Enhancing STD/HIV prevention among adolescents: the importance of parenteral monitoring

The risk of acquiring sexually transmitted diseases (STDs) and HIV infection is one of the most significant and immediate risks to the health and well being of adolescents. One promising strategy to protect adolescents from STD/HIV infection is to promote parental monitoring. In this article, we first review selected observational studies that provide evidence supporting the value of parental monitoring in reducing adolescents' risk of STD/HIV acquisition. Subsequently, we discuss the potential implications of the research in regards to clinic- and community-based STD/HIV prevention programs for adolescents.     

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.     

Influenza vaccination among children with asthma in medicaid managed care.

OBJECTIVE: To describe influenza vaccination rates and identify risk factors for missing vaccination among children with asthma in managed Medicaid. METHODS: As part of a longitudinal study of asthma care quality, parents of children aged 2-16 years with asthma enrolled in Medicaid managed care organizations in Massachusetts, Washington, and California were surveyed by telephone at baseline and 1 year. We evaluated influenza vaccination rates during the follow-up year. RESULTS: The study population included 1058 children with asthma. The influenza vaccination rate was 16% among all children with asthma and 21% among those with persistent asthma. Children with persistent asthma (odds ratio [OR] 0.53, 95% confidence interval [CI] 0.36-0.79) and those who had been hospitalized during the follow-up year (OR 0.29, 95% CI 0.11-0.76) were less likely to miss vaccination.Children older than 9 years (OR 1.66, 95% CI 1.13-2.46) and children of parents with less than a high school education (OR 2.29, 95% CI 1.05-5.03), compared with a college degree, were at risk for missing vaccination. Among children with persistent asthma, older children (OR 1.65, 95% CI 1.01-2.69) and children of parents with less than a high school education (OR 4.13, 95% CI 1.43-11.90) were more likely to miss influenza vaccination. CONCLUSIONS: Our findings suggest that interventions directed toward older children and families with lower educational levels may help improve influenza vaccination rates among this high-risk group. The low overall vaccination rate highlights the need for improvement in this important component of asthma care quality for all children with asthma.     

Patterns of care among adolescents with malignancy in Ohio

Adolescents with malignancy represent a unique population in oncology that traditionally has received care at a variety of institutions. Recent data have shown that clinical trial involvement and patient outcomes in this age group may be influenced by the type of hospital at which they are treated. This article examines factors influencing the location of treatment of patients aged 15 to 19 years from selected areas in Ohio. Patients 15 to 19 years of age with malignancy from the selected 45 counties between 1996 and 1999 were identified from the Ohio Cancer Incidence and Surveillance System database. Factors analyzed included specific diagnosis, age, race, and treating institution. A total of 169 patients were identified, with 46.7% treated at pediatric institutions, 24.8% at adult academic centers, and 28.5% at community hospitals. Diagnosis influenced treatment location: leukemias, central nervous system tumors, and sarcomas were treated more often at pediatric hospitals, whereas melanoma was more often treated at adult academic centers. Patient age and distance from an academic center were also found to affect the location of treatment. Specific diagnosis, age, and geographic location influence the site of treatment of adolescent patients. Efforts to improve survival and increase enrollment in clinical trials must take these factors into account.     

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

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

Psychiatric considerations in children and adolescents with HIV/AIDS

The psychosocial impact of human immunodeficiency virus (HIV) disease has been recognized since the beginning of the epidemic for affected adults, but there has been less focus on the impact of HIV on young people. Among HIV-positive (HIV+) adults, high levels of distress, psychiatric symptoms, and their associations with worse health outcomes were recognized early in the epidemic. Subsequently, many studies have focused on understanding the prevalence of psychiatric symptoms among HIV+ adults and on identifying effective treatments for these symptoms. Fewer studies have examined these symptoms and their treatments among HIV+ children and adolescents. This article reviews what is known about psychiatric syndromes among HIV+ youths, their treatments, and other psychosocial factors of concern to the psychiatrist when treating children and adolescents with HIV disease.     

HIV and AIDS in adolescents

HIV infection in adolescents continues to challenge health care providers, policy makers, and advocates for youth. Primary care providers working with parents of adolescents and at-risk youth are in a unique position to identify or help develop HIV prevention and care programs that address many needs. Effective interventions are those that move beyond moralism to realism and a willingness to engage youth and their families. Youth at high risk for HIV should be identified and engaged in primary care as soon as possible. HIV-infected youth need intensive individual and group interventions to keep themselves healthy and reduce transmission to others. Incumbent on all providers is to make adolescents' services visible, flexible, affordable, confidential, culturally appropriate, and available for all youth.     

HIV/STD risk reduction interventions for African American and Latino adolescent girls at an adolescent medicine clinic: a randomized controlled trial

BACKGROUND: Adolescent girls in the United States and around the world are at a heightened risk for sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV). OBJECTIVE: To determine the efficacy of a skill-based HIV/STD risk-reduction intervention in reducing self-reported unprotected sexual intercourse among African American and Latino adolescent girls. DESIGN: Randomized controlled trial with 3-, 6-, and 12-month follow-ups. SETTING AND PARTICIPANTS: Sexually experienced African American and Latino adolescent girls recruited from the adolescent medicine clinic of a children's hospital serving a low-income inner-city community (N = 682, mean age, 15.5 years); 88.6% were retained at the 12-month follow-up. INTERVENTIONS: Three 250-minute interventions based on cognitive-behavioral theories and elicitation research: an information-based HIV/STD intervention provided information necessary to practice safer sex; a skill-based HIV/STD intervention provided information and taught skills necessary to practice safer sex; or a health-promotion control intervention concerned with health issues unrelated to sexual behavior. MAIN OUTCOME MEASURES: Primary outcome measure was self-reported frequency of unprotected sexual intercourse; secondary outcomes included the frequency of sexual intercourse while intoxicated, the number of sexual partners, biologically confirmed STDs, and theoretical mediator variables, including the intention to use condoms, beliefs about using condoms, and condom-use knowledge. RESULTS: No differences between the information intervention and the health control intervention were statistically significant. Skills-intervention participants (mean [SE], 2.27 [0.81]) reported less unprotected sexual intercourse at the 12-month follow-up than did information-intervention participants (mean [SE], 4.04 [0.80]; P = .03), or health control-intervention participants (mean [SE], 5.05 [0.81]; P = .002). At the 12-month follow-up, skills-intervention participants (mean [SE], 0.91 [0.05]) reported fewer sexual partners (P = .04) compared with health control-intervention participants (mean [SE], 1.04 [0.05]) and were less likely to test positive for STD (mean [SE], 10.5% [2.9%]) than were health control-intervention participants (mean [SE], 18.2% [2.8%]; P = .05). No differences in the frequency of unprotected sexual intercourse, the number of partners, or the rate of STD were observed at the 3- or 6-month follow-up between skill-intervention participants and information-intervention or health control-intervention participants. CONCLUSION: Skill-based HIV/STD interventions can reduce sexual risk behaviors and STD rate among African American and Latino adolescent girls in clinic settings.     

Second-dose varicella vaccination coverage in children and adolescents in a managed care organization in California, 2006-2009

We assessed trends of second-dose varicella-containing vaccine coverage among children and adolescents in Kaiser Permanente Southern California health plan since the Advisory Committee on Immunization Practices recommendation of 2-dose varicella vaccination in 2006. The overall second-dose coverage increased rapidly from 42.1% in 2007 to 74.6% in 2009. The increasing trend was observed in all strata defined by age and race/ethnicity, with the highest coverage among children aged 5 to 6 years old. However, non-Hispanic White race/ethnicity and living in a neighborhood with higher education level were inversely associated with the second-dose uptake.