Prevalence and correlates of pelvic examinations in sexually active female adolescents.

OBJECTIVES: The pelvic examination is an important component of reproductive health services for adolescent girls and is recommended for those who become sexually active. The aims of this study were to describe self-reported rates of pelvic examinations in sexually active adolescent girls and to determine factors associated with having obtained an examination. METHODS: Cross-sectional data from a national self-administered survey of nurses' adolescent daughters were used. Subjects were those girls (N = 635) who reported ever having had sexual intercourse. Bivariate and multivariate analyses were used to identify demographic and psychological variables, preventive health behaviors, and risk behaviors associated with having ever obtained a pelvic examination. RESULTS: Median subject age was 16.0 years (range 12-19 years), and 46% of subjects reported having had a pelvic examination. Variables associated with having obtained an examination were older age (odds ratio [OR] 1.29, 95% confidence interval [CI] 1.09-1.53), cigarette smoking (OR 1.51, 95% CI 1.02-2.24), higher number of sexual partners (OR 1.29, 95% CI 1.14-1.47), and no condom use during last sexual intercourse (OR 1.80, 95% CI 1.19-2.70). CONCLUSIONS: Fewer than half of these sexually active adolescents had ever obtained a pelvic examination. Younger subjects who did not smoke regularly, had fewer partners, and used condoms were less likely to have obtained an examination; these adolescents may not be seeking reproductive health care services or be recognized by parents or providers as being in need of services.     

Sexual behaviour and early coitarche in a national sample of 17-year-old Swedish boys

AIM: To describe sexual behaviour as reported by 17-year-old boys in Sweden. METHODS: The national cross-sectional SAM 73-90 questionnaire survey was performed in 1990, and comprised 2% of students and school non-attenders born in 1973. The respondents included 814 students and 92 non-students, response rates 90.6% and 40.2%, respectively. Data from the two groups are treated separately. RESULTS: In the student group, 54.2% of boys had experienced vaginal intercourse and 16.7% were "early starters" with coitarche before 15 y of age. Independent predictors for coital experience were the vocational study programme OR (odds ratio) 1.91 (95% CI 1.31-2.78), early puberty OR 1.69 (95% CI 1.11-2.57), use of tobacco OR 5.32 (95% CI 2.43-11.7) and alcohol OR 4.09 (2.79-5.98). Sexually transmitted infections (STIs) were reported by 4.1% of coitally active student boys, and impregnating a girlfriend by 4.3%. Of the early starters, 14.6% reported having more than 10 sex partners as compared with 2.5% of the later starters (p < 0.0001) and this was predictive of STI, OR 5.4 (95% CI 1.5-19.7). First-date intercourse more than twice was predictive of pregnancy, OR 14.4 (95% CI 3.8-54.5). Among school non-attenders, 74.2% reported coital experience, 33.7% were early starters, and 12.5% had impregnated a girl. CONCLUSION: Boys' early sexual experience was related to early puberty, and to general adolescent risk-taking behaviour. Early coitarche per se was not predictive of STI or pregnancy, but the associated high number of "lifetime" sexual partners and first-date intercourse were predictive factors. School non-attenders constituted a group at risk.     

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 orientation and risk of suicide attempts among a representative sample of youth.

OBJECTIVE: To examine whether sexual orientation is an independent risk factor for reported suicide attempts. DESIGN: Data were from the Massachusetts 1995 Centers for Disease Control and Prevention Youth Risk Behavior Survey, which included a question on sexual orientation. Ten drug use, 5 sexual behavior, and 5 violence/ victimization variables chosen a priori were assessed as possible mediating variables. Hierarchical logistic regression models determined independent predictors of suicide attempts. SETTING: Public high schools in Massachusetts. PARTICIPANTS: Representative, population-based sample of high school students. Three thousand three hundred sixty-five (81%) of 4167 responded to both the suicide attempt and sexual orientation questions. MAIN OUTCOME MEASURE: Self-reported suicide attempt in the past year. RESULTS: One hundred twenty-nine students (3.8%) self-identified as gay, lesbian, bisexual, or not sure of their sexual orientation (GLBN). Gender, age, race/ethnicity, sexual orientation, and all 20 health-risk behaviors were associated with suicide attempt (P<.001). Gay, lesbian, bisexual, or not sure youth were 3.41 times more likely to report a suicide attempt. Based on hierarchical logistic regression, female gender (odds ratio [OR], 4.43; 95% confidence interval [CI], 3.30-5.93), GLBN orientation (OR, 2.28; 95% CI, 1.39-3.37), Hispanic ethnicity (OR, 2.21; 95% CI, 1.44-3.99), higher levels of violence/ victimization (OR, 2.06; 95% CI, 1.80-2.36), and more drug use (OR, 1.31; 95% CI, 1.22-1.41) were independent predictors of suicide attempt (P<.001). Gender-specific analyses for predicting suicide attempts revealed that among males the OR for GLBN orientation increased (OR, 3.74; 95% CI, 1.92-7.28), while among females GLBN orientation was not a significant predictor of suicide. CONCLUSIONS: Gay, lesbian, bisexual, or not sure youth report a significantly increased frequency of suicide attempts. Sexual orientation has an independent association with suicide attempts for males, while for females the association of sexual orientation with suicidality may be mediated by drug use and violence/victimization behaviors.     

Acculturation as a predictor of the onset of sexual intercourse among Hispanic and white teens

OBJECTIVE: To investigate ethnic differences in onset of sexual intercourse among Hispanic/Mexican American and white adolescents based on acculturation. DESIGN/METHODS: Preprogram survey data from 7270 Hispanic or white teens in 7th to 12th grade involved in the Arizona Abstinence-Only Education Program were used to predict the probability of onset of sexual intercourse based on age, sex, family structure, program location, religiosity, free school lunch, grades, rural residence, acculturation, and ethnicity. Specific attention was given to the influence of acculturation among Hispanic teens. The primary language spoken by the respondents (English, Spanish, or both) was used as a proxy measure for acculturation. RESULTS: Hispanic youth were at a greater risk for experiencing onset of intercourse than white youth, while controlling for all other predictors (odds ratio [OR], 1.40 [95% confidence interval (CI), 1.21-1.63]). This risk was amplified for highly acculturated Hispanic teens (OR, 1.69 [95% CI, 1.43-1.99]). However, less acculturated Hispanic youth were actually less likely to have experienced first intercourse than white youth (OR, 0.59 [95% CI, 0.42-0.82]), English-speaking Hispanic youth (OR, 0.35 [95% CI, 0.25-0.49]), or bilingual Hispanic youth (OR, 0.45 [95% CI, 0.31-0.64]). CONCLUSIONS: Low acculturation emerges as a significant protective factor while controlling for other social and cultural factors, in spite of the increased risk of initiating sexual intercourse for Hispanic teens overall. Hispanic Spanish speakers were least likely to have initiated intercourse, while Hispanic English speakers were the most likely.     

The association between health risk behaviors and sexual orientation among a school-based sample of adolescents

OBJECTIVE: This study is one of the first to examine the association between sexual orientation and health risk behaviors among a representative, school-based sample of adolescents. DESIGN: This study was conducted on an anonymous, representative sample of 4159 9th- to 12th-grade students in public high schools from Massachusetts' expanded Centers for Disease Control and Prevention 1995 Youth Risk Behavior Survey. Sexual orientation was determined by the following question: "Which of the following best describes you?" A total of 104 students self-identified as gay, lesbian, or bisexual (GLB), representing 2.5% of the overall population. Of GLB youth, 66.7% were male and 70% were white (not Hispanic). Health risk and problem behaviors were analyzed comparing GLB youth and their peers. Those variables found to be significantly associated with GLB youth were then analyzed by multiple logistic regression models. RESULTS: GLB youth were more likely than their peers to have been victimized and threatened and to have been engaged in a variety of risk behaviors including suicidal ideation and attempts, multiple substance use, and sexual risk behaviors. Four separate logistic regression models were constructed. Model I, Onset of Behaviors Before Age 13, showed use of cocaine before age 13 years as strongly associated with GLB orientation (odds ratio [OR]: 6.10; 95% confidence interval [CI] = 2.45-15.20). Early initiation of sexual intercourse (2.15; 10.6-4.38), marijuana use (1.98; 1.04-4.09), and alcohol use (1.82; 1.03-3.23) also was associated with GLB orientation. Model II, Lifetime Frequencies of Behaviors, showed that frequency of crack cocaine use (1.38; 1.06-1.79), inhalant use (1.30; 1.05-1.61), and number of sexual partners (1.27; 1.06-1.43) was associated with GLB orientation. Model III, Frequency of Recent Behaviors, showed smokeless tobacco use in the past 30 days (1.38; 1. 20-1.59) and number of sexual partners in the previous 3 months (1. 47; 1.31-1.65) were associated with GLB orientation. Model IV, Frequency of Behaviors at School, showed having one's property stolen or deliberately damaged (1.23; 1.08-1.40) and using marijuana (1.29; 1.05-1.59) and smokeless tobacco (1.53; 1.30-1.81) were associated with GLB orientation. Overall, GLB respondents engaged disproportionately in multiple risk behaviors, reporting an increased mean number of risk behaviors (mean = 6.81 +/- 4.49) compared with the overall student population (mean = 3.45 +/- 3.15). CONCLUSION: GLB youth who self-identify during high school report disproportionate risk for a variety of health risk and problem behaviors, including suicide, victimization, sexual risk behaviors, and multiple substance use. In addition, these youth are more likely to report engaging in multiple risk behaviors and initiating risk behaviors at an earlier age than are their peers. These findings suggest that educational efforts, prevention programs, and health services must be designed to address the unique needs of GLB youth.     

Associations between health risk behaviors and opposite-, same-, and both-sex sexual partners in representative samples of vermont and massachusetts high school students

OBJECTIVE: To examine associations between health risk behaviors and sexual experience with opposite-, same-, or both-sex partners in representative samples of high school students. DESIGN: We used 1995 and 1997 data from the Vermont and Massachusetts Youth Risk Behavior Surveys. Logistic regression and multiple regression analyses were used to compare health risk behaviors among students who reported sex with opposite-sex partners only (opposite-sex students), with same-sex partners only (same-sex students), and with both male and female sexual partners (both-sex students). SETTING: Public high schools in Vermont and Massachusetts. PARTICIPANTS: Representative, population-based samples of high school students. The combined samples had 14 623 Vermont students and 8141 Massachusetts students. MAIN OUTCOME MEASURE: Violence, harassment, suicidal behavior, alcohol and other drug use, and unhealthy weight control practices. RESULTS: In both states, both-sex students were significantly more likely to report health risk behaviors than were opposite-sex students. For example, both-sex students had odds 3 to 6 times greater than opposite-sex students of being threatened or injured with a weapon at school, making a suicide attempt requiring medical attention, using cocaine, or vomiting or using laxatives to control their weight. In both states, same-sex students were as likely as opposite-sex students to report most health risk behaviors. CONCLUSION: Relative to opposite- and same-sex students, both-sex students may be at elevated risk of injury, disease, and death by experiencing serious harassment and engaging in violence, suicidal behavior, alcohol and other drug use, and unhealthy weight control practices.     

Sexually transmitted diseases in a health maintenance organization teen clinic: associations of race, partner's age, and marijuana use.

OBJECTIVE: To determine the role of sociodemographic risk markers and behavioral risk factors associated with sexually transmitted diseases (STDs) in sexually experienced youth seeking care at an urban, general health maintenance organization teen clinic. DESIGN: Cross-sectional. PARTICIPANTS: A consecutive, racially and ethnically diverse sample of 285 sexually experienced youth who were preponderantly female (58.6%) and who were aged 16.7 years on average. METHODS: All participants completed a self-report questionnaire and were screened for Chlamydia trachomatis using the ligase chain reaction technique and for Neisseria gonorrhoeae and other STDs using conventional methods. RESULTS: Many of these youth were at high risk for STDs, having a self-reported history of sex with multiple partners (49.1%), sex with a new partner (42.5%), inconsistent use of condoms (71.9%), and frequent substance use (24.5% used marijuana 1-2 times per week or more). Sexually transmitted disease screening revealed that 11.6% of the participants had 1 or more STDs. A logistic regression analysis to determine the best model for predicting STDs indicated that youth who are African American (odds ratio, 3.34; 95% confidence interval, 1.52-7.35), had sexual partners who were 2 or more years older (odds ratio, 2.63, 95% confidence interval, 1.22-5.67), and used marijuana 1 to 2 times or more per week (odds ratio, 2.27; 95% confidence interval, 1.01-5.13) were more likely to have STDs at screening. CONCLUSIONS: A brief sociodemographic and behavioral risk assessment that includes these factors may be useful for clinicians in deciding when to screen for STDs in sexually active youth seeking care for reasons not related to reproductive health.     

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.     

Cross-sectional study of female students reporting anabolic steroid use

OBJECTIVE: To determine the characteristics of female US high school students reporting anabolic steroid use. DESIGN: Cross-sectional assessment using the 2003 Centers for Disease Control and Prevention national school-based Youth Risk Behavior Survey database. SETTING: Nationally representative sample of US high schools. PARTICIPANTS: Female students in grades 9 through 12 (n = 7544). MAIN OUTCOME MEASURES: Participants' self-reported anabolic steroid use was compared with other health-related behaviors and with sports participation. RESULTS: Prior or ongoing anabolic steroid use was reported by 5.3% of female high school students. Those adolescent girls had a marked increase in other health-compromising behaviors, including past 30-day use of alcohol (odds ratio [OR], 8.83; 95% confidence interval [CI], 5.49-14.20]), cigarettes (OR, 5.14; 95% CI, 3.14-8.42), marijuana (OR, 7.91; 95% CI, 5.20-12.04), cocaine (OR, 10.78; 95% CI, 6.18-18.81), and diet pills (OR, 4.86; 95% CI, 2.98-7.93). They were more likely to carry a weapon (OR, 7.54; 95% CI, 4.83-11.76), have had sexual intercourse before age 13 years (OR, 2.90; 95% CI, 1.58-5.33), and have had feelings of sadness or hopelessness almost every day for at least 2 consecutive weeks (OR, 4.13; 95% CI, 2.57-7.22). They were less likely to play school-sponsored team sports (OR, 0.52; 95% CI 0.34-0.80). Steroid users participating in sports shared the same problem behaviors as steroid users not participating in team athletics. CONCLUSION: Self-reported anabolic steroid use is not confined to adolescent girls in competitive athletics and is an indicator of adolescent girls with a marked increase in a cluster of other health-harming behaviors.     

A randomized controlled trial testing an HIV prevention intervention for Latino youth

OBJECTIVE: To test the efficacy of a prevention intervention to reduce sexual risk behavior among Latino adolescents. DESIGN: Randomized controlled trial from April 2000 through March 2003, with data collection before and after intervention and at 3, 6, and 12 months. SETTING: Northeast Philadelphia schools. PARTICIPANTS: Latinos aged 13 through 18 years (249 males and 304 females); 81.6% retained at 12-month follow-up. INTERVENTIONS: The HIV and health-promotion control interventions consisted of six 50-minute modules delivered by adult facilitators to small, mixed-gender groups in English or Spanish.Main Outcome Measure Self-reported sexual behavior. RESULTS: Analyses using generalized estimation equations over the follow-up period revealed that adolescents in the HIV intervention were less likely to report sexual intercourse (odds ratio, 0.66; 95% confidence interval [CI], 0.46-0.96), multiple partners (odds ratio, 0.53; 95% CI, 0.31-0.90), and days of unprotected intercourse (relative risk, 0.47; 95% CI, 0.26-0.84) and more likely to report using condoms consistently (odds ratio, 1.91; 95% CI, 1.24-2.93). Baseline sexual experience and language use moderated intervention efficacy. Adolescents assigned to the HIV intervention who were sexually inexperienced at baseline reported fewer days of unprotected sex (relative risk, 0.22; 95% CI, 0.08-0.63); Spanish speakers were more likely to have used a condom at last intercourse (odds ratio, 4.73; 95% CI, 1.72-12.97) and had a greater proportion of protected sex (mean difference, 0.35; P<.01) compared with similar adolescents in the health-promotion intervention. CONCLUSION: Results provide evidence for the efficacy of HIV intervention in decreasing sexual activity and increasing condom use among Latino adolescents.     

Prevalence of behaviors related to cigarette-caused fires: a survey of Ontario smokers.

OBJECTIVE: To identify the prevalence and correlates of behaviors related to the risk of cigarette-caused fires. DESIGN AND SETTING: Random-digit-dialed telephone survey in Ontario, Canada, July-September, 2005. SUBJECTS: 596 current cigarette smokers. OUTCOME MEASURES: Prevalence of fire-risk events and behaviors such as burning clothing or objects in the home, leaving lit cigarettes unattended, dozing while smoking, and smoking in bed and correlates of these behaviors. Respondents were also asked if they ever worry about cigarette-caused fires. RESULTS: One in four smokers admitted to leaving lit cigarettes unattended in the last 30 days, while 15% admitted to smoking while in bed. Leaving lit cigarettes unattended was independent of demographic, socioeconomic or nicotine dependence indicators, but was related to worry about burning other persons with a cigarette (OR 1.72, 95% CI 1.04 to 2.85) and smoking inside the home (OR 2.98, 95% CI 1.66 to 5.35). Persons who were not white (OR 3.97, 95% CI 1.80 to 8.80), aged 18-24 years (OR 3.75, 95% CI 1.41 to 9.96), who had high nicotine dependence (OR 9.13, 95% CI 2.22 to 37.52) and worried about burning objects in their home (OR 2.43, 95% CI 1.31 to 4.52) were more likely to smoke in bed. 10 (1.7%) smokers reported having ever had a fire in their home started by a cigarette. CONCLUSIONS: Smokers engage in behaviors such as smoking in bed and leaving lit cigarettes unattended that may place them at an increased risk of cigarette-caused fires. As governments move to regulate cigarette ignition propensity, it is important to establish surveillance for behaviors related to fire risk.     

Academic and school health issues among children exposed to maternal intimate partner abuse

OBJECTIVE: To determine the association between children's exposure to maternal intimate partner violence (IPV) and academic problems and school health concerns. DESIGN: The study population consisted of 153 children aged 5 to 16 years who attended public school and whose mothers experienced police- or court-reported IPV. The comparison group consisted of public school peers of the exposed children. Generalized linear modeling using a binomial distribution and log-link function served as the primary method of analysis. SETTING: Urban public school district. MAIN OUTCOME MEASURES: The occurrence of academic problems and type-specific school nurse visits during the 1-year study period. RESULTS: Children whose mothers experienced IPV were more likely to be suspended from school (relative risk [RR], 1.8; 95% confidence interval [CI], 1.2-1.7) and to have had frequent non-suspension-related absences (RR, 1.6; 95% CI, 1.0-2.3) than comparison children after adjusting for relevant confounders. Intimate partner violence-exposed children were more likely to have a school nurse visit for social or emotional complaints (RR, 2.2; 95% CI, 1.3-3.9), a visit that resulted in being sent home from school (RR, 1.6; 95% CI, 1.1-2.3), or a visit that led to referral to the school speech pathologist (RR, 7.5; 95% CI, 1.9-29.6) relative to comparison schoolchildren after adjusting for relevant confounders. CONCLUSIONS: Children's exposure to maternal IPV is significantly associated with the occurrence of academic problems and school health concerns. Describing the increased risk of the academic and health problems exhibited by IPV-exposed children relative to nonexposed children offers the possibility of improving the likelihood that clinicians will identify the woman who experienced abuse and her children, and promote referral to appropriate resources.     

Risk factors for work related violence in a health care organization

OBJECTIVE: Identify the exposure effects of job family, patient contact, and supervisor support on physical and non-physical work related violence. DESIGN: Cross sectional study of employees in a Midwest health care organization, utilizing a specially designed mailed questionnaire and employer secondary data. SUBJECTS: Respondents included 1751 current and former employees (42% response rate). RESULTS: Physical and non-physical violence was experienced by 127 (7.2%) and 536 (30.6%) of the respondents, respectively. Multivariate analyses of physical violence identified increased odds for patient care assistants (odds ratio (OR) 2.5, 95% confidence interval (CI) 1. 1 to 6.1) and decreased odds for clerical workers (OR 0.1, 95% CI 0.03 to 0.5). Adjusted for job family, increased odds of physical violence were identified for moderate (OR 5.9, 95% CI 2.1 to 16.0) and high (OR 7.8, 95% CI 2.9 to 20.8) patient contact. Similar trends were identified for non-physical violence (OR 1.4, 95% CI 1.1 to 2.0 and OR 1.7, 95% CI 1.3 to 2.3). Increased supervisor support decreased the odds of both physical (OR 0.7, 95% CI 0.6 to 0.95) and non-physical violence (OR 0.5, 95% CI 0.4 to 0.6), adjusting for job family and demographic characteristics. CONCLUSIONS: Increased odds of physical violence were identified for the job family of nurses, even when adjusted for patient contact. Increased patient contact resulted in increased physical and non-physical violence, independent of job family, while supervisor support resulted in decreased odds of physical and non-physical violence.     

Sexual activity among adolescents in romantic relationships with friends, acquaintances, or strangers

OBJECTIVE: To explore the influence of preexisting social ties between romantic partners (ie, knowing the partner as a friend or acquaintance before a relationship was considered "romantic" by the adolescent) on sexual risk behaviors among adolescents.Design, Setting, and PARTICIPANTS: By using data from 6658 adolescents from Wave II of the National Longitudinal Study of Adolescent Health, we examined associations between preromantic social ties between partners and several sexual risk behaviors using logistic regression analyses. MAIN OUTCOME MEASURES: Whether the couple had intercourse, and if they did have intercourse, whether the couple talked about contraception or sexually transmitted infections and whether one of them used some method of birth control every time they had sexual intercourse. RESULTS: Knowing one's partner as a friend (vs being acquaintances) before a romantic relationship was protective against engaging in sexual intercourse for male and female adolescents (odds ratios and 95% confidence intervals, 0.66 [0.51-0.86] and 0.76 [0.62-0.94], respectively). For female adolescents, sexually active relationships with partners they had not known before the romantic relationship began were less likely to include discussions of sexually transmitted infections or contraception, and were less likely to include consistent use of birth control (odds ratios and 95% confidence intervals, 0.37 [0.22-0.62] and 0.62 [0.39-0.99], respectively). Preromantic social ties did not play a statistically significant role for these outcomes among male adolescents (odds ratios and 95% confidence intervals of friends and of those who had not met, respectively, are 0.85 [0.60-1.18] and 0.90 [0.50-1.63] for talking about sexually transmitted infections or contraception and 0.93 [0.66-1.30] and 1.17 [0.71-1.96] for always using birth control). CONCLUSION: The existence and nature of an adolescent's prior relationship with a future romantic partner have significant implications for an adolescent couple's later sexual decisions, but patterns differ for male and female adolescents.     

Factors influencing child mental health: A state‐wide survey of Victorian children

Aims: This study aims to estimate the prevalence of mental health problems among Victorian children and to investigate factors associated with poorer mental health. Method: Computer‐assisted telephone interviews were undertaken with the parents of 3370 randomly selected Victorian children aged 4 to 12 years. They reported on their child's mental health and special health‐care needs as well as their own mental health, family functioning and a range of community and socio‐demographic variables. Population estimates and odds ratios (OR) were calculated with 95% confidence intervals (95% CI). Results: Overall, 11.6% (95% CI = 10.3–12.9%) of Victorian children were estimated to be at risk of having mental health problems. Factors independently placing children at increased risk of mental health problems that were ‘of concern’ include a child having special health‐care needs (OR = 7.89, 95% CI 5.16 to 12.08), unhealthy family functioning (OR = 3.84, 95% CI 2.19 to 6.74), parental mental health problems (OR = 7.89, 95% CI 5.16 to 12.08), neighbourhood safety (OR = 2.47, 95% CI 1.20 to 5.07) and area of residence (OR = 2.01, 95% CI 1.33 to 3.02). Conclusions: A significant proportion of Victorian children are at some risk of mental health problems. These limited but important predictors of children's mental health reinforce the need for policy solutions that will extend beyond those offered by traditional mental health service systems.     

Inequalities in the Distribution of Childhood Adversity From Birth to 11 Years

ObjectiveExposure to early adversity carries long term harmful consequences for children's health and development. This study aims to 1) estimate the prevalence of childhood adversity for Australian children from infancy to 10–11 years, and 2) document inequalities in the distribution of adversity according to socioeconomic position (SEP), Indigenous status, and ethnicity.MethodsAdversity was assessed every 2 years from 0–1 to 10–11 years in the nationally representative birth cohort of the Longitudinal Study of Australian Children (N = 5107). Adversity included legal problems; family violence; household mental illness; household substance abuse; harsh parenting; parental separation/divorce; unsafe neighborhood; family member death; and bullying (from 4 to 5 years). Adversities were examined individually and summed for a measure of multiple adversity (2+ adverse experiences).ResultsBy 10–11 years, 52.8% (95% confidence interval [CI] 51.0–54.7) of children had been exposed to 2 or more adversities. When combined with low SEP, children from ethnic minority and from Indigenous backgrounds had 4 to 8 times the odds of exposure to 2 or more adversities than children from higher SEP Anglo-Euro backgrounds, respectively (odds ratio [OR] 4.3, 95% CI 2.8–6.6 and OR 8.1, 95% CI 4.4–14.8). Ethnic minority and Indigenous children from higher SEP backgrounds had increased odds of exposure to multiple adversity than similarly advantaged Anglo-Euro children (OR 1.8, 95% CI 1.4–2.3 and OR 2.3, 95% CI 1.3–4.3, respectively).ConclusionsAddressing early adversity is a significant opportunity to promote health over the life course, and reduce health inequalities experienced by marginalized groups of children.     

Association of condom use, sexual behaviors, and sexually transmitted infections with the duration of genital human papillomavirus infection among adolescent women

OBJECTIVE: To examine the association of potentially modifiable factors such as condom use, sexual behaviors, and concurrent sexually transmitted infections with duration of genital human papillomavirus (HPV) infections among adolescent women. DESIGN: Longitudinal observational study. SETTING: Study conducted at 3 inner-city clinics in Indianapolis, Ind. PARTICIPANTS: Forty-nine HPV-positive adolescents were tested frequently for HPV infection and provided sexual behavior diaries.Main Exposures Condom use, sexual behaviors, number of partners, and concurrent infections with Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis. MAIN OUTCOME MEASURES: Time from onset to clearance of type-specific HPV infections was analyzed with proportional hazard models. Adjusted hazard ratios (AHRs) were used to assess the effects of risk factors on the duration of HPV infection. Because viral clearance is a preferred outcome, a variable with an AHR less than 1 was considered a risk factor (ie, associated with reduced chance of viral clearance and prolonged infection). RESULTS: Prolonged HPV infection was associated with oncogenic HPV types (AHR, 0.58 [95% confidence interval (CI), 0.39-0.84]) less than median level of condom use during an HPV infection (AHR, 0.53 [95% CI, 0.33-0.84]) and coinfection with C trachomatis (AHR, 0.58 [95% CI, 0.31-0.89]) or T vaginalis (AHR, 0.32 [95% CI, 0.16-0.64]). Not having multiple sexual partners during an HPV infection was associated with early HPV clearance (AHR, 5.52 [95% CI, 3.28-9.30]). CONCLUSIONS: These findings support public health messages of reducing the number of sexual partners, promoting routine condom use, and frequent sexually transmitted infection screening that may be beneficial with HPV infections.     

Bullied by peers in childhood and borderline personality symptoms at 11 years of age: a prospective study

Background: Abuse by adults has been reported as a potent predictor of borderline personality disorder (BPD). Unclear is whether victimisation by peers increases the risk of borderline personality symptoms. Method: The Avon Longitudinal Study of Parents and Children (ALSPAC) prospective, longitudinal observation study of 6050 mothers and their children. Child bullying was measured by self‐report and mother and teacher report between 4 and 10 years. Family adversity was assessed from pregnancy to 4 years; parenting behaviours from 2 to 7 years, sexual abuse from 1.5 to 9 years, and IQ and DSM‐IV axis I diagnoses at 7 to 8 years. Trained psychologists interviewed children at 11.8 years to ascertain DSM‐IV BPD symptoms (five or more). Results: Accounting for known confounders, victims of peer bullying had an increased risk of BPD symptoms according to self‐report (OR, 2.82; 95% CI, 2.13–3.72); mother report (OR, 2.43; 95% CI, 1.86–3.16); and teacher report (OR, 1.95; 95% CI, 1.34–2.83). Children who reported being chronically bullied (OR, 5.44; 95% CI, 3.86–7.66) or experienced combined relational and overt victimisation (OR, 7.10; 95% CI, 4.79–10.51) had highly increased odds of developing BPD symptoms. Children exposed to chronic victimisation according to mother report were also at heightened risk of developing BPD symptoms (OR, 3.24; 95% CI, 2.24–4.68). Conclusions: Intentional harm inflicted by peers is a precursor or marker on the trajectory towards the development of BPD symptoms in childhood. Clinicians should be adequately trained to deal with, and ask users of mental health services routinely about, adverse experiences with peers.     

Association between bullying victimization and physical fighting among Filipino adolescents: Results from the Global School-Based Health Survey

Objective  Interpersonal violence is an important, but neglected public health issue in low and middle-income countries. Adolescent physical fighting not only results in injury, disability and death, but is also associated with other potentially harmful behaviors such substance use and premarital sex. The study aims at dose-response association to prevent adolescent problem behaviors. Methods  We used data from the 2003-2004 Global School-Based Health Survey conducted among school adolescents in the Philippines. We estimated the prevalence of bullying victimization and physical fighting. We also conducted logistic regression analysis to assess the association between a selected list of explanatory variables and physical fighting. We hypothesized that there would be a dose-response relationship between physical fighting and number of times the adolescent reported being bullied in the past 30 days. Results  Of the 7,338 respondents, 35.5% (34.7% males and 36.1% females) were bullied and 50.0% (51.6% males and 48.8% females) reported having been in a physical fight in the past 12 months. There was a dose-response relationship between bullying victimization and physical fighting (p-trend <0.001). Compared to subjects who were not bullied, those who reported being bullied were more likely to engage in physical fighting after controlling for age, gender, substance use (smoking, alcohol drinking or drug use), and parental supervision (OR=2.38; 95% CI [1.99, 2.86] for 1-2 days of bullying victimization per month, OR=3.55; 95% CI [2.61, 4.83]) for 3-5 days/month per month, OR=4.45; 95% CI [2.61, 7.60]) for 6–9 days/ month, OR=1.91; 95% CI [1.17, 3.13]) for 10-30 days/month.) Conclusion  The dose-response relationship between physical fighting and the number of times an adolescent had been a victim of bullying deserves further study. If causal relationship exists, preventing bullying, even if not totally eliminated, may have significant results in preventing physical fighting.