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.     

Plasma visfatin and adiponectin concentrations in physically active adolescent girls: relationships with insulin sensitivity and body composition variables

The purpose of this study was to evaluate the associations of visfatin and adiponectin concentrations with insulin resistance and body composition in regularly physically active pubertal girls. In 129 girls, aged 13-15 years (pubertal stages 3-5), visfatin, adiponectin, insulin resistance measured by homeostasis model assessment (HOMA), and body composition measured by dual-energy X-ray absorptiometry were evaluated. Visfatin concentration was related to HOMA and overall adiposity (body mass index, fat mass) markers, whereas adiponectin concentration was related to overall adiposity (fat mass), central adiposity (trunk fat) and fat free mass values. These relationships remained significant (p < 0.05) after adjusting for pubertal stage. Visfatin was independently related to body mass index (beta = 0.936; p = 0.0001) and HOMA (beta = 0.444; p = 0.039) indices, whereas adiponectin was independently related to fat free mass (beta = 0.889; p = 0.003) and trunk fat (beta = -0.468; p = 0.042) values. In conclusion, visfatin could be related to insulin resistance and overall adiposity indices, whereas adiponectin was related to different body composition values in regularly physically active pubertal girls.     

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.     

Menstrual patterns under hormonal contraception in adolescent girls and young women

Adolescents are more likely to discontinue hormonal contraception because of disturbances in their menstrual patterns. Menstrual disturbances occur as spotting, breakthrough bleeding, as well as missed withdrawal bleeding depending on both the prevailing levels of estrogens and the more or less suppressed endometrium. Patients on cyclic prescribed oral combined micro-pills are found to have the fewest menstrual disturbances compared with all other hormonal regimens. Combined micro-pills as long term therapy should be given for medical indications only. Oral gestagen-only mini-pills are suitable for adolescent girls when estrogens are contraindicated. Irregular bleeding was found in more than 50% of patients. Long term contraceptives of all hormonal contraceptives show the highest rate of menstrual disturbance. They are suitable for adolescent girls in special indications only.     

Sexually transmissible infectious agents in sexually active and virginal asymptomatic adolescent girls

Sixty-eight sexually active and 52 virginal adolescent girls were evaluated for six sexually transmissible infectious agents: Gardnerella vaginalis, Ureaplasma urealyticum, Mycoplasma hominis, Chlamydia trachomatis, Trichomonas vaginalis, and Neisseria gonorrhoeae. There were significant differences between sexually active and virginal girls with respect to the prevalence of isolation of U urealyticum (75% v 33%, P less than .005), M hominis (27% v 10%, P less than .05), and C trachomatis (19% v 2%, P less than .025) but not for G vaginalis (34% v 17%, P = .09). N gonorrhoeae and T vaginalis were isolated exclusively from sexually active girls, but their low prevalence (6% and 9%, respectively) made the difference statistically insignificant (P = .2 and .06, respectively). Race, current v previous sexual activity, multiple sexual partners, oral contraceptive use, and concurrent isolation of another organism did not identify those at increased risk for chlamydial isolation. Such girls were significantly more likely to have inflammatory Papanicolaou smears (36% v 10%, P less than .05) and excessive WBC in their vaginal secretions (50% v 19%, P = .05). The data support the contention that C trachomatis, N gonorrhoeae, and T vaginalis are organisms that are predominantly acquired via sexual routes. Significant nonsexual modes of transmission are supported by the data for the genital mycoplasmas and G vaginalis. Finally, a history of sexual activity in an adolescent female warrants specific diagnostic testing for Chlamydia.     

Douching: a problem for adolescent girls and young women.

OBJECTIVE: To compile available published data on the prevalence of douching practices in adolescent girls and young women and the effects of douching on gynecologic health, including studies of gynecologic changes due to douching in adolescent girls and young women, surveys that demonstrated the prevalence of douching in the populations, and policy statements or lack thereof from professional and medical organizations with regard to the practice of douching. DATA SOURCES: We did Internet searches, including a MEDLINE search, a literature review, and used the telephone, mail, and e-mail to contact professional organizations. RESULTS: Douching has been found to be strongly associated with increased risk for pelvic inflammatory disease, bacterial vaginosis, and ectopic pregnancy, the former of which is especially prevalent in adolescent girls and young women. Douching is practiced by 15.5% of adolescent girls and young women in the United States, with significantly higher prevalences in certain groups in the population. We have not found any official position of professional and medical organizations on the practice of douching. CONCLUSIONS: Because vaginal douching has been shown to be associated with bacterial vaginosis, pelvic inflammatory disease, and ectopic pregnancy, and because no benefits are conferred on those who practice it, douching should be discouraged among adolescent girls and young women. There is a great need for further studies, particularly prospective ones, to determine if there is evidence of a direct causative influence of douching on pelvic inflammatory disease, ectopic pregnancy, and/or bacterial vaginosis, and to determine why adolescent girls and young women douche.     

Deleterious functional impact of anemia on young adolescent school girls

Iron deficiency anemia during adolescence may reduce physical work capacity and cognitive function. OBJECTIVES: To assess the physical work capacity and cognition of underprivileged anemic schoolgirls in Vadodara in early adolescence as compared to their non-anemic counterparts. DESIGN: Prior to initiating anemia control interventions, schoolgirls in early adolescence were studied with regard to their hemoglobin status, physical work capacity and cognitive functions. SETTING: Schoolgirls from four municipal primary schools in the age of 9 - 14 years were studied. METHODS: In four Primary Municipal schools, hemoglobin of subjects was assessed using standard methods; physical work capacity using Modified Harvards Step test and cognitive functions using selected tests from the modified Wechsler Intelligence Scale for Children (WISC), suitably adapted for this group (n = 230). RESULTS: The mean hemoglobin was 11.32 g/dL, and anemia prevalence: 67%. A higher number of steps were climbed and a shorter time was taken to revert to the basal pulse rate (recovery time) by non-anemic girls compared to anemic girls (P < 0.001). Significantly lower scores in digit span and visual memory test were seen in anemic compared to non-anemic girls. The adverse impact of anemia remained after controlling for undernutrition (BMI). CONCLUSION: Anemia is likely to adversely affect physical work capacity and cognition in young adolescent girls undergoing pubertal development. Further research should be conducted in both school and community based settings to cover non-school going children.     

Acute affective responses to prescribed and self-selected exercise intensities in young adolescent boys and girls

This study examined the patterning of acute affective responses to prescribed and self-selected exercise intensities in a young adolescent population. Twenty-two young adolescents (13.3 +/- .33 years) completed a maximal exercise test to identify ventilatory threshold (VT). Participants then completed two prescribed intensities (one set above and one below the VT) and a self-selected intensity. Pre-, during, and postexercise affective valence was measured. Results revealed that during exercise, affective valence assessed by the Feeling Scale (FS) remained positive in the self-selected and low-intensity conditions but declined in the high-intensity condition. Postexercise FS responses rebounded to preexercise levels, eradicating divergent trends that occurred during exercise.     

Asymptomatic rickets in adolescent girls

Objective Inadequate sunlight exposure and calcium intake during rapid growth at puberty lead to hypocalcemia, hypovitaminosis D and eventually to overt rickets. To determine serum biochemical findings of rickets in healthy 11–15 yr old girls, the effect of sunlight exposure and oral vitamin D supplementation on serum 25-hydroxy vitamin D and calcium administration in girls with abnormal findings during December 2002 through March 2003 in Tehran, Iran. Methods Healthy middle school girls were selected for estimation of vitamin D, calcium and phosphorus intake by a three-day food recall. And measurement of serum calcium, phosphorus, parathyroid hormone, alkaline-phosphatase and 25-hydroxyvitamin D concentration. The girls with abnormal findings divided in two groups. Hypovitaminosis D girls subdivided into two groups, supplementary sunlight exposure and vitamin-D administrated for them and calcium administration for the second group for 20 days. Results Of 414 girls, the mean daily vitamin D acquirment and calcium intake were 119 ± 52 IU and 360 ± 350 mg among all girls respectively. Mean serum 25-hydroxyvitamin D with two or more abnormal biochemical findings in 15 (3.6%) girls (group I) were 7.8 ng/ml and alkaline phosphatse with normal or low calcium in 29 (7%) girls (group II) was 1187 IU/L. Mean serum calcium was 8.2 mg % in 8 of 29 girls. Serum 25-hydroxyvitamin D before and after sunlight exposure was 7.1 ± 1.9 ng/ml and 13.9 ± 2.4 ng/ml and vitamin D administration was 7.4 ± 1.8 ng/ml (group la) and 27.9 ± 4.2ng/ml (group lb) respectively. Serum alkaline phosphatase before and after calcium administration were 1187 IU/L and 666 IU/L respectively. Conclusion We conclude that low daily calcium intake, and vitamin D acquirement are two important problems in Iranian girls during rapid growth at puberty; therefore, for prevention of overt rickets calcium and vitamin D Supplementation appear to be necessary.     

Eating disorders in adolescent girls*

Eating disorders are common in contemporary society. New information is emerging on the pathogenesis of anorexia nervosa and bulimia nervosa and includes psychologic, biologic, family, environmental, genetic and social factors. The physician providing care to adolescents is challenged to carry out a careful evaluation and monitor the patient for complications, especially loss of bone mass. Treatment requires a multidisciplinary team.     

Nutrition of adolescent girls in Lorraine

A survey concerning the nutritional habits, using the method of the dietary history, was undertaken among 273 girls aged 10 to 16 and examined at the Preventive Medicine Center in Nancy. The energy amount, on average 2,363 calories/day (9.88 MJ) and the distribution among the various nutriments differed little from the French recommendations. Energy intakes varied with bone ages and the socio-cultural level of parents. No intake changes were found with respect to the degree of overweight or to the growth peak. The study of the distribution of intakes according to the main groups of aliments showed the important place of dairy products (14.6%), breads (13.9%) as well as sweets and pastries (11.8%, 12.9%), distribution independent of age. Lunch represents the most important meal of the day (35.7%). Snacks provide as much energy as breakfast. The latter is insufficient in 20% of cases. However, this insufficiency is compensated during the day.