Incarcerated adolescents' experiences as perpetrators of sexual assault

OBJECTIVES: To identify self-reported characteristics of past sexual assaults perpetrated by incarcerated juveniles and to determine potential precursors of this behavior. PARTICIPANTS AND METHODS: Participants completed an anonymous written questionnaire regarding their experiences of sexual abuse and/or assault as both a victim and a perpetrator. The questionnaire was incorporated into an existing annual survey of gang-related behaviors. RESULTS: A total of 805 adolescents (707 boys, 91 girls, and 7 gender-not-designated) participated. Of these teens, 79 males (11% of the males), 9 females (10% of the females), and 5 (71%) gender-not-designated said they had forced sex on someone (165 did not answer the question). Twenty-eight males (30% of the male perpetrators) and 4 females (44% of the female perpetrators) were both victims and perpetrators. Drugs and/or alcohol were frequently used by both the assailant (58% of the males and 55% of the females) and the victim (56% for the males and 66% for the females). The attributes of adolescent boys at highest risk of becoming perpetrators were all related to violence, including exposure to parents who were violent in the home (adjusted odds ratio, 2.68), being a victim of physical or sexual assault (adjusted odds ratio, 2.83), having parents who encouraged gang membership (adjusted odds ratio, 3.58), and knowing a perpetrator of sexual violence (adjusted odds ratio, 3.83). CONCLUSIONS: Adolescent boys and girls were both victims and perpetrators of sexual assault. Programs that identify and target violence in young children's lives, particularly intrafamilial violence, may reduce the risk of teenagers becoming perpetrators of sexual violence. Anticipatory guidance during teen years, regarding risk and avoidance of sexual exploitation, may be helpful in reducing the chances of sexual assaults.     

Recording of community violence by medical and police services

OBJECTIVES: To determine the extent to which community violence that results in injury treated in emergency departments appears in official police records and to identify age/gender groups at particular risk of under-recording by the police. METHODS: Non-confidential data for patients with assault related injury treated in the emergency departments of two hospitals in one South Wales city (Swansea) during a six month period were compared with data relating to all recorded crimes in the category "Violence against the person" in the police area where the hospitals were located. RESULTS: Over the six month period a total of 1513 assaults were recorded by Swansea emergency departments and the police (1019, 67.3% injured males and 494, 32.7% injured females). The majority of these assaults (993, 65.6%) were recorded exclusively by emergency departments; 357 (23.6%) were recorded only by the police and 163 (10.8%) were recorded by both emergency departments and the police. Equal proportions of males (67.3%) and females (67.5%) injured in assaults were recorded by both emergency departments and the police, but men were more likely to have their assault recorded exclusively in emergency departments (odds ratio (OR) 2.1, 95% confidence interval (CI) 1.7 to 2.7) while women were more likely to have their assault recorded exclusively by the police (OR 2.5, 95% CI 2.0 to 3.2). There were no significant relationships between exclusive emergency department recording and increasing age (OR 1.0, 95% CI 0.9 to 1.2), exclusive police recording and increasing age (OR 1.1, 95% CI 1.0 to 1.2), or between age and dual recording (OR 0.9, 95% CI 0.8 to 1.0). CONCLUSIONS: Most assaults leading to emergency department treatment, particularly in which males were injured, were not recorded by the police. Assaults on the youngest group (0-10, particularly boys) were those least likely to be recorded by police and females over age 45, the most likely. Emergency department derived assault data provide unique perspectives of community violence and police detection.     

Identification and characteristics of victims of violence identified by emergency physicians, triage nurses, and the police

OBJECTIVES: The objectives of the study were threefold-to evaluate the identification and characteristics of victims of assault who attend an accident and emergency (A&E) department; to compare the total number of assaults recorded in the A&E department with the number recorded by the police; and to assess a system for collecting the location and method of assault. SETTING: The A&E department of Chorley and South Ribble Hospital Trust, Lancashire, England. METHODS: A three month prospective study was performed. Victims of violence recorded on computer by doctors at discharge were compared with those identified at initial nurse triage. A comparison of police data with the A&E data relating to Chorley residents was performed. Additional information on the method and location of assault was also collected. RESULTS: During the period 305 (2.6%) of the patients attending A&E were identified as having been assaulted. Of the 305 individuals, 236 (77%) were identified by a doctor while 173 (57%) such patients were identified by a triage nurse. A&E identified twice the number of assaults involving Chorley residents as the police. Both men and women were most likely to have been injured on the street (44% and 37% respectively), although a greater proportion of women were injured at home (24%) than men (10%). The majority of injuries were sustained by blows from fists, feet, and heads (73%). CONCLUSIONS: A&E doctors identify significantly more patients as the victims of violence than do nurses at triage. Using A&E data identifies assaulted individuals not identified by the police. Computer systems can be used in A&E to provide a more complete picture of the occurrence of violence in the community.     

Predictors of injury from fighting among adolescent males

OBJECTIVES: To identify violence related behaviors associated with injuries among adolescent males involved in fights. METHODS: Data from the National Longitudinal Study of Adolescent Health were used to develop weighted estimates of injury prevalence and associations between injury and violence related behaviors. RESULTS: Forty seven per cent injured others and 18% were themselves injured in a fight among adolescent males in the preceding 12 months. Group fighting, fighting with strangers, and weapon use were predictive of injury in this sample. CONCLUSIONS: These findings suggest that injuries associated with fighting are a health risk among adolescent males. Certain behaviors, such as fighting in groups and fighting with strangers, increase the likelihood of injuries requiring medical attention.     

Injuries to children who had preinjury cognitive impairment: a 10-year retrospective review

OBJECTIVE: To determine differences between hospitalized injured children who had preinjury cognitive impairments (IMPs) and children who had no preinjury cognitive conditions (NO). DESIGN: Comparative analysis, excluding fatalities, of patients with IMP (n = 371) with patients with NO (n = 58 745), aged from 0 to 19 years. MAIN OUTCOME MEASURES: Demographics, injury characteristics, injury nature and severity, use of resources, disability, and disposition at discharge from acute care. DATA SOURCE: Medical records of children injured between January 1, 1989, and December 31, 1998, submitted to the National Pediatric Trauma Registry, Boston, Mass. RESULTS: Compared with children with NO, children with IMPs were more likely to be boys (72.5% vs 64.3%), to be older (53.1% vs 40.0%, aged 10-19 years), to be victims of child abuse (5.9% vs 1.6%), and to be individuals with self-inflicted injuries (2.2% vs 0.1%). They were more likely to be injured as pedestrians (19.9% vs 13.8%), less likely to be injured in sport activities (2.7% vs 6.9%), and less likely to sustain a penetrating injury (3.8% vs 8.3%). They were more likely to sustain injuries to multiple body regions (57.4% vs 43.7%) and the head (62.0% vs 45.1%), and to be severely injured. They were more likely to be admitted to the intensive care unit (52.6% vs 25.2), and their mean length of stay was twice as long (9.9 vs 4.8 days). They were also more likely to develop impairments from the current injury (46.6% vs 41.0%) and more likely to be discharged to a rehabilitation facility (11.1% vs 2.3%). The IMPs became worse in 75 children. CONCLUSIONS: Preinjury cognitive impairments in a pediatric population had a significant effect on the causes, nature, severity of injury, and outcomes. Targeted prevention programs should consider the characteristics of this population.     

Adolescent risk-taking behavior and the occurrence of sexual assault

The medical records of adolescent sexual assault victims presenting to Harborview Medical Center's Emergency Trauma Center, Seattle, were examined to determine behavioral risk factors preceding the assault. Twenty-six percent of the group were impaired by alcohol or other drugs during the assault. Forty-six percent of the assaults occurred after social interactions with strangers in unprotected surroundings. Five percent occurred after adolescents "hitchhiked" and accepted rides from strangers. Many of the assaults occurred between 10 PM and 4 AM. The incidence of injuries in victims was high (39%), while the incidence of serious injury was zero. Risk-taking behaviors were commonly encountered in adolescent sexual assault victims.     

Characterization of interpersonal violence events involving young adolescent girls vs events involving young adolescent boys

BACKGROUND: Multiple studies have demonstrated that girls are engaging in interpersonal violence. However, little is known about the potentially unique aspects of violent events involving girls. OBJECTIVES: To describe characteristics of interpersonal violence events in preadolescents and young adolescents and to determine if events involving any girl are different than those involving only boys. DESIGN: A cross-sectional survey of 8- to 14-year-old patients who were being evaluated at an urban children's hospital emergency department for injuries caused by interpersonal violence was conducted between September 2000 and August 2001. The survey asked the patient to describe details about event circumstances, opponents, weapon use, and injury severity. RESULTS: We enrolled 190 patients into the study; 58 (31%) were girls. Seventy-four events (39%) had a girl involved, 156 (82%) occurred on a weekday, 127 (67%) were classified as fights, 140 (74%) were with a known opponent, and 93 (49%) occurred at school. Events involving girls were more likely than events involving all boys to occur at home (relative risk [RR], 1.6; 95% confidence interval [CI], 1.0-2.5). Both boys and girls reported "being disrespected" and "teasing" as popular reasons for a fight. Events involving girls were more commonly related to a "recurrence of a previous fight" (RR, 6.4; 95% CI, 1.9-21.5), were more likely to end because of adult intervention (RR, 1.7; 95% CI, 1.1-2.6), and have a family member try to physically break up the fight (RR, 3.7; 95% CI, 1.5-9.1). CONCLUSION: Violent events involving preadolescent and early adolescent girls are more likely to be in response to a previous event and to involve the home environment and family member intervention. Health care professionals should screen violently injured girls for safety concerns and retaliation plans and consider engaging the family in efforts to prevent future events.     

Dating violence, sexual assault, and suicide attempts among urban teenagers

OBJECTIVE: To evaluate the relationship between dating violence, sexual assault, and suicide attempts among urban adolescents. DESIGN: Secondary analysis of the 2005 New York City Youth Risk Behavior Survey. SETTING: Eighty-seven New York City public high schools. PARTICIPANTS: Representative population-based sample of 8080 students, 14 years and older. MAIN EXPOSURES: Dating violence in the past year and lifetime history of sexual assault. OUTCOME MEASURE: One or more suicide attempts in the past year. RESULTS: Respondents were 50.0% female and primarily black (36.0%) or Hispanic (40.1%). In the past year, 11.7% of females and 7.2% of males reported 1 or more suicide attempts. Lifetime history of sexual assault was reported by 9.6% of females and 5.4% of males. Dating violence in the past year was reported by 10.6% of females and 9.5% of males. In multivariate models, controlling for persistent sadness, sexual orientation, and significant risk behaviors, recent dating violence (odds ratio, 1.61; 95% confidence interval, 1.05-2.47) was associated with suicide attempts in adolescent girls, while lifetime history of sexual assault (odds ratio, 3.86; 95% confidence interval, 2.11-7.06) was associated with suicide attempts in adolescent boys. CONCLUSIONS: In this population of urban youth, recent dating violence among females and lifetime history of sexual assault among males were significantly associated with suicide attempts. Clinicians and educators should be trained to routinely screen adolescents for violence victimization and should have a low threshold for referring these at-risk teenagers for mental health services.     

Self-reported weight status and dieting in a cross-sectional sample of young adolescents: National Health and Nutrition Examination Survey III.

OBJECTIVE: To explore the relationship of self-reported weight status and dieting to actual weight and height in a cross-sectional nationally representative sample of young adolescents. METHODS: Weights and heights were obtained on 1932 adolescents aged 12 to 16 years enrolled in the National Health and Nutrition Examination Survey III. Information on adolescents' perception of weight status, desired weight, and weight loss attempts was obtained by questionnaire. RESULTS: Adolescents' reports of whether they considered themselves overweight or normal weight correlated poorly with medical definitions of overweight: 52% of girls who considered themselves overweight were, in fact, normal weight (body mass index < or = 85th percentile), while only 25% of boys who considered themselves overweight were normal weight (P<.001). Adolescent white girls were significantly more likely to consider themselves overweight, even when their weight status was normal, than black girls (P<.001), black boys (P<.001), and white boys (P<.001). Adolescent white girls were also more likely to diet than black girls (P<.001), black boys (P<.001), and white boys (P<.001). Dieting behavior was associated with whether adolescents viewed themselves as overweight independent of whether they actually were overweight. Racial differences between dieting and self-perceived weight status were limited to girls. There were no significant differences in self-perceived weight status (P = .28), dieting behaviors (P = .99), and desire to weigh less (P = .95) among black and white boys. CONCLUSIONS: Significant sex and racial differences existed in weight perception, desired weight, and dieting. A high proportion of normal-weight white girls consider themselves overweight and have attempted to lose weight.     

Adolescent pregnancy and homicide: findings from the Maryland Office of the Chief Medical Examiner, 1994-1998

Homicide has remained the third leading cause of death among girls aged 10 to 19 for more than a decade. Recent research indicates that pregnant or postpartum teens are three times more likely to be victims of homicide compared to their nonpregnant counterparts. These findings portray a compelling picture that leads the authors to investigate the relationship between homicide and pregnancy among teens in Maryland. The purpose of this study is to compare women whose deaths had been evaluated by the medical examiner and who had evidence of pregnancy to women without evidence of pregnancy, with a particular focus on adolescents; 329 (17.7%) adults and 66 (32.7%) adolescents were victims of homicide. Adolescent homicide victims were 3.7 (1.2 to 11.8) times more likely to be pregnant compared to adult homicide victims. The rate of homicide was nearly double in all women who were pregnant. Further research is necessary to evaluate factors associated with these risks so that the future generation and society are protected.     

Health-compromising behaviors: why do adolescents smoke or drink?: identifying underlying risk and protective factors

OBJECTIVES: To better understand the motivation for adolescent smoking and drinking and to identify the underlying risk and protective factors associated with these behaviors among adolescents. DESIGN: Cross-sectional, school-based survey of students in grades 5 through 12. PARTICIPANTS: A nationally representative sample of 2574 boys and 2939 girls in grades 7 through 12 from 297 public, private, and parochial schools across the United States who participated in The Commonwealth Fund Survey of the Health of Adolescent Girls and Boys in 1997. MAIN OUTCOME MEASURES: Sex-specific adjusted relative risks (RRs) and 95% confidence intervals (CIs) comparing self-reported regular smokers and regular drinkers by risk and protective factors with adolescents reporting none of these behaviors. RESULTS: Adolescent boys and girls were equally likely to be regular smokers (11.2%). The prevalence rate of regular drinking was only slightly higher for boys (22.4%) than it was for girls (19.3%). The rates of both health-risk behaviors were significantly higher for those reporting risk factors, and the strengths of associations varied by sex. Sex differences also emerged in motivation for engaging in these behaviors. When we adjusted for demographic characteristics, exposure to childhood abuse (RR, 4.1; 95% CI, 2.4-7.0) and stressful life events (RR, 2.4; 95% CI, 1.1-5.4) were strongly associated with increased risk for boys' regular smoking. Similar associations were found for regular drinking. For girls, a history of abuse (RR, 1.8; 95% CI, 1.1-2.8), violence within the family (RR, 2.2; 95% CI, 1.6-3.2), depressive symptoms (RR, 1.6; 95% CI, 1.0-2.4), and stressful life events (RR, 3.1; 95% CI, 1.8-5.6) were significantly associated with increased risk for regular smoking. Similar associations were again found for regular drinking. Parental support was protective against both health-risk behaviors for both sexes. Participation in extracurricular activities was associated with lower risk for regular smoking for boys (RR, 0.4; 95% CI, 0.2-0.7) and for girls (RR, 0.3; 95% CI, 0.2-0.5); however, there was no significant association between drinking behavior and participation in activities. CONCLUSIONS: The increased risk for regular smoking and regular drinking among adolescents with a history of abuse, family violence, depressive symptoms, and stressful life events suggests that routine screening for abuse, violence, and other family experiences should be an essential component of adolescent health care visits. Effective prevention programs to reduce smoking and drinking among adolescents should recognize that health-risk behaviors may be associated with other negative life experiences and that the strength of these associations differs by sex.     

Sexual victimization and reproductive health outcomes in urban youth.

OBJECTIVE: Adolescents and adults with a history of sexual victimization (SV) are at increased risk of engaging in sexual risk behaviors. This study seeks to examine race- and gender-based differences in SV as well as the association between SV and reproductive health outcomes (pregnancy and sexually transmitted infections [STIs]) among young adults from an urban community with high rates of both outcomes. METHODS: This study used cross-sectional data from the Young Adult Survey of the Baltimore Prevention Program's intervention trials. Participants initially enrolled as first graders were interviewed for the Young Adult Survey as they entered adulthood. A total of 1698 participants were asked about SV, pregnancy, and STIs. Data were analyzed by logistic regression analysis. RESULTS: History of SV did not vary by racial background, but female participants were more likely to report SV than their male peers. Results for models predicting STIs revealed a significant interaction between gender and SV. Adolescent girls who reported a SV were significantly more likely to have an STI than adolescent girls who did not report victimization. Both adolescent boys and girls who reported SV were more likely to report involvement in a pregnancy. CONCLUSIONS: Youth in urban communities with a history of SV are far more likely than those without victimization histories to have a pregnancy or STI before young adulthood. Further research is needed to explore the mediators of these outcomes and the value of sexual safety and child protection programs for pregnancy and STI prevention in urban environments.     

Weight concerns and weight control behaviors of adolescents and their mothers

OBJECTIVE: To assess the association between weight concerns and weight control practices of adolescents and their mothers. DESIGN AND PARTICIPANTS: Cross-sectional study of 5331 adolescent girls and 3881 adolescent boys (age range, 11.8-18.4 years) in an ongoing cohort study and their mothers. Participants were included in the analysis if both the adolescent and his or her mother returned a questionnaire mailed in 1999 and provided information on weight, height, and weight concerns. RESULTS: More adolescent girls (33.0%) than boys (8.1%) thought frequently about wanting to be thinner. Compared with adolescent girls who accurately perceived that their thinness was not important to their mother, girls who misperceived (odds ratio [OR] = 1.9; 95% confidence interval [CI], 1.3-2.8) or accurately perceived (OR = 2.85; 95% CI, 1.0-8.4) that it was important to their mother that they be thin were significantly more likely to think frequently about wanting to be thinner. Among the adolescent boys, only those who accurately perceived that it was important to their mother that they not be fat were more likely than their peers to think frequently about wanting to be thinner (OR = 3.8; 95% CI, 2.3-6.2). Adolescents who accurately perceived that it was important to their mother to be thin or not fat were significantly more likely to be frequent dieters than their peers who accurately perceived that their weight was not important to their mother. CONCLUSION: Among adolescents, an accurate perception that weight status is important to their mother is associated with thinking frequently about wanting to be thinner and about frequent dieting.     

Relationships of US youth homicide victims and their offenders, 1976-1999

BACKGROUND: Homicide is the second leading cause of death in children aged 0 to 19 years. Tailoring violence prevention programs to high-risk individuals requires understanding victim-offender relationships. OBJECTIVE: To elucidate differences in the relationships between homicide victims aged 0 to 19 years and their offenders. DESIGN: Cross-sectional study using the Uniform Crime Reports: Supplemental Homicide Reports, 1976-1999. SETTING AND PARTICIPANTS: The Supplemental Homicide Reports contain incident-level information about criminal homicides, including location and victim and offender characteristics. National coverage is approximately 92%; 70 258 victims were studied. MAIN OUTCOME MEASURES: Differences in the relationships of homicide victims and offenders based on sex, age, population of homicide location, and weapon. RESULTS: Odds ratios and 95% confidence intervals (CIs) are reported. Using strangers as the referent group, murdered girls were 3.6 (95% CI, 3.4-3.9) times more likely to have been killed by family members and 21.3 (95% CI, 18.5-24.4) times more likely to have been killed by intimate partners than murdered boys. Victims younger than 10 years were 33 (95% CI, 30.4-36.1) times more likely than victims older than 10 years to have been killed by a family member and 2.4 (95% CI, 2.2-2.6) times more likely to have been killed by someone else known to them. Stranger homicides occurred in areas with approximately 145 000 more residents (P<.01). Handguns were more likely to be used during homicides committed by strangers (P<.01). These associations remained after adjusting for potential confounders. CONCLUSIONS: Future violence prevention programs may have more effect when targeted to specific sex and age groups. Elucidation of the origins of sex differences, focus on evidence-based child abuse prevention efforts, and enforcement of current gun control laws may help reduce the number of homicides among children.     

Violent death and injury in US children and adolescents

Violence, including homicide, child abuse and neglect, and assault by peers and others, causes over 2000 deaths a year to US children aged 0 to 19 years. Homicide is a leading cause of death for US children and adolescents, and so a major cause of years of potential life lost. Infantile and adolescent patterns of homicide are recognized: child abuse by parents characterizes the former; gunshots and other assaults by peers characterize the latter. Nonfatal violent injury is far more prevalent than the fatalities. Reliable estimates indicate that each year close to 1 million female adolescents are sexually assaulted, and more than 1.5 million children and adolescents are abused by the adults responsible for them. Adolescents experience violent crimes at extremely high rates. Risk factors for violent injury are recognized. The most consistent include male sex (except for sexual abuse) and urban residence. Despite the toll of violence, surprisingly little is known about its origins and means to prevent it. The only prevention approach that has been both well evaluated and of apparent benefit is the home health visitor for prevention of child abuse in infants of young, impoverished, unmarried primiparous women. Many other approaches are plausible, promising, and/or being implemented, and these require thorough trial and evaluation. Research on numerous aspects of the precursors and correlates of violence against children is also needed.     

Injuries to children with attention deficit hyperactivity disorder

OBJECTIVES: To determine differences between hospital admitted injuries to children with preinjury attention deficit hyperactivity disorder (ADHD) and injuries to those with no preinjury conditions (NO). DESIGN: Comparative analysis, excluding fatalities, of ADHD patients (n = 240) to NO patients (n = 21 902), 5 through 14 years of age. OUTCOME MEASURES: Demographics, injury characteristics, length of stay, admission to the intensive care unit, surgical intervention, disability, and disposition at discharge. DATA SOURCE: Retrospective review of charts submitted by more than 70 hospitals participating in the National Pediatric Trauma Registry between October 1988 and April 1996. RESULTS: Compared with the NO children, the children with ADHD were more likely to be boys (87.9% vs 66.5%), to be injured as pedestrians (27.5% vs 18.3%) or bicyclists (17.1% vs 13.8%), and to inflict injury to themselves (1.3% vs 0.1%). They were more likely to sustain injuries to multiple body regions (57.1% vs 43%), to sustain head injuries (53% vs 41%), and to be severely injured as measured by the Injury Severity Score (12.5% vs 5.4%) and the Glasgow Coma Scale (7.5% vs 3.4%). The ADHD mean length of stay was 6.2 days versus 5.4 in the NO group. In both groups, 40% had surgery, but the ADHD children were admitted more frequently to the intensive care unit (37.1% vs 24.1%). The injury led to disability in 53% of the children with ADHD vs 48% of the NO children. Children with ADHD with any disability were twice as likely to be discharged to rehabilitation/extended care than were the NO children. CONCLUSIONS: Injured children with ADHD are more likely to sustain severe injuries than are children without ADHD. More research is needed to identify prevention efforts specifically targeted at this population.     

Can neighborhoods explain racial/ethnic differences in adolescent inactivity?

OBJECTIVE: To determine if neighborhoods and their attributes contribute to racial/ethnic disparities in adolescent inactivity. METHODS: We undertook a cross-sectional analysis of the National Longitudinal Study of Adolescent Health (n = 17,007), a nationally representative school-based study in the United States. Stratifying by gender, we used multivariate linear regression and multi-level modeling to determine whether neighborhood of residence may partially explain racial/ethnic disparities in adolescent physical inactivity, defined as hours viewing television or videos/DVDs and/or playing computer/video games each week. RESULTS: Participants lived in largely segregated communities. Black and Hispanic adolescent girls reported higher levels of inactivity than White adolescent girls (21 vs. 15 vs. 13 hours/week, respectively, p <0.001). Similar patterns were seen in adolescent boys, with Black adolescent males reporting a mean of 26 hours/week; Hispanic boys a mean of 20 hours/week; and White boys a mean of 17 hours/week of inactivity (p <0.001). After accounting for between-neighborhood variation, there were no residual within-neighborhood differences in inactivity between Hispanic and White adolescent girls (gamma = -0.06, p =0.93); when living in the same neighborhood Hispanic and White girls had similar levels of inactivity. Black adolescent girls and boys were found to have higher levels of inactivity no matter where they lived (gamma =7.00, p <0.001 for girls; gamma = 6.96, p <0.001 for boys). Hispanic boys had similar patterns of inactivity to White boys (gamma =-1.57, p = 0.12). In both males and females, the reported rate of violent crime in the neighborhood was associated with inactivity, despite the individual's perception of his/her neighborhood as safe not being predictive. CONCLUSIONS: Although inactivity varies by race/ethnicity and gender, only in Hispanic adolescent girls does neighborhood fully explain the differential use. Our findings suggest that approaches other than changing neighborhood characteristics are needed to eliminate racial/ethnic disparities in adolescent inactivity.     

Health concerns of sexual minority adolescent girls

PURPOSE OF REVIEW: The goal of this article is to provide an overview of up-to-date health information about sexual minority female youth so that healthcare practitioners can better serve their healthcare needs. RECENT FINDINGS: Sexual minority adolescent girls may follow diverse sexual developmental trajectories. Many in this population are quite healthy, but some may be disproportionately vulnerable to health risks, perhaps because of the stigma associated with minority sexuality in society. If sexually active, girls in this population often have sex with boys as well as girls and confront risks attendant with sex with both genders. They may demonstrate fluidity in their sexual identity as they move through adolescence. Data suggest that sexual minority adolescent girls are more likely to smoke cigarettes, drink alcohol, or use illicit drugs compared with girls who are heterosexual. They may be more likely to be victims of violence or victimization or to be depressed or suicidal. SUMMARY: Sexual minority adolescent girls may be quite resilient, but they face a range of possible adverse health risks. Healthcare practitioners should keep their health issues in mind so they can offer healthcare and counseling that is sensitive, comprehensive, and appropriate.