European American female community health nurse and a Latino American male community worker, supplemented by case management and home visits by both these persons. Findings from a retrospective group interview conducted with 11 of the 12 original participants are presented. This is the first step in a series of pilot studies designed to refine the Teen Club intervention in anticipation of a future prospective, randomized investigation of this health promotion and disease prevention model of nursing care.     

Nutritional approach in pregnant and nursing adolescents: basic strategy to prevent risks

OBJECTIVE: To present the different factors that can interfere in the neonatal evolution and results, as well as the approach strategic nutritional aspects in health promotion and attention of pregnant nursing adolescents. METHOD: National and international literature provided with subsidies to discuss and summarize practical and relevant aspects for the clinical assistance of pregnant and nursing adolescents, especially the lower age group. RESULTS: The approach to pregnant adolescents requires evaluation of parameters of clinical, nutritional, and psychosocial risk. Among the very young adolescents, in addition to those parameters, their gynecological age and physical growth stage are also relevant. The nutritional evaluation and the dietary orientation of the pregnant and nursing adolescents constitute support steps in health promotion and attention, preventing risks such as malnutrition, anemia, vitamin deficiency, in addition to low intrauterine growth, low birth weight and postnatal undernourishment. CONCLUSION: The complexity of the factors interfering in the course of precocious pregnancy requires deep knowledge of the problem by the health staff in order to be able to effectively to intervene in more critical and prior aspects of the health support for this risk group.     

Addressing health disparities in type 1 diabetes through peer mentorship

Pronounced health disparities exist in type 1 diabetes (T1D) based on socioeconomic status (SES) yet there are a lack of programs designed to promote health equity for vulnerable communities. The All for ONE (Outreach, Networks, and Education) mentoring program was piloted pairing college students and publicly insured teenagers with T1D to assess feasibility as a possible intervention. There were 22 mentors recruited (mean age 20 ± 2 years; 17 [77%] females; mean HbA1c 8.4 ± 1.5%) and matched with mentees based on gender. There were 42 teens randomized to treatment and control groups including 22 teens in the treatment group (age 14 ± 2 years; 17 [77%] females; HbA1c 9.8 ± 2.3%) and 20 teens in the control group (age 14 ± 2 years; 15 [75%] females; HbA1c 8.9 ± 2.0%) followed over 9 months. Outcome measures included HbA1c and the Children's Hope Scale. The intervention included automated text reminders for blood glucose monitoring, text exchanges, social events with education, and clinic visits with mentors/mentees. Mean change in HbA1c for teens was +0.09% in the intervention group, compared with +0.28% in the control group (P = .61); college students had a reduction in HbA1c of ?0.22% (P = .38). Treatment group teens had marked improvement in their hope for the future compared to control group teens (P = .04) and were more likely to attend clinic visits (P = .02). This program established feasibility for a model that could be replicated and modified for other types of settings. Additional research is warranted to study the potential long‐term benefits of participating in the All for ONE mentoring program.     

Computer-assisted detection and intervention in adolescent high-risk health behaviors

Because adolescents avoid bringing sensitive issues, such as substance abuse, suicide, and sexual activity, to pediatricians, and may fail to realize that they need health education or services, a computer program was designed to facilitate reporting of high-risk psychosocial and health behaviors and to provide specific health advice and referral for timely professional intervention. Computer printouts done anonymously by a random sample of 265 adolescents after a physical examination were compared with those of a matched group of 294 who were predirected to share the printout with the clinician at their examinations. The former elicited more positive responses to sensitive health problems, but both computer groups responded significantly more often about most high-risk issues than a matched written questionnaire group of 251. Almost all adolescents said that they reported true information to the computer and read all the information it printed. Experience with 3327 teenagers demonstrated that 89% preferred the computer over a questionnaire or personal interview, but nearly all were willing to share the printout with the pediatrician, which should facilitate clinical evaluation. The nonjudgmental computer can identify problem areas and deliver automated medical advice and referral. Automated health assessment and education may become a useful adjunct for addressing adolescent health issues.     

Effectiveness of a Reproductive Sexual Health Education Package among School Going Adolescents

Objective

To assess the effectiveness of a school based “Adolescent Reproductive Sexual Health Education (ARSHE) Package” in improving students’ knowledge on reproductive sexual health matters.

Methods

An ARSHE package originally developed at Child Development Centre, Kerala, modified and approved by ICMR taskforce group was administered in three urban schools (One boys only, one girls only and one co-education) and one co-education rural school at Thiruvananthapuram district, Kerala. The study sample consisted of 1,586 adolescents including 996 boys and 560 girls of class IX and XI. Pre and post intervention knowledge regarding reproductive sexual health matters was assessed using a self-administered questionnaire.

Results

In the pre-intervention period, it was observed that majority of adolescents were poorly informed about reproductive sexual health matters, particularly about contraceptives. As compared to boys, girls had much poorer knowledge about prevention of pregnancy and after intervention; there was a statistically significant increase in the knowledge in both boys and girls. Among girls percentage of poor knowledge had reduced significantly from 64.1% to 8.3% and among boys from 37.7% to 3.5%. Similarly, increase in knowledge level was also observed in various other aspects of reproductive and sexual health including, STI, HIV/AIDS and perceptions about premarital sex.

Conclusions

The study results revealed the feasibility and effectiveness of school based reproductive and sexual health education intervention programs for adolescents.

     

Short-term effects of school-based weight gain prevention among adolescents

OBJECTIVE: To determine whether a multicomponent health promotion intervention for Dutch adolescents would be successful in influencing body composition and aerobic fitness. DESIGN: Randomized controlled trial. SETTING: Ten intervention and 8 control prevocational secondary schools. PARTICIPANTS: A total of 978 adolescents (mean age, 12.7 years). INTERVENTION: An interdisciplinary multicomponent intervention program with an adapted curriculum for 11 biology and physical education lessons and environmental change options, including additional lessons on physical education and advice on the school canteen selection. MAIN OUTCOME MEASURES: Body height and weight, hip and waist circumference, 4 skinfold thickness measurements, and aerobic fitness. RESULTS: Multilevel analyses showed significant differences in changes after the 8-month intervention period in favor of the intervention group with regard to hip circumference (mean difference, 0.53 cm; 95% confidence interval, 0.07 to 0.98) and sum of skinfolds among girls (mean difference, -2.31 mm; 95% confidence interval, -4.34 to -0.28). In boys, the intervention resulted in a significant difference in waist circumference (mean difference, -0.57 cm; 95% confidence interval, -1.10 to -0.05). No significant intervention effects were found related to aerobic fitness. CONCLUSIONS: The multicomponent Dutch Obesity Intervention in Teenagers program positively influenced several measures of body composition among both girls and boys. Our results indicate that secondary prevocational school curriculum changes may contribute to excessive weight gain prevention among adolescents.     

A STD/HIV prevention trial among adolescents in managed care

OBJECTIVE: To determine if sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infection, risk assessment, and education tools provided as part of office-based primary care reduce adolescent risky sexual behaviors. DESIGN: A randomized intervention trial with 3- and 9-month follow-up. SETTING: Five staff-model managed care sites in Washington, DC (n = 19 pediatricians). PATIENTS: Consecutive 12- to 15-year-olds receiving a general health examination; 81% minority. Participation rate = 215/432 (50%). Nine-month follow-up rate = 197/215 (92%). INTERVENTION: Audiotaped STD risk assessment and education about staying safe (safer = condoms, safest = abstinence). MAIN OUTCOME MEASURES: Adolescent-reported sexual intercourse and condom use. RESULTS: More intervention adolescents reported pediatrician discussion on 11/13 sexual topics. Although more vaginal intercourse (odds ratio [OR] = 2.46, 95% confidence interval [CI] = 1.04-5.84) was reported in the intervention group at 3 months, this was not true of overall sexual intercourse (OR = 1.55, 95% CI =.73-3.32). More sexually active adolescents reported condom use in the intervention group at 3 months (OR = 18.05, 95% CI = 1.27-256.03). At 9 months, there were no group differences in sexual behaviors; however, more signs of STD were reported by the control (7/103) than the intervention group (0/94). CONCLUSIONS: STD risk assessment and education tools administered in a single office visit facilitated STD/HIV prevention education. Any impact on sexual activity and condom use was short-lived. Further research is needed to develop brief, office-based sexual risk reduction for young adolescents.     

Effects of the Seattle social development project on sexual behavior, pregnancy, birth, and sexually transmitted disease outcomes by age 21 years

OBJECTIVE: To examine the long-term effects of the full Seattle Social Development Project intervention on sexual behavior and associated outcomes assessed at age 21 years. DESIGN: Nonrandomized controlled trial with long-term follow-up. SETTING: Public elementary schools serving children from high-crime areas in Seattle, Wash. PARTICIPANTS: Ninety-three percent of the fifth-grade students enrolled in either the full-intervention or control group were successfully interviewed at age 21 years (n = 144 [full intervention] and n = 205 [control]). INTERVENTIONS: In-service teacher training, parenting classes, and social competence training for children. MAIN OUTCOME MEASURES: Self-report measures of all outcomes. RESULTS: The full-intervention group reported significantly fewer sexual partners and experienced a marginally reduced risk for initiating intercourse by age 21 years as compared with the control group. Among females, treatment group status was associated with a significantly reduced likelihood of both becoming pregnant and experiencing a birth by age 21 years. Among single individuals, a significantly increased probability of condom use during last intercourse was predicted by full-intervention group membership; a significant ethnic group x intervention group interaction indicated that after controlling for socioeconomic status, single African Americans were especially responsive to the intervention in terms of this outcome. Finally, a significant treatment x ethnic group interaction indicated that among African Americans, being in the full-intervention group predicted a reduced probability of contracting a sexually transmitted disease by age 21 years. CONCLUSION: A theory-based social development program that promotes academic success, social competence, and bonding to school during the elementary grades can prevent risky sexual practices and adverse health consequences in early adulthood.     

The use of focus groups in pediatric and adolescent research.

Through this past decade, health care research has focused on clinical trials and establishing intervention versus control group research to improve the health of children and adolescents. Many of these clinical intervention trials have not demonstrated significantly improved health for these persons. One possible reason for the failure to demonstrate improved health is that the young persons' perspective is lacking. Focus group method of data collection is an excellent vehicle to help gain the young person's perspective on a variety of issues related to health and wellness. Including the young person's perspective when designing a program may encourage this person to participate in the new initiative, which would ultimately improve the health of children and adolescents to a greater degree than when their perspective is not taken into account. This article discusses the use of focus groups as an important part of the research process in pediatric and adolescent populations.     

A peer education example on HIV/AIDS at a high school in Ankara

Adolescence is a transition period between childhood and adulthood in which physical, sexual and psychosocial changes occur. Sexually Transmitted Infections (STI) are the most common reproductive health problems adolescents face. Peer education is a very useful method in adolescents' education, especially on risk factors and risk taking behaviors. This peer education intervention study, including two base line studies (one before and one after the intervention), was conducted in four classes of an Anatolian high school in Ankara in 2000. The aim of the study was to evaluate the success of the peer education model. There was a significant difference in the general scores of the students before (29.52; SD = 4.38) and after (31.89; SD = 4.96) education by peer educators (p = 0.000). This study might have assisted the study population in establishing safe sex practices for a healthy sexual future.     

Adolescent transplant recipients as peer mentors: A program to improve self‐management and health‐related quality of life

The purpose of this study was to examine the safety, feasibility, acceptability, and preliminary efficacy of a cross‐age peer mentoring program created to improve adherence and psychosocial outcomes for pediatric liver transplant recipients. Twenty‐two participants were assigned to a “mentor now” or “mentor later” waitlist control group. Tacrolimus SD, a validated measure of adherence, was assessed for six months pre‐ and post‐intervention for both groups. Self‐report measures of self‐management and HRQOL were completed at recruitment and three months after training. Participant report indicated the acceptability of the intervention. Clinically significant improvement in adherence was detected. No significant changes on the psychosocial outcome measures at follow‐up were observed. This study demonstrated that an outpatient‐based mentoring program is a safe, feasible, and acceptable option to incorporate within a pediatric liver transplant program with potential for promising application in other transplantation populations as well. These results also suggest that the program may have been associated with meaningful improvement in adherence, although further evaluation is warranted.     

Long-term effects of a middle school- and high school-based human immunodeficiency virus sexual risk prevention intervention

OBJECTIVE: To determine the longer-term effect (mean +/- SD, 41.2 +/- 15.3 weeks; range, 14.1-80.5 weeks) of a middle school (MS)- and high school (HS)-based human immunodeficiency virus and sexuality intervention (Rochester AIDS Prevention Project for Youth [RAPP]) on knowledge, self-efficacy, behavior intention, and behaviors. DESIGN: Quasi-experimental design with 3 intervention groups and 1 control group. SETTING: Urban, predominantly ethnic, minority MS and HS health classes. PARTICIPANTS: Middle school and HS students (N = 4001) enrolled in health classes in 10 schools. Fifty percent were African American; 16%, Hispanic; 20%, white; and 14%, other. Less than 10% of the students refused participation. INTERVENTIONS: There were 4 study conditions: (1) control, usual health education curriculum taught by a classroom teacher; (2) RAPP adult health educator, intervention curriculum implemented by highly trained health educators; (3) RAPP peer educator, intervention implemented by extensively trained HS students; and (4) a comparison of the RAPP intervention curriculum taught by regular health teachers, implemented with MS students only. MAIN OUTCOME MEASURE: A confidential questionnaire was administered to all study subjects before and at long-term follow-up after the intervention, containing scales to measure knowledge, self-efficacy, behavior intention, and behaviors, including onset of sexual intercourse experience and engagement in risky sexual behaviors. RESULTS: Rates of baseline sexual activity in the sample were comparable to those found in other urban school-based surveys. Long-term knowledge (MS females, P<.001; and MS males, P<.01) and sexual self-efficacy (MS females, P<.05; and HS females, P<.01) scores were higher among the intervention groups (male and female are used in this study to describe those aged 9(1/2)-23 years). Intention to remain safe regarding sexual behavior was also greater among intervention groups in MS but not HS. However, subjects who were already sexually active at pretest were less likely to show a positive intervention effect. An intervention effect for the onset of intercourse and risky sexual behavior was found most significantly among MS females. CONCLUSIONS: A positive long-term effect from the RAPP intervention was observed, particularly for youth who were involved in less risk (eg, not yet sexually active) at study enrollment. Thus, we propose that the most appropriate time for intervention implementation is earlier in adolescence, before the onset of risky behaviors.     

A school-based, teacher-mediated prevention program (ERASE-Stress) for reducing terror-related traumatic reactions in Israeli youth: a quasi-randomized controlled trial

Background:  Since September 2000 Israeli children have been exposed to a large number of terrorist attacks. A universal, school-based intervention for dealing with the threat of terrorism as well as with terror-related symptoms, ERASE-Stress (ES), was evaluated in a male religious middle school in southern Israel. The program was administered by the homeroom teachers as part of the school curriculum. It consists of 12 classroom sessions each lasting 90 minutes, and included psycho-educational material, skill training and resiliency strategies delivered to the students by homeroom teachers.
Methods:  One hundred and fourteen 7th and 8th grade students were randomly assigned to the ES intervention or were part of a waiting list (WL). They were assessed on measures of posttraumatic symptomatology, depression, somatic symptoms and functional problems before and 3 months after the intervention or the WL period.
Results:  Three months after the program ended, students in the experimental group showed significant reduction in all measures compared to the waiting-list control group.
Conclusions:  The ERASE-Stress program may help students suffering from terror-related posttraumatic symptoms and mitigate the negative effects of future traumatic experiences. Furthermore, a school-based universal program such as the ERASE-Stress may potentially serve as an important and effective component of a community mental health policy for communities affected by terrorism.     

On intimacy, sexual activities and exposure to sexual abuse among children and adolescents with mobility impairment

AIM: The aim was to describe experiences of intimacy and sexual activity and exposure to sexual abuse among children and adolescents with mobility impairment, and to relate these experiences to socio-demographic data, disability characteristics and well-being. METHODS: This study included semi-structured interviews with 141 children and adolescents aged 7-18 years with mobility impairment. Interpersonal experiences of intimacy and sexuality, socio-demographic data, disability characteristics and well-being were registered. RESULTS: About half of the children and adolescents in the study had been in a boy- or a girlfriend relationship, and about a fifth had an ongoing relationship. Of the adolescents, 15% had at least one experience of a sexual relationship. Whereas no particular sexual dysfunction was reported, 15% had concerns about their future sexual activities, presumably related to mobility impairment. A history of sexual abuse was reported by 7% in the age cohort of 13-18 years. The socio-demographic and disability-related features had a marginal influence on the experiences of intimacy and sexual activities. CONCLUSION: Several aspects of sexual health are not fully realized for children and adolescents with impaired mobility, and there is a need for specialized sexual health care services to protect the sexual rights of this group.     

Deliberate self-harm by Taiwanese adolescents

Aim: Prevalence rates for deliberate self‐harm (DSH) are unusually high among Taiwanese high school students. Several models have been advanced to explain the occurrence of DSH. One, the experiential avoidance model suggests that self‐mutilation helps the individual escape from unwanted emotional experiences. The purpose of this study was to examine the demographic, health and behavioral correlates of DSH in a population (Taiwanese adolescents) known to have a high rate of DSH. Method: A structured, self‐administered questionnaire survey was completed by a sample of 742 vocational high school students in Taiwan. Results: Eighty‐four students (11.3%) acknowledged DSH behavior. Results of multivariate logistic regression analysis indicated that female students were 3.47 times as likely as male students to be in the DSH group. Avoidance behaviors of running away from school [odds ratio (OR) = 3.45] and suicide attempt (OR = 13.05), a history of headache (OR = 8.96), a history of sexual abuse (OR = 4.26) and drinking (OR = 4.12) were also significantly associated with DSH. Conclusions: Gender and a history of headaches, a history of sexual abuse, drinking, running away from school, or suicidal attempts were factors associated with DSH among Taiwanese adolescents. School personnel should be aware of these to formulate appropriate and timely interventions.     

A practitioner-based asthma intervention program with African American inner-city school children.

INTRODUCTION: Asthma is the most prevalent chronic illness, affecting more than 7 million children younger than 17 years. Asthma has become a leading public health concern because of the dramatic rise in the incidence of this disease during the past 15 years, particularly in minority populations. This study tested a two-part intervention on selected psychosocial and health outcomes of 8- to 13-year-old inner city minority students with asthma. METHOD: The intervention consisted of participation in an asthma education program (Open Airways) followed by 5 monthly visits with a nurse practitioner. The total sample of 52 children was composed of 28 children in the treatment group who received the intervention and 24 children who served as a control group. RESULTS: Students in the treatment group scored significantly higher than the control group over time on measures of asthma knowledge, asthma self-efficacy, general self-care practices, and asthma self-care practices. No significant differences were found between the two groups on health outcomes. DISCUSSION: A school-based intervention program can improve psychosocial outcomes for inner-city minority children with asthma. Recommendations for future research and clinical practice are discussed.     

Emotion regulation and internalizing symptoms in a longitudinal study of sexual minority and heterosexual adolescents

Background: Sexual minority adolescents appear to be at increased risk for internalizing disorders relative to their heterosexual peers, but there is a paucity of research explaining this elevated risk. Emotion regulation deficits are increasingly understood as important predictors of internalizing psychopathology among general samples of adolescents. The present study sought to examine whether deficits in emotion regulation could account for disparities in internalizing symptoms between sexual minority and heterosexual adolescents. Methods: The present study utilized longitudinal data from a racially/ethnically diverse (68% non‐Hispanic Black and Hispanic/Latino) community sample of 1,071 middle school students (ages 11–14). Results: Adolescents who endorsed same‐sex attraction evidenced higher rates of internalizing symptoms at both time points. Structural equation modeling indicated that sexual minority adolescents exhibited greater deficits in emotion regulation (rumination and poor emotional awareness) than their heterosexual peers. Emotion regulation deficits in turn mediated the relationship between sexual minority status and symptoms of depression and anxiety. Conclusions: The results demonstrate the importance of considering normative psychological processes in the development of internalizing symptomatology among sexual minority adolescents, and suggest emotion regulation deficits as specific targets of prevention and intervention efforts with this population. Future studies are needed to determine whether stigma‐related stressors are responsible for emotion regulation deficits among sexual minority youth.     

Sexuality in adolescence: development, experience, and proposals for intervention

OBJECTIVE: To present a literature review of some aspects concerning the development of sexuality in the period between childhood and adolescence, and to work on some proposals for prevention and intervention. METHODS: Review of literature on relevant issues related to the process of psychosocial and sexual development during childhood and adolescence, and to the importance of prevention education. RESULTS: Differently from genitality, which is only concerned with biological aspects, sexuality encompasses emotional aspects, life history and cultural values. These factors contribute to the formation of general identity and to the components of sexual identity: gender identity, gender role, and sexual orientation. Psychosocial and sexual development, emotional balance, and social relations are based on sexual experience during childhood and adolescence. During adolescence, the relationship with family and social group go through marked changes: conflicts arise, and experimentation and risk behavior are enhanced. The family, school, and health systems represent important links of identification, support, and protection for children and adolescents before they reach maturity. CONCLUSIONS: Sexuality education, either individually or in group, allows adolescents to experience sexuality and their emotional relations in a satisfactory, creative, and risk-free manner, combined with mutual respect and absence of gender discrimination.     

Effects of sexual orientation-based bullying on feelings of loneliness and sleeping difficulty among Brazilian middle school students

ObjectiveTo investigate the extent to which sexual orientation-based bullying relates to self-reported feelings of loneliness and sleeping difficulty among Brazilian middle school students.MethodThis is a cross-sectional study using data from the 2015 PeNSE (Pesquisa Nacional de Saúde do Escolar), a survey designed to monitor the health of children and adolescents enrolled in the ninth grade in public and private Brazilian schools. Multiple linear regressions stratified by sex were used on a sample of 101,646 students, considering as reference students who had not experienced bullying, as well as students who had experienced other causes of bullying; a significance level of p < 0.05 was accepted.ResultsWhen the reference group was composed of students who had not experienced bullying, the associations between sexual orientation-based bullying and feelings of loneliness and between sexual orientation-based bullying and sleeping difficulty were positive (p < 0.05) for both male and female students, with magnitudes about twice as large as those found among those who reported having experienced other cause s of bullying. However, when the reference group was composed of students who had experienced other causes of bullying, only the association between sexual orientation-based bullying and feelings of loneliness was positive (p < 0.05) for both male and female students.ConclusionThis study highlights that sexual orientation-based bullying is a predictor of feelings of loneliness.