The influence of parental monitoring on adolescent sexual initiation

OBJECTIVE: To explain the influence of parental monitoring on adolescent sexual initiation within the context of a cognitive behavioral model. DESIGN, SETTING, AND PARTICIPANTS: Virginal youth (N = 307) recruited from a health maintenance organization adolescent medicine clinic were interviewed at baseline and at 6 months about parental monitoring and other known cognitive factors associated with the initiation of sexual behavior. Participants were followed up at 6 months and potentially at 12 months to assess the initiation of sexual intercourse. RESULTS: Adolescents reporting successful parental monitoring (accurately knowing the adolescents' whereabouts and activities outside the home) significantly expressed cognitions less favorable of initiating intercourse, while adolescents reporting more unrestricted time were more likely to express cognitions that favored initiating intercourse. In adjusted analysis, cognitions (attitudes, perceived peer behaviors, and subjective norms) that favored intercourse significantly predicted a greater intention to engage in intercourse. However, adolescents who reported successful parental monitoring significantly expressed less sexual intention, and successful parental monitoring moderated the effect of attitude on the intention to initiate intercourse among female subjects. Overall, behavioral intention was the only significant predictor of actual sexual onset. CONCLUSIONS: These findings are useful in directing further research and in designing interventions to delay the onset of sexual intercourse in adolescence. More research is required to understand how attitudes toward sexual initiation are formed during adolescence and how parents may facilitate the formation of these attitudes. Parental interventions that promote successful communication and support effective parental monitoring may be an important component of interventions designed to delay sexual initiation during adolescence.     

Preventing adolescent health-risk behaviors by strengthening protection during childhood

OBJECTIVE: To examine the long-term effects of an intervention combining teacher training, parent education, and social competence training for children during the elementary grades on adolescent health-risk behaviors at age 18 years. DESIGN: Nonrandomized controlled trial with follow-up 6 years after intervention. SETTING: Public elementary schools serving high-crime areas in Seattle, Wash. PARTICIPANTS: Of the fifth-grade students enrolled in participating schools, 643 (76%) were given written parental consent for the longitudinal study and 598 (93%) were followed up and interviewed at age 18 years. INTERVENTIONS: A full intervention provided in grades 1 through 6 of 5 days of in-service training for teachers each intervention year, developmentally appropriate parenting classes offered to parents when children were in grades 1 through 3 and 5 through 6, and developmentally adjusted social competence training for children in grades 1 and 6. A late intervention, provided in grades 5 and 6 only, paralleled the full intervention at these grades. MAIN OUTCOME MEASURES: Self-reported violent and nonviolent crime, substance use, sexual activity, pregnancy, bonding to school, school achievement, grade repetition and school dropout, suspension and/or expulsion, and school misbehavior; delinquency charges from court records; grade point average; California Achievement Test scores: and disciplinary action reports from school records. RESULTS: Fewer students receiving full intervention than control students reported violent delinquent acts (48.3% vs 59.7%; P=.04), heavy drinking (15.4% vs 25.6%; P=.04), sexual intercourse (72.1% vs 83.0%; P=.02), having multiple sex partners (49.7% vs 61.5%; P=.04), and pregnancy or causing pregnancy (17.1% vs 26.4%; P=.06) by age 18 years. The full intervention student group reported more commitment (P=.03) and attachment (P=.006) to school, better academic achievement (P=.01), and less school misbehavior (P=.02) than control students. Late intervention in grades 5 and 6 only did not significantly affect health-risk behaviors in adolescence. CONCLUSIONS: A package of interventions with teachers, parents, and children provided throughout the elementary grades can have enduring effects in reducing violent behavior, heavy drinking, and sexual intercourse by age 18 years among multiethnic urban children. Results are consistent with the theoretical model guiding the intervention and support efforts to reduce health-risk behaviors through universal interventions in selected communities or schools serving high-crime neighborhoods.     

Psychosocial predictors of adolescent sexual behavior

Objective  To find out the psychosocial factors associated with adolescent sexual behavior. Methods  A cross sectional study was carried out in Chandigarh Union Territory of India by enrolling 11^th class students from six randomly selected schools. A pre-tested questionnaire containing 83 items was administered after ensuring privacy and confidentiality. Socio-economic status, residence, gender, grade in the class, religion, acculturation level, self esteem, social support and coping behavior were considered as independent explanatory variables and physical sexual contact (which included kissing, hugging and sexual intercourse) was taken as dependent variable. Results  Two hundred and fifty seven students enrolled for the study had mean age of 17 yr. The prevalence of sexual activity was 20% (95% CI: 13.6%–28.1%) among males and 6% (95% CI: 1.3%–18.8%) among females. Four percent of males and 1% of females reported sexual intercourse. The main reason for not having sexual physical contact was societal norms. After adjusting for confounders in multivariate analysis, male gender (OR: 3.5; 95%CI: 1.5–8.1) and modern attitudes (OR: 0.77; 95%CI: 0.6–0.98) were found to be the risk factors for initiation of sexual activity in adolescence. Conclusion  Cultural norms rather than the individual/psychological factors tend to govern adolescent sexual behavior in Indian society.     

Long-term effects of a middle school- and high school-based human immunodeficiency virus sexual risk prevention intervention

OBJECTIVE: To determine the longer-term effect (mean +/- SD, 41.2 +/- 15.3 weeks; range, 14.1-80.5 weeks) of a middle school (MS)- and high school (HS)-based human immunodeficiency virus and sexuality intervention (Rochester AIDS Prevention Project for Youth [RAPP]) on knowledge, self-efficacy, behavior intention, and behaviors. DESIGN: Quasi-experimental design with 3 intervention groups and 1 control group. SETTING: Urban, predominantly ethnic, minority MS and HS health classes. PARTICIPANTS: Middle school and HS students (N = 4001) enrolled in health classes in 10 schools. Fifty percent were African American; 16%, Hispanic; 20%, white; and 14%, other. Less than 10% of the students refused participation. INTERVENTIONS: There were 4 study conditions: (1) control, usual health education curriculum taught by a classroom teacher; (2) RAPP adult health educator, intervention curriculum implemented by highly trained health educators; (3) RAPP peer educator, intervention implemented by extensively trained HS students; and (4) a comparison of the RAPP intervention curriculum taught by regular health teachers, implemented with MS students only. MAIN OUTCOME MEASURE: A confidential questionnaire was administered to all study subjects before and at long-term follow-up after the intervention, containing scales to measure knowledge, self-efficacy, behavior intention, and behaviors, including onset of sexual intercourse experience and engagement in risky sexual behaviors. RESULTS: Rates of baseline sexual activity in the sample were comparable to those found in other urban school-based surveys. Long-term knowledge (MS females, P<.001; and MS males, P<.01) and sexual self-efficacy (MS females, P<.05; and HS females, P<.01) scores were higher among the intervention groups (male and female are used in this study to describe those aged 9(1/2)-23 years). Intention to remain safe regarding sexual behavior was also greater among intervention groups in MS but not HS. However, subjects who were already sexually active at pretest were less likely to show a positive intervention effect. An intervention effect for the onset of intercourse and risky sexual behavior was found most significantly among MS females. CONCLUSIONS: A positive long-term effect from the RAPP intervention was observed, particularly for youth who were involved in less risk (eg, not yet sexually active) at study enrollment. Thus, we propose that the most appropriate time for intervention implementation is earlier in adolescence, before the onset of risky behaviors.     

Characteristics of eighth-grade students who initiate self-care in elementary and junior high school

The purpose of this paper is to examine whether children who care for themselves for longer periods of time are at increased risk of poor grades, truancy, anger, family conflict, stress, risk-taking, and peer influences (in addition to the increased risk of substance use previously reported). Demographic characteristics of eighth-grade students who initiate self-care in junior high school are compared with those initiating self-care in elementary school. Further, increased risks for those initiating self-care in elementary school are examined. Over two thirds of the respondents (67.8%) cared for themselves after school without adult supervision at some time during the week; 23.5% for 1 to 4 hours per week, 15.7% for 5 to 10 hours per week, and 28.6% for 11 or more hours per week. Of those in self-care, 48.5% initiated self-care during elementary school and 51.5% during junior high school. Students who were in the highest category of self-care (greater than or equal to 11 hours per week) vs those in self-care zero hours per week were 1.5 to 2 times as likely to score high on risk-taking, anger, family conflict, and stress, to be more likely to see their friends as their major source of influence, and to attend more parties. The self-reports of academic grades did not differ. The grade of initiation of self-care (elementary vs junior high school) conferred additional risk for drinking alcohol (odds ratio = 1.4), risk-taking tendencies (odds ratio = 1.5), and attending parties (odds ratio = 1.6).     

Television viewing and risk of sexual initiation by young adolescents

OBJECTIVE: To determine if television viewing is associated with the risk of initiating sexual intercourse in young adolescents. DESIGN: Secondary analysis of data obtained from 1994 through 1996. SETTING: The National Longitudinal Study of Adolescent Health. PARTICIPANTS: The 4808 students younger than 16 years who had not initiated intercourse before baseline interview. EXPOSURES: Primary exposure was self-reported daily television watching, categorized as low (< 2 hours) or high (> or =2 hours) use. Secondary exposure was parental regulation of television programming watched. MAIN OUTCOME MEASURE: Odds ratio for initiating intercourse by 1-year follow-up, adjusted for potential confounders. RESULTS: At baseline, 2414 (48.8%) subjects watched television 2 or more hours per day. By 1-year follow-up, 791 (15.6%) subjects had initiated intercourse. Sexual initiation was associated with high television use (adjusted odds ratio, 1.35; 95% confidence interval, 1.01-1.79) and lack of parental regulation of television programming (adjusted odds ratio, 1.35; 95% confidence interval, 1.01-1.80). Most subjects (73.8%) reported strong parental disapproval of sex; their overall rate of initiation was 12.5%, and their risk was independently associated with high television use (adjusted odds ratio, 1.72; 95% confidence interval, 1.24-2.40) and lack of parental regulation of television programming (adjusted odds ratio, 1.35; 95% confidence interval, 1.01-1.81). Among adolescents who did not report strong parental disapproval, the rate of sexual initiation was higher (24.1%) but unrelated to television use. CONCLUSION: Among young adolescents who reported strong parental disapproval of sex, watching television 2 or more hours per day and lack of parental regulation of television programming were each associated with increased risk of initiating sexual intercourse within a year.     

Factors associated with sexual intercourse initiation: a retrospective cohort of Lebanese adolescents in schools

ObjectivesEarly sexual initiation is known to be associated with deleterious health outcomes. The objective of this study was to evaluate factors (bullying, weight status, smoking and alcohol consumption, peer influence, relations with parents) associated with the initiation of sexual intercourse among Lebanese adolescents in schools.MethodsA retrospective cohort was formed using a convenient sampling of Lebanese students (n=1635) in private schools from Beirut and Mount Lebanon.ResultsYounger age of adolescents at first sexual intercourse was significantly associated with finding it very easy to talk about things that worry them with an older brother, having a best friend who drinks sometimes compared to no drinking, and a best friend who smokes sometimes or every day compared to not smoking. Moreover, older age at the first sexual relationship was significantly associated with female gender (HRa=0.25), as was older age at first time drinking alcohol, first time getting drunk, and smoking cigarettes.ConclusionThis study sheds light on some of the factors associated with age at first sexual intercourse in Lebanese adolescents.     

Children's Adjustment After Parental Separation: Teacher, Peer and Self-report in a Greek Sample: a Research Note

Abstract— The purpose of this study was to assess the psychosocial and academic competence of children from divorced families in Greece and to compare it with findings in other countries. The sample of the study consisted of fifth and sixth grade elementary school pupils (mean age = 11.3) attending Greek public schools. The "divorced family" group consisted of 26 children, while the control group consisted of all classmates of these students (N = 381) from intact families. Teacher, peer and self-rating instruments were used. Children from divorced families were found to experience serious difficulties in various aspects of their behavior and competence.     

乌鲁木齐市近视小学生社交焦虑现状及其危险因素分析

目的 了解乌鲁木齐市四至六年级近视学生社交焦虑的发生情况,分析近视小学生社交焦虑发生的危险因素。方法 采用分层整群随机的抽样方法抽取乌鲁木齐市4所小学中552名四至六年级近视学生为研究对象,采用自行设计的调查表、儿童社交焦虑量表和自尊量表调查学生一般人口学资料和社交焦虑、自尊现状,并采用多因素logistic回归分析调查近视学生社交焦虑的危险因素。结果 552名儿童中,社交焦虑检出为31.3%（173例）。多因素logistic回归分析结果显示,较高年级学生、女生以及专制型家庭环境、高度近视、低自尊或戴镜时间 > 2年的近视学生更易发生社交焦虑（P < 0.05）。结论 乌鲁木齐市四至六年级近视学生社交焦虑问题较为突出,其社交焦虑的发生与年龄、性别、近视程度、戴镜时间、父母教育方式及自尊水平等因素有关。     

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.     

Opportunities for appropriate care: health care and contraceptive use among adolescents reporting unwanted sexual intercourse

BACKGROUND: Unwanted sexual contact, reported by 30% to 42% of young women and 10% to 34% of young men, has been associated with negative health outcomes and increased teenaged pregnancy. OBJECTIVE: To determine health services and contraceptive use among adolescents reporting unwanted sexual intercourse. METHODS: Random-digit dial methods were used to survey 1040 adolescents in Monroe County, New York; 389 (37%) were sexually active and answered a question about whether they had ever been forced or pressured to have sexual intercourse. The data were weighted to reflect the county population. RESULTS: Among sexually active adolescents, 20% of females and 7% of males reported unwanted intercourse (P<.001). For 37% of male and 17% of female adolescents, the survey was the first time they had disclosed the incident (P =.17). Among female adolescents reporting unwanted intercourse, 91% have a usual source of care and 62% reported a well visit in the previous 6 months. Female adolescents reporting unwanted sex were more likely to have wanted contraceptives but not gotten them because of fear their parents would find out (32% vs 11%; P =.01) and to have had sex without contraception (69% vs 52%; P =.05) than those who had not had unwanted sex. CONCLUSIONS: Many adolescents have been forced or pressured to have sexual intercourse. Although many have never told anyone about the incident, most have visited a primary care physician or clinician. Physicians and other clinicians should screen for a history of unwanted intercourse and provide needed referrals for counseling and/or contraceptive information.     

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.     

Reproductive health education intervention trial

Objective: To measure the effectiveness of a reproductive health education package in improving the knowledge of adolescent girls aged 15–19 years in Chandigarh (India).Methods: A reproductive health education package, developed in consultation with parents, teachers and adolescents, was delivered to randomly sampled classes of two senior secondary schools and one school was selected as control. In one school, a nurse conducted 15 sessions for 94 students in three batches using conventional education approach. In another school she conducted sessions for a selected group of 20 adolescents who later disseminated the messages informally to their 84 classmates (peer education). Using a 70-item structured questionnaire the knowledge of 95 adolescents from conventional, 84 from peer, and 94 from control school were assessed before and one month after the last session. Change in the score in intervention and control groups was tested by ANOVA taking age and socio-economic status as covariates.Results: Teachers, parents and students overwhelmingly (88%, 95.5% and 93% respectively) favoured reproductive health education program. Five percent of the respondents reported that someone in their class is having sexual relations, and 13% of the girls approved of pre-marital sexual relations. Reproductive health knowledge scores improved significantly after intervention in conventional education (27.28) and peer education group (20.77) in comparison to the controls (3.64). Post-test scores were not significantly different between peer education group and conventional education group (43.65 and 40.52 respectively) though the time consumed in delivering the peer education intervention was almost one third of the time taken to implement conventional education.Conclusion: Peer education and conventional education strategies were effective in improving the reproductive health knowledge of adolescent girls but peer strategy was less time consuming     

Three-year maintenance of improved diet and physical activity: the CATCH cohort. Child and Adolescent Trial for Cardiovascular Health.

OBJECTIVE: To assess differences through grade 8 in diet, physical activity, and related health indicators of students who participated in the Child and Adolescent Trial for Cardiovascular Health (CATCH) school and family intervention from grades 3 through 5. DESIGN: Follow-up of the 4-center, randomized, controlled field trial with 56 intervention and 40 control elementary schools. PARTICIPANTS: We studied 3714 (73%) of the initial CATCH cohort of 5106 students from ethnically diverse backgrounds in California, Louisiana, Minnesota, and Texas at grades 6, 7, and 8. RESULTS: Self-reported daily energy intake from fat at baseline was virtually identical in the control (32.7%) and intervention (32.6%) groups. At grade 5, the intake for controls remained at 32.2%, while the intake for the intervention group declined to 30.3% (P<.001). At grade 8, the between-group differential was maintained (31.6% vs 30.6%, P = .01). Intervention students maintained significantly higher self-reported daily vigorous activity than control students (P = .001), although the difference declined from 13.6 minutes in grade 5 to 11.2, 10.8, and 8.8 minutes in grades 6, 7, and 8, respectively. Significant differences in favor of the intervention students also persisted at grade 8 for dietary knowledge and dietary intentions, but not for social support for physical activity. No impact on smoking behavior or stages of contemplating smoking was detected at grade 8. No significant differences were noted among physiologic indicators of body mass index, blood pressure, or serum lipid and cholesterol levels. CONCLUSION: The original CATCH results demonstrated that school-level interventions could modify school lunch and school physical education programs as well as influence student behaviors. This 3-year follow-up without further intervention suggests that the behavioral changes initiated during the elementary school years persisted to early adolescence for self-reported dietary and physical activity behaviors.     

Elementary School Students’ Prosocial Experiences in South Korea: A Case Study

This case study demonstrates how elementary school students’ selective prosocial responding towards their peers is associated with the targets’ different peer sociometric status in the classroom. Participants include 23 fourth graders and their teacher in a private elementary school in Seoul, South Korea. The findings of this study include: 1) Students were selectively prosocial toward their peers, based on the targets’ peer acceptance and popularity; 2) The group norms associated with the criteria of peer acceptance and popularity seemed to be related to liking of liked individuals; and 3) Being friendly and comforting was commonly enacted by the students in the classroom, even toward disliked individuals; however, giving and instrumental helping was more frequent with popular targets than with disliked ones. The findings of the study indicate that students’ prosocial experiences are shaped by their selective choice of behavior based on in-group-out-group distinctions.     

School performance characteristics preceding onset of smoking in high school students

The cigarette smoking status of 1,442 high school students was determined by questionnaire. Of the respondents (smoking and nonsmoking), 60% had been enrolled in the same school system during elementary school. Thus, records were available of school absence, grades, achievement tests, and IQ tests during elementary school, prior to the time when the smokers had commenced the practice. Smoking in high school was significantly related to high absence rates, low achievement test scores, and low grade point averages during elementary school years, prior to the onset of smoking. The IQ was not significantly different in the third grade among pupils who became smokers in high school and those who did not, but sixth-grade IQ scores were significantly lower in students who later identified themselves as smokers. Although smokers demonstrated these characteristics prior to beginning smoking, the differences were not large enough to predict which elementary school students would become high school smokers. The findings support the view that smoking and these school-related characteristics may both be part of a "smoker life-style."     

School performance of survivors of neonatal encephalopathy associated with birth asphyxia at term

School performance testing was completed at 8 years of age on 145 children who had had neonatal encephalopathy associated with birth asphyxia as term infants and on a comparison peer group of 155 children. The prospectively identified clinical categories of encephalopathy for the neonates were 56 mild (hyperalertness, hyperexcitability), 84 moderate (lethargy, hypotonia, suppressed primitive reflexes), and 5 severe (stupor, flaccidity, absent primitive reflexes). The mortality rate to 8 years of age was 13%. The incidence of impairment, which included cerebral palsy, blindness, cognitive delay, convulsive disorder, and severe hearing loss, was 16% among those assessed at 8 years (75% of survivors). Intellectual, visual-motor integration, and receptive vocabulary scores, as well as reading, spelling, and arithmetic grade levels for those with moderate or severe encephalopathy, were significantly below (p less than 0.01) those in the mild encephalopathy or peer comparison groups. Predictors of reading performance for the study group included category of encephalopathy, birth weight for gestational age, native language, and mother's educational level (multiple R = 0.58). Nonimpaired survivors of moderate encephalopathy were more likely to be more than one grade level delayed than were children from the peer group (reading 35% vs 15%, spelling 18% vs 8%, arithmetic 20% vs 12%, p less than 0.01). Thus children who had moderate and severe neonatal encephalopathy are at risk for physical and mental impairment and reduced school performance. Children with mild encephalopathy had school performance scores similar to those of their peers.     

Prevalence and characteristics of sexual abuse in a national sample of Swedish seventeen-year-old boys and girls

The aims of this study, which was part of a survey on adolescent sexual behaviour, were to investigate adolescents' experience of child sexual abuse and to present possible abuse-related problems. Representative samples of 2% of Sweden's 17-y-old male and female students and school non-attenders were selected in a two-step procedure. In all, 1943 students and 210 school non-attenders answered a self-administered anonymous questionnaire, distributed by school nurses. Six out of 170 questions dealt with personal experiences of child sexual abuse, i.e. age at onset, frequency of abuse and relationship to the offender. Peer abuse was excluded by the definitions used. The overall response rate was 92.2% for students and 44.2% for school dropouts. Among male and female students, 3.1% and 11.2%, respectively, acknowledged sexual abuse, 2.3% and 7.1%, respectively, when exhibitionism was excluded. Mean age at onset was 9.1 y (SD 4.3) for boys and 9.0 y (SD 3.9) for girls; 1.2% of the boys and 3.1% of the girls reported abusive oral, vaginal and/or anal intercourse. Suicide attempts or other acts of self-harm were reported by 33.3% of the male students reporting abuse and by 5.1% (p < 0.001) of those who had not been abused, and by 30.4% of the abused student girls compared to 9.1% of the non-abused (p < 0.001). Sleep and eating disorders, use of alcohol at an early age and/or experimentation with illicit drugs and consensual coitarche before age 15 y was reported significantly more often by abused than non-abused girls (p < 0.001, differences not found among the student boys). Of school non-attenders, 4% of the boys and 28% of the girls reported sexual abuse. Of the abused girls, 49% reported abusive vaginal intercourse and 64% reported self-destructive behaviour or suicide attempts. No abused boys and few abused girls had confided in a teacher, health professional or social worker. Results from the student sample should be interpreted as markers of "minimum prevalence", as female school non-attenders report significantly higher prevalence of sexual abuse. Potential high-risk groups are better included in prevalence investigations of child sexual abuse. The fact that so few adolescents confided in "professionals" about the abuse, despite having severe symptoms and signs of distress, underlines the need to address sexual abuse when recording the social, medical and psychiatric histories of adolescents.     

Behavioral risks for HIV in adolescents

A psychosocial perspective on adolescent risk behavior is used to highlight aspects of psychological development and social environment that are relevant to sexual activity and substance use. Differences in behavior are also related to factors such as age and gender that have biological, developmental, and demographic implications. Sexual activity and substance use increase during adolescence, and are often interrelated. In the USA in 1992, 69% of 8th graders and 88% of 12th graders had drunk alcohol. In 1990, 54% of high school students had had sexual intercourse. Age of sexual initiation has decreased in recent cohorts, but condom use by adolescents has increased, with 35% of 15–19-year-old women reporting using condoms. Interventions that successfully change adolescent risk behavior take account of the teen's level of development and social context.     

Adolescents with type 1 diabetes and risky behaviour

Aim: The aim of the student is to assess whether adolescents with type 1 diabetes mellitus (T1DM) in Italy differ from their healthy peers in regard to risky behaviour. Methods: Data were collected from 215 patients, aged 14 ± 2 years with a mean disease duration of 7 ± 5 years. The control group was comprised of 464 healthy adolescents recruited among high school students. Each patient completed an anonymous confidential questionnaire to determine the prevalence of sexual behaviour, alcohol and tobacco consumption, illicit drug use, and, among patients with diabetes and frequency of mismanagement related to diabetes care. Results: Compared with controls, subjects with diabetes showed a similar rate of sexual intercourse among males and lower rates among females (34.8% vs 35.5%, p NS and 29.4% vs 41.4%, p < 0.05, respectively). Males in the diabetes group reported a higher rate of tobacco use, whereas females showed similar or higher rates of use for every illicit drug studied. Among patients with diabetes, those who are engaged in risky behaviour showed a higher rate of treatment mismanagement (76% vs 34%, p < 0.01). Conclusion: Adolescents with T1DM are as likely as their healthy peers to engage in risky behaviour, indicating the potential benefit of anticipatory guidance concerning glycaemic control and increased risk of acute and chronic complications.