Barriers to HPV immunization for African American adolescent females

Purpose

The objective of this study was to identify motivations and barriers to HPV vaccination and culturally relevant and meaningful opportunities for vaccine promotion among African American mothers and adolescent daughters. Qualitative methods were employed to identify barriers to HPV immunization and understand mothers motivations to vaccinate their daughters. We conducted in-depth interviews with 19 mother–daughter pairs focused on 5 key areas: health history, prior vaccine experience, knowledge of HPV and HPV vaccine, relationship with physician, and experience of cervical dysplasia and cervical cancer (CD/CC).

Results

Four key factors drive HPV immunization among African-American mothers of adolescent daughters. First, mothers’ CD/CC disease experiences motivated a strong commitment to protect daughters from the trauma of CD/CC. Second, limited understanding of HPV and its connection to CD/CC made it difficult for mothers to assess the risk of infection or explain the medical benefits of the vaccine to their daughters. Third, mothers anticipate the sexual debut of adolescent daughters and advocate for healthcare interventions to protect them. Mothers were not deterred by multiple visits to complete the vaccine series; they likened HPV immunization to injectable contraceptives that require a series of injections and offer protection from the unintended consequences of sexual activity. Finally, mothers trusted physicians to initiate discussion of HPV immunization. Physicians who failed to initiate discussion and offer unconditional endorsement generated doubt about the vaccine among mothers and missed opportunities for immunization.

Conclusions

Our initial results indicate that physicians can engage in culturally relevant vaccine promotion in urban, underserved African American communities by initiating discussions of HPV immunization that (1) acknowledge mothers’ own CD/CC experiences, (2) support parenting strategies that aim to protect daughters from the unintended consequences of sexual activity, and (3) make explicit the connection between CD/CC and HPV infection, and between prevention of HPV infection and HPV immunization.     

Initiation of dieting among adolescent females

OBJECTIVE: This brief report identifies the factors that distinguish girls who have begun dieting recently from those who have never dieted, using Huon and Strong's (International Journal of Eating Disorders 23:361-369, 1998) model of dieting. METHOD: Sixty-two initiating dieters were carefully matched with 62 never dieters, according to school, grade, age, language spoken at home, and country of birth. Both groups completed a battery of questionnaires that assessed their dieting status, perceived social influence to diet, conformity disposition, assertiveness, and familial context. RESULTS: A discriminant function analysis showed that initiating dieters and never dieters could be distinguished most clearly by their levels of peer and parental influence. Initiating dieters conformed and complied more to their parents. They were also more competitive with their peers than were the girls who had never dieted. Perceived supportiveness of fathers was also found to set apart those girls who had never dieted. DISCUSSION: Girls who are just beginning to diet differ from those who have never dieted, predominantly in terms of their perceived social influence. The forms of parental influence that distinguish the two groups differ in nature from the type of influence exerted by peers.     

Characteristics of African American adolescent females who perceive their current boyfriends have concurrent sexual partners

PurposePerceived partner concurrency, reporting that a current sexual partner has other sexual partners, may pose sexual health risks to adolescents. We examined the contextual characteristics of African American female adolescents who reported their current boyfriend was having concurrent sexual relationships.MethodsParticipants were African American adolescent females (N = 511; mean age = 17.6) recruited from sexual health clinics. Before participating in an STD/HIV prevention trial, the participants completed audio computer-assisted self-interviews with measures of perceived partner concurrency and individual- (e.g., depression, substance use), interpersonal- (e.g., social support, interpersonal stress), and community-level factors (i.e., neighborhood quality).ResultsTwenty-seven percent of participants reported their belief that their current boyfriend had concurrent sexual partners during their relationship. In a logistic regression analysis, participants endorsing perceived partner concurrency reported less relational power (adjusted odds ratio [AOR] = .94, 95% confidence interval [CI] = .89–.98, p < .01), decreased relationship commitment (AOR = .88, 95% CI = .80–.96, p < .01), elevated perceived interpersonal stress (AOR = 1.02, 95% CI = 1.003–1.04, p < .05), and previous STD diagnoses (AOR = 2.07, 95% CI = 1.31–3.28, p < .01; overall model: χ² = 67.25; p < .001).ConclusionsResults suggest that the efficacy of sexual risk reduction interventions may be improved by emphasizing the increased HIV/STD risks associated with having a boyfriend with concurrent sex partners. In addition, interventions may benefit from incorporating stress management training and addressing key relationship dynamics, particularly among adolescents with a history of STDs.     

Processes of change for increasing fruit and vegetable consumption among economically disadvantaged African American adolescents

This study sought to identify Transtheoretical Model processes of change associated with consumption of ≥ 5 daily servings of FVs in a sample of economically disadvantaged African American adolescents (N = 549; mean (SD) age = 12.44 (.99) years; 61% female; 15% African American Hispanic). Participants completed measures of stages and processes of change, and were ranked according to intake level based on their reported stage. Spearman correlations and independent samples t tests were used in cross-sectional analyses of the relationship between processes of change and FV consumption. Consciousness raising, environmental reevaluation, helping relationships and stimulus control processes were significantly associated with FV consumption (ρ ≥ .12; p < .01), and were practiced more often by youths who consumed ≥ 5 daily servings of FVs relative to those who did not (p < .05). Findings highlight the potential of these processes for increasing FV consumption in this population.     

Hypertension among females in a highly disadvantaged community in Jordan

This study was conducted with the aim of finding the prevalence rate of hypertension and the relationship between hypertension and selected socioeconomic and dietary parameters in females aged 15-49 years in a disadvantaged community in Jordan. A household survey was carried out, using a questionnaire as an instrument for interviewing subjects. About 19% of females had hypertension, ranging between 7.5% in the very young to 58% in women aged 45-49 years. Hypertension was significantly associated with almost all variables studied such as age, education, marital status, parity, obesity, and dietary patterns. Some strategies were suggested to improve the situation in the future.     

Patterns of sexual partnerships among adolescent females

Objective: To develop a multidimensional classification of sexual partnerships.Methods: Eighty-two female subjects (ages 15–20 years; 77% African American) used coital logs to record dates of 1265 coital events, partner initials, and condom use. Logs were collected at 1-, 3-, 9-, 15-, and 21-month return visits. Three adolescent health professionals independently classified partnership patterns of each subject; classification schemes were revised until complete consensus for each subject was obtained.Results: Complete agreement in partnership classification was reached after 3 rounds. The consensus partnership classification had three dimensions: number (1, ≥2 partners), pattern (1 partner, serially exclusive, concurrent), and duration (any partnership ≤21 days, all partnerships >21 days). A total of 34 of 82 (34%) of subjects had ≥2 partners; 11 of 34 (32%) had concurrent partnerships. Twenty of 82 (24%) had only partnerships lasting >21 days. Condom use was less common for subjects in only longer-term (>21 days) partnerships, but did not significantly vary by number or pattern.Conclusion: Multiple dimensions of adolescent sexual partnerships may be identified. Detailed research and clinical assessments along these dimensions may improve understanding of protective behaviors such as condom use.     

Health risk factors among detained adolescent females

OBJECTIVES: To identify the prevalence of health risk factors among a sample of detained adolescent females and determine whether there are racial/ethnic differences. DESIGN AND SETTING: A cross-sectional survey of 197 adolescent females (aged 14 to 18 years) recruited within eight detention facilities. OUTCOME MEASURES: Thirty-five measures, comprising four domains, were assessed. Domains were sex-related risk factors, violence-related risk factors, selected mental health issues, and substance abuse behaviors. Measures were collected using audio-computer-assisted self-interviewing. A biological assessment for the presence of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis was also conducted. RESULTS: Several health risk factors were especially prominent. Mean age of sexual debut was 13 years. The mean number of sex partners (lifetime) was 8.8. Twenty percent tested positive for an STD, and 32.2% had ever been pregnant. Of those reporting sexual activity, 33.9% had not used any form of contraception in the past 2 months and about 40% reported having recent sex with a casual partner. More than 40% reported that a friend had been beaten, attacked, or hurt by others in the past year. More than one half had witnessed violence (past year) and nearly 30% had ever belonged to a gang. Forty percent had thought about committing suicide in the past 2 months, with 35% informing someone of their intent, and 25% attempting suicide. Recent use of illegal substances was common. Correlations between the four domains were significant (p < 0.03), but weak. With some notable exceptions (STD prevalence, trading sex for money, witnessing violence), no difference was found between minority and nonminority adolescents with respect to risk factors. After creating an index of all the risk factors, a normal distribution was obtained (mean number of factors, 10.3; standard deviation, 5.0). CONCLUSIONS: Preventive medicine programs for adolescent females within detention facilities are warranted. Our evidence suggests that health risk behaviors in this population may be quite diverse; therefore, these programs should be broad in scope and that depth of the programs should vary as a function of risk level.     

Pregnancy termination among South African adolescents

Although African adolescents' risk of undergoing abortion and of related health complications is well-documented, little is known about the procedure's prominence in their lives and the pathways that lead to their reliance upon it. This study investigates abortion dynamics among male and female Zulu adolescents in KwaZulu/Natal, South Africa. It explores the role of abortion in young people's sexual and reproductive experience, its acceptability, the reasons and likelihood of young people's choosing abortion, and the commonly used methods of pregnancy termination. The study, a rural-urban comparison using focus-group discussions, narrative workshops, and role playing, involved surveys and in-depth interviews. Factors contributing to the commonplace nature of backstreet procedures among adolescents include: social stigma, inadequate knowledge of the legal status of abortion, and a complex group decisionmaking process. Young people invoke "relative moralities" concerning adolescent abortion, recognizing and condoning it on a context-specific basis. Age, gender, and geographic differences are examined. The methodological triangulation used offers the opportunity for alternative theoretical and methodological approaches to research on abortion-related issues.     

The treatment of eating disorders as addiction among adolescent females

As science and medicine enter the new millennium, the influences of genetics and neurochemistry as high-risk determinants in the etiology and development of eating disorders are increasingly manifest in professional literature. Eating disorders are now recognized as major medical and psychiatric problems affecting millions throughout the world. Psychoeducational, cognitive, behavioral, and psychopharmacologic treatments form the basis of most interventions which, for the most part, tend to view the eating disorder as a symptom of underlying psychopathology. The Israel Counseling and Treatment Center of the North has been treating eating disorders as addictive disease by applying the twelve step program of the Anonymous Fellowships as an adjunct to counseling and treatment for those who suffer from compulsive overeating and bulimia. Following the ongoing program of interventions with adults, a counseling group for adolescent females was co-facilitated under the supervision of the author. A co-therapist, in recovery from bulimia and comulsive overeating, uses the twelve step philosophy and served as a role model in this group intervention. Another sample of adolescent females was offered individual counseling adhering to the same addiction treatment approach. Success rates were operationally defined and measured by weight loss in the obese population and the cessation of purging behaviors among bulimic subjects for a six-month period. The two adolescent treatment samples had success rates of 62% and 33% respectively. A higher success rate of 71% was observed with adult bulimic females who participated in group counseling. A mean weight loss of 3.9 kg for the small sample of adolescents and a 9.7 kg. mean weight loss for obese adults in treatment was reported. The theoretical basis of the addiction treatment paradigm for eating disorders is presented. Results and problems encountered specific to treating the adolescent population are discussed.     

GO GIRLS!: results from a nutrition and physical activity program for low-income, overweight African American adolescent females.

This article describes the development, implementation, and results of an intervention designed for inner-city, overweight African American adolescent women. Fifty-seven participants were recruited from four public housing developments. Participants were administered physiologic, dietary, and cognitive assessments at baseline and immediately postintervention. Each session comprised three elements: (1) an educational/behavioral activity, (2) 30 to 60 minutes of physical activity, and (3) preparation and tasting of low-fat meals. In the absence of a control group, results were compared for high and low attenders, the former defined as attending at least 50% of the sessions. High attenders (n = 26) showed more favorable 6-month posttest values for most outcomes compared with low attenders (n = 31). These effects achieved statistical significance for nutrition knowledge, low-fat practices, perceived changes in low-fat practices, and social support.     

Physical activity influences in a disadvantaged African American community and the communities' proposed solutions

The purpose of this assessment is to increase our understanding of how safety and environmental factors influence physical activity among African American residents living in a low-income, high-crime neighborhood and to get input from these residents about how to best design physical activity interventions for their neighborhood. Twenty-seven African American adult residents of a low-income, high-crime neighborhood in a suburban southeastern community participated in three focus groups. Participants were asked questions about perceptions of what would help them, their families, and their neighbors be more physically active. Two independent raters coded the responses into themes. Participants suggested three environmental approaches in an effort to increase physical activity: increasing law enforcement, community connectedness and social support, and structured programs. Findings suggest that safety issues are an important factor for residents living in disadvantaged conditions and that the residents know how they want to make their neighborhoods healthier.     

A flowchart for managing sexually transmitted infections among Nigerian adolescent females

OBJECTIVE: To devise a flowchart suitable for assessing risk of trichomoniasis, chlamydia and gonorrhoea in an adolescent population, not all of whom will be sexually experienced or currently in a relationship. METHODS: The data used to derive the flowchart were generated from cross-sectional microbiological surveys of girls aged 14-19 years in Port Harcourt, Nigeria. The flowchart screened on the basis of: (i) sexual experience; (ii) recent sexual activity; (iii) a positive urine leukocyte esterase (LE) test; and (iv) among LE negatives, a history of malodorous/pruritic discharge. FINDINGS: Using this flowchart, we found that 26.2% of all adolescents screened would receive treatment for cervicitis and vaginitis. Chlamydial, gonococcal, and trichomonal infections were correctly diagnosed in 37.5%, 66.7%, and 50% of the cases, respectively. CONCLUSION: Although the flowchart is more suitable for an adolescent population than the vaginal discharge algorithm used in syndromic management protocols, it still lacks precision and needs adapting to local settings.