中国北方两城市青少年健康危险行为聚集模式分析

目的 探讨城市青少年健康危险行为聚集模式及特点。方法 北方两所大城市随机抽取市区初二、高二和大学二年级7230名学生进行集体自填匿名问卷调查。以10种主要健康危险行为为聚类指标，采用样本聚类方法分别对男、女学生进行聚类。结果 根据行为发生严重程度和高发行为特点男、女生分别隶属于低危险组（男44．0％；女49．5％）、中度危险组（模式2组：男24．8％，女25．4％；模式3组：男16．3％，女12．1％）和高危险组（男14．8％；女12．9％）4类健康危险行为聚集模式人群。吸烟和饮酒在男、女生某中度危险组中高发，男、女吸烟率分别为26．8％和女8．5％；饮酒率为100％，远高于该人群总体水平，吸烟饮酒呈聚集现象；女生高危险组中自杀意念、不健康减肥和滥用药物三类“内隐性行为”发生率分别为100％，8．4％和7．5％，远高于人群总体水平和其他3组，表明这三类行为呈现聚集性，而男生高危险组中大部分行为高发，呈现“外显问题行为和内隐性行为”的高度聚集现象。结论 应针对青少年中某些行为聚集发生和聚集方式多样特点，根据性别特点，有针对性地开展一级、二级、三级预防等综合性预防干预措施。     

大学生危险行为的流行病学调查

目的 了解大学生危险行为的流行病学特征及其相关因素，以便更好地预防和控制大学生危险行为的发生。方法 按照分层整群抽样方法，随机抽取1100名大学生，由统一培训合格的调查员以无记名方式对苏州市大学生危险行为进行现场问卷调查。结果 危险行为在大学生中普遍存在，吸烟率为37％，饮酒率为86．5％，有9．6％的学生考虑过自杀，有4．9％的学生曾经有过性行为。结论 应高度重视大学生危险行为的现状并从多方面来预防和控制大学生危险行为的发生。     

Characteristics of alcohol use by school children in a northcentral Wisconsin county

Before a school-based substance abuse prevention program was introduced, students in grades 5 through 12 in a northcentral Wisconsin county completed a questionnaire on their experience with tobacco, alcohol, and other drugs. Alcohol abuse was widespread, even among the youngest students surveyed. Commencement of alcohol use in the 5th grade or earlier appears to be increasing in recent years. There was a dose response relationship observed between the amount of alcohol consumed and the reported frequency of poor grades, thoughts and attempts of suicide, driving after drinking, remorse, and memory loss. Physicians caring for adolescents need to consider the possible role of alcohol abuse in a number of clinical situations. Because of their unique expertise and stature in the community, physicians also have an important role in community-oriented substance abuse prevention programs.     

流出地校外青少年艾滋病相关危险行为及其影响因素

目的：了解流出地15~24岁未婚校外青少年艾滋病相关危险行为发生情况及影响因素,为对此人群开展相关健康教育提供参考。方法：采用整群抽样方法,抽取某县某所劳务培训和输出机构所有15~24岁未婚校外青少年进行问卷调查。以理性行为理论为基础设计结构式问卷,匿名,在调查员的指导下填写后当场装入信封回收。共收回问卷1 800份,有效问卷1 712份。利用Epidata 3.0建立数据库用SPSS 13.0软件进行统计分析。结果： (1)流出地校外青少年艾滋病危险行为发生率较高,婚前性行为的发生率为18.0%,其中过去3个月中性行为从未使用过安全套的占27.3%,有多性伴者占30.8%,有过商业性行为者占31.0%,有过使用毒品经历占9.7%;艾滋病知识知晓率仅为25.1%;同伴环境较差;(2)性行为中使用安全套与艾滋病知识得分、性关系中能谈论安全套相关;发生多性伴行为与年龄、朋友中有多性伴者、对多性伴的态度、主观规范相关;发生商业性行为与艾滋病知识得分、家庭住址、朋友中有发生商业性行为、主观规范、商业性行为意向相关;静脉吸毒与年龄、艾滋病知识得分、朋友吸毒、主观规范、吸毒意向相关;(3)理性行为理论框架中主观规范和行为意向对校外青少年艾滋病危险行为的发生影响较大。结论：流出地校外青少年感染艾滋病的危险性主要表现为缺乏相关知识和应对不良的伙伴压力的能力,应帮助他们树立良好的行为规范,外出打工前期是对校外青少年进行相关健康教育的“关键期”。     

Dating violence against adolescent girls and associated substance use, unhealthy weight control, sexual risk behavior, pregnancy, and suicidality

CONTEXT: Intimate partner violence against women is a major public health concern. Research among adults has shown that younger age is a consistent risk factor for experiencing and perpetrating intimate partner violence. However, no representative epidemiologic studies of lifetime prevalence of dating violence among adolescents have been conducted. OBJECTIVE: To assess lifetime prevalence of physical and sexual violence from dating partners among adolescent girls and associations of these forms of violence with specific health risks. DESIGN, SETTING, AND PARTICIPANTS: Female 9th through 12th-grade students who participated in the 1997 and 1999 Massachusetts Youth Risk Behavior Surveys (n = 1977 and 2186, respectively). MAIN OUTCOME MEASURES: Lifetime prevalence rates of physical and sexual dating violence and whether such violence is independently associated with substance use, unhealthy weight control, sexual risk behavior, pregnancy, and suicidality. RESULTS: Approximately 1 in 5 female students (20.2% in 1997 and 18.0% in 1999) reported being physically and/or sexually abused by a dating partner. After controlling for the effects of potentially confounding demographics and risk behaviors, data from both surveys indicate that physical and sexual dating violence against adolescent girls is associated with increased risk of substance use (eg, cocaine use for 1997, odds ratio [OR], 4.7; 95% confidence interval [CI], 2.3-9.6; for 1999, OR, 3.4; 95% CI, 1.7-6.7), unhealthy weight control behaviors (eg, use of laxatives and/or vomiting [for 1997, OR, 3.2; 95% CI, 1.8-5.5; for 1999, OR, 3.7; 95% CI, 2.2-6.5]), sexual risk behaviors (eg, first intercourse before age 15 years [for 1997, OR, 8.2; 95% CI, 5.1-13.4; for 1999, OR, 2.4; 95% CI, 1.4-4.2]), pregnancy (for 1997, OR, 6.3; 95% CI, 3.4-11.7; for 1999, OR, 3.9; 95% CI, 1.9-7.8), and suicidality (eg, attempted suicide [for 1997, OR, 7.6; 95% CI, 4.7-12.3; for 1999, OR, 8.6; 95% CI, 5.2-14.4]). CONCLUSION: Dating violence is extremely prevalent among this population, and adolescent girls who report a history of experiencing dating violence are more likely to exhibit other serious health risk behaviors.     

Childhood Adversity Phenotypes and Risky Health Behaviors among Chinese Adolescents: Extending the Concept of Adversity

ObjectiveTo present an approach to phenotyping ACEs and explore the association between ACEs and adolescent health risky behaviors based on the social context of China.MethodsTotally, 5,726 adolescents aged 12–18 years were investigated about their ACEs in the family, peer, school, and personal domains and the occurrence of six types of risky health behaviors (i.e., smoking, drinking, sexual intercourse, self-harm, and suicidal ideation and attempts). Latent class analysis (LCA) was used to explore the ACE patterns.ResultsSix latent classes of ACEs were identified, including low adversity, school adversity, school adversity and peer victimization, peer victimization, maltreatment and peer victimization, and high adversity, and associated with risky health behaviors in adolescents. Being physically punished by a teacher, experiencing sexual abuse, and experiencing family trauma most strongly differentiated from the six ACE classes and were correlated with an increased risk for risky adolescent health behaviors.ConclusionThis study supports a positive association between ACEs and risky adolescent health behaviors. Peer victimization, school adversity and associated contexts need to be considered in future ACE studies.     

Foregone health care among adolescents

CONTEXT: No annual national population estimates exist of the numbers of adolescents who think they need but do not receive health care or their risk of health problems. OBJECTIVE: To describe the proportion of adolescents who report foregone health care each year and the influence of sociodemographic factors, insurance status, past health care, and health risks/behaviors on foregone care. DESIGN: Cross-sectional analyses of data from wave 1 of the National Longitudinal Study of Adolescent Health, conducted during 1995. SETTING: In-home interviews conducted throughout the United States. PARTICIPANTS: Of 27000 adolescents in grades 7 through 12 who were invited to participate, 20746 (76.8%) completed the in-home interview. MAIN OUTCOME MEASURE: Reported foregone health care in the preceding year by individual and family characteristics, insurance status, past health care, health/behavior risk factors, and symptoms. RESULTS: On average, 2268 (18.7%) of 12 079 adolescents reported foregone health care within the past year. Factors associated with decreased risk of foregone care included continuous private or public insurance (adjusted relative risk [95% confidence interval], 0.64 [0.50-0.82] to 0.82 [0.70-0.96]), and having a physical examination within the past year (0.87 [0.78-0.97] for male and 0.79 [0.70-0.88] for female adolescents). Factors associated with increased risk of foregone care included older age (1.12 [1.06-1.15] for male), minority race/ethnicity (1.25 [1.06-1.46] to 1.50 [1.30-1.73]), single-parent home (1.31 [1.18-1.46] for female), and disability (2.03 [1.61-2.52] for male and 1.66 [1.20-2.10] for female). Adolescents participating in the following behaviors were more likely to report foregone care than those who did not: daily cigarette use (26.0% vs 16.8%; 1.34 [1.16-1.55]), frequent alcohol use (30.3% vs 18.1%; 1.34 [1.11-1.62] for male), and sexual intercourse (25.1% vs 15.1%; 1.23 [1.09-1.39] for male and 1.39 [1.23-1.56] for female). From 32.4% to 38.2% of adolescents with symptoms suggesting health problems reported foregone care (1.61 [1.13-2.26] to 2.03 [1.81-2.28]). CONCLUSIONS: Our study suggests that adolescents who forego care are at increased risk of physical and mental health problems. Efforts to improve adolescent health through health care should address factors influencing foregone care.     

海口市2011年青少年健康危险行为调查

目的了解海口市青少年健康危险行为的现状和影响因素，为制定有效的干预措施提供科学依据。方法采用分层随机抽样的方法，于2011年9-10月份对海口市6所学校18个班级907人进行不记名自填式问卷调查。结果在过去30天骑车违规、闯红灯过马路不走斑马线分别为19．74％、16．21％，过去-年有离家出走、有到过无安全防范措施场所游泳、有过自杀念头分别为10．14％、10．47％、2．43％，每周体育活动少于3次的31．5％，吸过烟26．6％，喝过酒48．1％，控制食物摄入量减肥11．7％，网络成瘾12．1％，看过色情书籍或者音像制品28．6％，有过性行为8．2％。男生在过去30天骑车违规、闯红灯过马路不走斑马线、过去-年有到过无安全防范措施场所游泳、吸过烟、喝过酒、网络成瘾、看过色情书籍或者音像制品、有过性行为的比例高于女生（P〈0．05），而女生在每周体育活动少于3次、控制食物摄入量减肥、过去-年有离家出走情况、有过自杀念头的比例高于男生（P〈0．05）。结论海口市在校青少年学生健康危险行为不容忽视，应加强健康教育，开展综合性行为干预，提高在校青少年的整体健康水平。     

小学六年级及初中一年级女生青春期性教育干预研究

目的探讨并实践对青少年学生进行性教育的方法和尺度。方法以阜新市３６３名小学六年级及初中一年级女生作为研究对象。以班级为单位，将研究对象分为干预组和对照组。在开展性教育前、性教育后１个月及性教育后４个月分别对学生进行问卷调查。结果教育后，学生性生理卫生知识得分由教育前的４．９上升到１７．２；对待月经的正确态度得分由教育前的３１．８上升到４２．３；月经来潮时具有健康乐观情绪的比例由教育前的４３．５％上升到８２．９％；能够主动寻求帮助（如有生殖系统疾病回答去医院就诊）的比例由教育前的５４．３％上升到８７．６％；注意经期卫生的比例由教育前的５０．９％上升到７９．０％；预防性侵犯意识和自我保护能力增强。教育后追踪调查结果表明，本次性教育效果具有一定的持续性。在整个性教育干预研究过程中，未发现诱导学生过早发生性行为现象。结论对小学六年级及初中一年级女生进行青春期早期的性教育在我国不但必要，而且可行。     

Substance abuse and adolescent suicidal behavior

Evidence suggests a significant association between use of psychoactive substances among adolescents and suicidal behavior among adolescents during the past two decades. Accumulating evidence, although not unanimous, supports the hypothesis of psychoactive substance abuse among adolescents as a risk factor for a range of suicidal behavior--ideation, attempted suicide, and completed suicide. With increasing rates of psychoactive substance abuse for the adolescent population during the past 20 years, this appears to be an increasingly important factor. It is not known if the association is causal. Psychoactive substance abuse appears to be associated with a greater frequency and repetitiveness of suicide attempts, more medically lethal attempts, a measured seriousness of intention, and greater suicidal ideation. Additional data support a specific association between alcohol intoxication and suicide by firearms among adolescents. Adolescents who abuse psychoactive substances, particularly those with any type of depressive disorder, appear to be at higher risk for suicidal behavior and may need appropriate psychiatric treatment.     

延安市医学生健康危险行为及其影响因素

目的 了解延安市医学生健康危险行为现况及其影响因素,为进一步改善医学生健康状况提供科学依据。方法 通过分层整群抽样法抽取延安市某大学共计1 103名医学生,借助《中国青少年健康行为调查问卷》(高中和大学版)进行匿名调查,并利用χ²检验、二元logistic回归分析法分析各维度健康危险行为的影响因素。结果 参与调查的医学生健康危险行为中不良饮食行为、缺乏锻炼行为和故意伤害行为的发生率较高,分别占比为66.6%、44.2%和51.5%。单因素分析中,性别、年级、自评学习成绩、BMI、缺乏锻炼、自杀意念、自杀未遂、离家出走意念、孤独感、饮酒成瘾、被欺负和吸烟成瘾等均是健康危险行为的影响因素(P<0.05);二元logistic回归结果显示,性别是不良饮食行为、缺乏锻炼行为的影响因素;BMI是不良饮食行为、物质成瘾行为的影响因素;饮酒成瘾是缺乏锻炼行为、非故意伤害行为的影响因素;吸烟成瘾是伤害行为、精神成瘾行为的影响因素,自杀未遂、网络成瘾和故意伤害行为是不良性行为的影响因素。结论 健康危险行为在延安市医学生中普遍存在,应当引起重视,要提高医学生健康危险行为意识,注...     

Contemporary threats to adolescent health in the United States

Over the past 30 years, adolescents have been the only population in the United States who have not experienced improvement in their health status. Violence has replaced communicable diseases as the primary cause of juvenile mortality and, currently, over 77% of adolescent deaths are caused by accidents, suicide, and homicide. Increasingly, poverty, life-style, and risk-taking behaviors are influencing the morbidities of youth, with associated sequelae of trauma, adolescent pregnancy, substance abuse, physical/sexual abuse, and most other major health problems of adolescents. Clinicians seem to be interested in addressing the shifting nature of adolescent morbidity, yet are insufficiently trained to be effective. The physician must go beyond traditional clinical medicine and address the social, environmental, and behavioral factors that underlie current morbidity.     

广州市海珠区中学生性行为现况及相关因素分析

目的了解广州市海珠区中学生性行为状况及其相关因素,为开展性健康教育提供依据。方法采取分层整群抽样的方法,应用"青少年健康相关行为调查问卷"对广州市海珠区4 308名中学生进行问卷调查。结果中学生从学校接受青春期知识教育的报告率为66.8%;观看色情信息的报告率为14.3%;特殊意义异性朋友(单独约会过)的自报率为26.1%;边缘性行为的报告率,拥抱为17.5%、接吻为12.2%、抚摸异性身体为8.5%;曾发生性交行为的报告率为3.5%,其中30.9%曾在被迫情况下与他人发生过性行为。性别、年级、父亲文化程度、每月零花钱、观看黄色刊物/音像制品、赞成中学生恋爱、约会过、有边缘性行为、吸烟、饮酒、使用镇静催眠类药物、吸毒史与性行为的发生有直接影响作用(P<0.001)。结论不良性行为已成为影响广州市海珠区中学生健康成长的危险行为之一。社会、家庭、学校应通力合作,采取干预措施,促进青少年健康成长。     

青少年危险行为群体发生频率和程度的比较分析

目的 探讨危险行为在青少年群体中发生频率和程度,为青少年危险行为的研究和干预提供理论依据.方法 抽取不同省份、不同年级的在校中学生和大学一年级学生,采用青少年危险行为问卷(RBQ-A)对他们进行测查,并对结果进行统计分析.结果 (1)在各类危险行为发生频率中,除攻击或暴力行为外,3个年龄段人群的危险行为均存在统计学差异(P<0.05或P<0.01).在不安全性行为、攻击或暴力行为、危险、破坏或非法行为、酒精或药物使用及吸烟危险行为中男性发生率(分别为3.10%、3.21%、2.38%、2.06%、9.73%)高于女性(分别为2.65%、2.80%、2.1%、1.40%、7.59%)(P<0.05或P<0.01).危险、破坏或非法行为,酒精或药物使用两种危险行为发生率城市高于农村(P<0.05或P<0.01).高收入家庭(人均收入>3000元)中不安全性行为、违规行为发生率高于低收入家庭(人均收入<3000元)(P<0.05或P<0.01);而低收入家庭中危险、破坏或非法行为,酒精或药物使用及吸烟发生率高于高收入家庭(P<0.05或P<0.01).(2)各类危险行为发生程度差异性比较中,在不安全性行为、攻击或暴力行为、危险、破坏或非法行为、酒精或药物使用、吸烟方面男性和女性间差异有显著性(P<0.05或P<0.01).16岁以上与14～15年龄组在危险、破坏或非法行为、酒精或药物使用及吸烟行为方面差异存在显著性(P<0.05或P<0.01).在违规行为、危险、破坏或非法行为方面,城乡间差异存在显著性(P<0.05或P<0.01).危险行为的总分在性别及城乡方面差异有显著性(P<0.05).结论 危险行为在年龄、性别、城乡等方面存在差异;发生率存在差异的危险行为,在程度和发生频率的总分上可能并没有差异,为进一步研究和有效干预提供理论依据.     

Communication with Parents and Peers on Sexual Matters： the Experience of Adolescents in the Northeastern of China

The China National Statistic Bureau reported that the average age at first marriage for women increased from 22.9 years in 1995 to 23.6 years in 1999[1]. As a result of the delayedmarriage and presumed earlier sexual debut, more young people are exposed t…     

Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: findings from the Adverse Childhood Experiences Study.

CONTEXT: Suicide is a leading cause of death in the United States, but identifying persons at risk is difficult. Thus, the US surgeon general has made suicide prevention a national priority. An expanding body of research suggests that childhood trauma and adverse experiences can lead to a variety of negative health outcomes, including attempted suicide among adolescents and adults. OBJECTIVE: To examine the relationship between the risk of suicide attempts and adverse childhood experiences and the number of such experiences (adverse childhood experiences [ACE] score). DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study of 17 337 adult health maintenance organization members (54% female; mean [SD] age, 57 [15.3] years) who attended a primary care clinic in San Diego, Calif, within a 3-year period (1995-1997) and completed a survey about childhood abuse and household dysfunction, suicide attempts (including age at first attempt), and multiple other health-related issues. MAIN OUTCOME MEASURE: Self-reported suicide attempts, compared by number of adverse childhood experiences, including emotional, physical, and sexual abuse; household substance abuse, mental illness, and incarceration; and parental domestic violence, separation, or divorce. RESULTS: The lifetime prevalence of having at least 1 suicide attempt was 3.8%. Adverse childhood experiences in any category increased the risk of attempted suicide 2- to 5-fold. The ACE score had a strong, graded relationship to attempted suicide during childhood/adolescence and adulthood (P<.001). Compared with persons with no such experiences (prevalence of attempted suicide, 1.1%), the adjusted odds ratio of ever attempting suicide among persons with 7 or more experiences (35.2%) was 31.1 (95% confidence interval, 20.6-47.1). Adjustment for illicit drug use, depressed affect, and self-reported alcoholism reduced the strength of the relationship between the ACE score and suicide attempts, suggesting partial mediation of the adverse childhood experience-suicide attempt relationship by these factors. The population-attributable risk fractions for 1 or more experiences were 67%, 64%, and 80% for lifetime, adult, and childhood/adolescent suicide attempts, respectively. CONCLUSIONS: A powerful graded relationship exists between adverse childhood experiences and risk of attempted suicide throughout the life span. Alcoholism, depressed affect, and illicit drug use, which are strongly associated with such experiences, appear to partially mediate this relationship. Because estimates of the attributable risk fraction caused by these experiences were large, prevention of these experiences and the treatment of persons affected by them may lead to progress in suicide prevention.     

Sexual behaviors and reproductive health outcomes: associations with wife abuse in India

CONTEXT: Wife abuse has been associated with a variety of health concerns. Associations between abuse and reproductive health in India are not well known. OBJECTIVE: To examine relationships between men's reports of wife abuse and reproductive health issues in northern India. DESIGN: Structured face-to-face interviews were conducted as part of the male reproductive health supplement of the PERFORM System of Indicators Survey, a systematic multistage survey conducted in 1995-1996. SETTING: The northern state of Uttar Pradesh, one of the least developed states in India. PARTICIPANTS: A total of 6632 married men aged 15 to 65 years who lived with their wives and completed all survey questions for the study variables reported here. MAIN MEASURES: Physically and sexually abusive behaviors toward wives, sexual activities outside marriage, sexually transmitted disease (STD) symptoms, contraception use, unplanned pregnancies, and sociodemographic characteristics. RESULTS: Fifty-four percent of men reported not abusing their wives, while 17% reported physically but not sexually abusing their wives, 22% reported sexual abuse without physical force, and 7% reported sexual abuse with physical force. Abuse was more common among men who had extramarital sex (for sexual abuse using force: odds ratio [OR], 6.22; 95% confidence interval [CI], 3.98-9.72). Similarly, men who had STD symptoms were more likely to abuse their wives (with current symptoms: OR, 2.43; 95% CI, 1.73-3.42). Unplanned pregnancies were significantly more common among wives of abusive men, especially sexually abusive men who used force (OR, 2.62; 95% CI, 1.91-3.60). CONCLUSIONS: Wife abuse appears to be fairly common in northern India. Our findings that abusive men were more likely to engage in extramarital sex and have STD symptoms suggest that these men may be acquiring STDs from their extramarital relationships, thereby placing their wives at risk for STD acquisition, sometimes via sexual abuse. These abusive sexual behaviors also may result in an elevated rate of unplanned pregnancies.     

Abstinence and Safer Sex HIV Risk-Reduction Interventions for African American Adolescents: A Randomized Controlled Trial

Context.— African American adolescents are at high risk of contracting sexually transmitted infection with human immunodeficiency virus (HIV), but which behavioral interventions to reduce risk are most effective and who should conduct them is not known. Objective.— To evaluate the effects of abstinence and safer-sex HIV risk-reduction interventions on young inner-city African American adolescents' HIV sexual risk behaviors when implemented by adult facilitators as compared with peer cofacilitators. Design.— Randomized controlled trial with 3-, 6-, and 12-month follow-up. Setting.— Three middle schools serving low-income African American communities in Philadelphia, Pa. Participants.— A total of 659 African American adolescents recruited for a Saturday program. Interventions.— Based on cognitive-behavioral theories and elicitation research, interventions involved 8 1-hour modules implemented by adult facilitators or peer cofacilitators. Abstinence intervention stressed delaying sexual intercourse or reducing its frequency; safer-sex intervention stressed condom use; control intervention concerned health issues unrelated to sexual behavior. Main Outcome Measures.— Self-reported sexual intercourse, condom use, and unprotected sexual intercourse. Results.— Mean age of the enrollees was 11.8 years; 53% were female and 92.6% were still enrolled at 12 months. Abstinence intervention participants were less likely to report having sexual intercourse in the 3 months after intervention than were control group participants (12.5% vs 21.5%, P=.02), but not at 6- or 12-month follow-up (17.2% vs 22.7%, P=.14; 20.0% vs 23.1%, P=.42, respectively). Safer-sex intervention participants reported significantly more consistent condom use than did control group participants at 3 months (odds ratio [OR]=3.38; 95% confidence interval [CI], 1.25-9.16) and higher frequency of condom use at all follow-ups. Among adolescents who reported sexual experience at baseline, the safer-sex intervention group reported less sexual intercourse in the previous 3 months at 6- and 12-month follow-up than did control and abstinence intervention (adjusted mean days over prior 3 months, 1.34 vs 3.77 and 3.03, respectively; P.01 at 12-month follow-up) and less unprotected intercourse at all follow-ups than did control group (adjusted mean days, 0.04 vs 1.85, respectively, P<.001, at 12-month follow-up). There were no differences in intervention effects with adult facilitators as compared with peer cofacilitators. Conclusion.— Both abstinence and safer-sex interventions can reduce HIV sexual risk behaviors, but safer-sex interventions may be especially effective with sexually experienced adolescents and may have longer-lasting effects.      

Sexual matters among teenagers

In the complex developmental period of puberty, adolescents experience biophysical changes and adapt to societal and cultural expectations of adulthood. Development of their sexuality is an important biopsychosocial change during this period that, when neglected, may result in unmet sexual and reproductive health needs. Patterns of behaviour in adolescence have repercussions across the lifespan. HEADSSS (home, education/employment/eating, activities, drugs, sexuality, sleep, suicide/depression and safety) is a systematic clinical screening tool for use with adolescents. Adolescents may view risk-seeking lifestyle patterns as appropriate behaviours, and physicians can help them recognise the risks and develop less harmful alternatives and strategies. Personal biases should not affect healthcare providers’ duty to respect the rights of adolescents and ability to provide developmentally appropriate care. Healthcare professionals should be familiar with the relevant legal statutes in Singapore and refer suspected sexual abuse or violence, risk of self-harm, teenage pregnancy, newly diagnosed sexual transmitted infections or multiple risk-seeking behaviours for further evaluation and help.     

Juvenile delinquency in American Indian youths: historical and cultural factors

This paper addresses health aspects of juvenile delinquency in American Indian youths. Comorbid conditions such as substance abuse and depression often complicate diagnosis and treatment. A survey of the literature and an examination of cultural, family, and school issues that influence the presentation and management of conduct problems in Native American youths are included. Cases are presented to emphasize the importance of cultural sensitivity in clinical assessment and intervention.