Teenagers'' Sexual Behavior in Sweden, Europe

Objective To investigate the development of sexuality from early to late adolescence,and to compare girls and boys of different agesMethods A cross sectional survey in all schools was performed covering all pupilsbetween 13 and 18years of age that were in school when the survey was conducted. Avalidated instrument, Q90, created for use in teenagers was distributed in the class-rooms to 3 216 teenagers. Q90 covers 30 questions about body development andsexual behavior. Non-response was insignificant (n=19; 0. 6%).Results Pubertal development was considered "early" or "late" by about 50% ofboth boys and girls. Eighty percent of the 13 to 15 years old boys and girls had had aromance and 30% had experience of sexual cuddling (petting), while significantlymore girls than boys had sexual intercourse (18% vs 13%; odds ratio 1.5, 95% CI1.1-1.9). The difference between girls and boys remained in those being 16-18 yearsold, where 63% of the girls and 53% of the boys (odds ratio 1.5, 95% CI 1.2-1.9)admitted having intercourse. Mean age at first intercourse was 14.9 and 15 years,respectively. At 16-18years of age, 23% of the sexually active girls, as compared with25% of the boys estimated that they had had 6 or more sexual partners. About 30% ofthe adolescents, irrespective of age and gender, did not use contraceptives at theirfirst and latest intercourse. Eight percent of the older girls had been pregnant, andthey had an increased history of sexually transmitted infections, as compared withthe boys (6.2% vs 2.7%; odds ratio 2.4, 95% CI 1.2-5.0).Conclusion Exploring sexuality and experimentation is a normal behavior inadolescence. The results of this study, however, indicate that there are substantialgroups of teenagers who practice sexual risk-taking. In addition to general sexualeducation, programs should also be directed to define sexual risks and its consequences.     

Contraceptive knowledge, attitudes and behavior about sexuality among college students in Beijing, China

Background  Sexual and reproductive health among adolescents have become increasingly important and aroused international concerns. In this study, we investigate sexual knowledge, attitudes, sexual behaviors, the unwanted pregnancy and the abortion rate and to explore related determinants among college students in Beijing.

Methods  This study is based on a cross-sectional survey of college students’ knowledge, attitudes and behavior. Multistage cluster sampling was used to select subjects in Beijing. The self-questionnaire designed by our research group including general information, knowledge, attitude and behavior about sexuality was used to collect information. A total of 2003 questionnaires were collected from June to July 2010.

Results  The data showed that most of the college students lacked knowledge about reproductive health. Only 17.9% of the respondents knew the appropriate time of abortion. Data also showed that the respondents had high-risk attitude about sex, 58.7% could accept premarital sex, and 29.7% had negative attitude towards contraception. Moreover, sexual activity of the respondents was active. Data showed that 18.5% of the respondents had had sexual activities. Significantly more boys than girls had sex (χ²=73.374, P <0.001). Among the boys and girls who reported sexual history, 43.1% of the boys had impregnated girlfriend and 49.3% of the girls among those people who have sex had unwanted pregnancies. Logistic regression analysis showed that the variables the gender (OR=3.12, 95% CI: 2.39–4.11), grade (OR=1.78, 95% CI: 1.40–2.26), specialty (OR=1.35, 95% CI: 1.12–1.74), family situation (OR=1.66, 95% CI: 1.15–2.38), score of knowledge (OR=0.74, 95% CI: 0.58–0.95) and attitude to sex activity (OR=0.09, 95% CI: 0.04–0.22) had a significant effect on having sexual behavior.

Conclusions  College students lack knowledge and methods to avoid risky sexual behaviors in Beijing. College students have high-risk sexual attitude and behaviors. Therefore, suitable and effective sex health measures to protect college students would be strongly recommended.

     

Determinants of consistent condom use among adolescents and young adults attending a tertiary educational institution in Ile-Ife, Nigeria

OBJECTIVES: This study evaluated the determinants of consistent condom use among adolescents and young adults aged 15 - 29 years. METHODS: This was a cross-sectional survey to which 600 (300 of each gender) adolescents/young adults who had never married were recruited. Information was collected from respondents by means of a purpose-designed, self-administered questionnaire. Information sought includes the respondents' social and demographic characteristics, sexual practices and issues relating to condom use. RESULTS: Five hundred and thirty-six (89.3%) of the 600 questionnaires were suitable for analysis; 372 (69.4%) had had sexual intercourse. A third reported that they were having sex frequently or fairly frequently; 145 (41.7%) had more than one partner while 74 (19.9%) were aware that their partners had other sexual partners. Two-thirds of currently sexually active respondents reported that condoms were readily available and cheap although only 90 (24.2%) reported using condoms consistently. The factors that were statistically significant predictors of consistent condom use among the males were age; younger respondents were more likely to be consistent users (p = 0.015), having more than one sexual partner (p = 0.030) and ability to refuse sex with a partner who would not want to use condom (p = 0.008). Among the females, statistically significant predictors were frequency of sexual intercourse; respondent who had sex frequently were more likely to use condoms consistently (p = 0.018) and having more than one partner (p=0.018). CONCLUSION: Inconsistent condom use is rampant and females were probably disadvantaged as far as condom negotiation is concerned.     

娱乐服务行业流动妇女性行为和性观念分析

目的 了解娱乐服务行业流动妇女的性行为和性观念现状。方法 对广州市某区17家桑拿、夜总会989名流动妇女进行匿名问卷调查。结果 调查对象平均年龄22．5岁,文化程度较低,未婚育龄妇女为主(83．0％)。76．4％的未婚妇女有婚前性行为,11．7％的人有多个性伴侣,近半年每次性生活部使用避孕套的妇女仅占23．2％。1．8％的妇女得过性病。结论 娱乐服务行业流动妇女性观念开放,婚前性行为和无保护性行为普遍,有必要在该人群开展生殖健康和安全性行为的健康教育。     

Survivors of sexual abuse: clinical, lifestyle and reproductive consequences

BACKGROUND: In recent years, an increase in the prevalence of sexual abuse of women has been reported in Canada and elsewhere. However, there are few empirical data on the extent of the problem in Canadian aboriginal populations. The authors investigated the presence of a reported history of sexual abuse and other health determinants in a sample of women attending a community health centre with a substantial aboriginal population. This allowed determination of whether reported sexual abuse and its associated demographic and health-related effects were different for aboriginal and non-aboriginal women. METHODS: A sample of 1696 women was selected from women attending a community health centre in a predominantly low-income inner-city area of Winnipeg for a cross-sectional survey designed to study the association between sexual behavior and cervical infections. The survey was conducted between November 1992 and March 1995 and involved a clinical examination, laboratory tests and an interviewer-administered questionnaire. A substudy was conducted among 1003 women who were asked 2 questions about sexual abuse. RESULTS: The overall response rate for the main study was 87%. Of the 1003 women who were asked the questions about sexual abuse, 843 (84.0%) responded. Among the respondents, 368 (43.6%) were aboriginal. Overall, 308 (36.5%) of the respondents reported having been sexually abused, 74.0% of the incidents having occurred during childhood. The prevalence was higher among aboriginal women than among non-aboriginal women (44.8% v. 30.1%, p < 0.001). Women who had been sexually abused were younger when they first had sexual intercourse, they had multiple partners, and they had a history of sexually transmitted diseases. In addition, non-aboriginal women who had been sexually abused were more likely than those who had not been abused to have been separated or divorced, unemployed and multiparous and to have used an intrauterine device rather than oral contraceptives. Aboriginal women who had been sexually abused were more likely than those who had not been abused to have been separated or divorced, unemployed and multiparous and to have used an intrauterine device rather than oral contraceptives. Aboriginal women who had been sexually abused were more likely than those who had not been abused to have had abnormal Papanicolaou smears. The proportion of smokers was higher among the abused women than among the non-abused women in both ethnic groups. INTERPRETATION: A history of sexual abuse was associated with other clinical, lifestyle and reproductive factors. This suggests that sexual abuse may be associated with subsequent health behaviors, beyond specific physical and psychosocial disorders. Aboriginal and non-aboriginal women who have suffered sexual abuse showed substantial differences in their subsequent health and health-related behaviours.     

流出地校外青少年艾滋病相关危险行为及其影响因素

目的：了解流出地15~24岁未婚校外青少年艾滋病相关危险行为发生情况及影响因素,为对此人群开展相关健康教育提供参考。方法：采用整群抽样方法,抽取某县某所劳务培训和输出机构所有15~24岁未婚校外青少年进行问卷调查。以理性行为理论为基础设计结构式问卷,匿名,在调查员的指导下填写后当场装入信封回收。共收回问卷1 800份,有效问卷1 712份。利用Epidata 3.0建立数据库用SPSS 13.0软件进行统计分析。结果： (1)流出地校外青少年艾滋病危险行为发生率较高,婚前性行为的发生率为18.0%,其中过去3个月中性行为从未使用过安全套的占27.3%,有多性伴者占30.8%,有过商业性行为者占31.0%,有过使用毒品经历占9.7%;艾滋病知识知晓率仅为25.1%;同伴环境较差;(2)性行为中使用安全套与艾滋病知识得分、性关系中能谈论安全套相关;发生多性伴行为与年龄、朋友中有多性伴者、对多性伴的态度、主观规范相关;发生商业性行为与艾滋病知识得分、家庭住址、朋友中有发生商业性行为、主观规范、商业性行为意向相关;静脉吸毒与年龄、艾滋病知识得分、朋友吸毒、主观规范、吸毒意向相关;(3)理性行为理论框架中主观规范和行为意向对校外青少年艾滋病危险行为的发生影响较大。结论：流出地校外青少年感染艾滋病的危险性主要表现为缺乏相关知识和应对不良的伙伴压力的能力,应帮助他们树立良好的行为规范,外出打工前期是对校外青少年进行相关健康教育的“关键期”。     

American Indian--Alaska Native youth health.

OBJECTIVE--To assess risk behaviors, health problems, worries and concerns, and resiliency-promoting factors among American Indian-Alaska Native adolescents. DESIGN--Survey. SETTING--Nonurban schools from eight Indian Health Service areas. PARTICIPANTS--A total of 13,454 seventh- through 12th-grade American Indian-Alaska Native youths. MAIN OUTCOME MEASURES--revised version of the Adolescent Health Survey, a comprehensive, anonymous, self-report questionnaire with 162 items addressing 10 dimensions of health. RESULTS--Poor physical health was reported by 2% of the study sample and was significantly correlated with social risk factors of physical and/or sexual abuse, suicide attempts, substance abuse, poor school performance, and nutritional inadequacies. Injury risk behaviors included never wearing seatbelts (44%), drinking and driving (37.9% of driving 10th through 12th graders), and riding with a driver who had been drinking (21.8%). Physical and sexual abuse prevalence was 10% and 13%, respectively, with 23.9% of females reporting physical abuse and 21.6% of females reporting sexual abuse by the 12th grade. Almost 6% of the entire sample endorsed signs of severe emotional distress. Eleven percent of the teens surveyed knew someone who had killed himself or herself, and 17% had attempted suicide themselves. Sixty-five percent of males and 56.8% of females reported having had intercourse by the 12th grade. Weekly or more frequent alcohol use rose from 8.2% of seventh graders to 14.1% by the 12th grade; for males, the survey noted an increase in regular alcohol use of 3% to 5% a year to 27.3% by the 12th grade. For each variable measured, rates are much higher for American Indian adolescents than those for rural white Minnesota youth, except for age at first intercourse and alcohol use. CONCLUSIONS--American Indian-Alaska Native adolescents reported high rates of health-compromising behaviors and risk factors related to unintentional injury, substance use, poor self-assessed health status, emotional distress, and suicide. Interventions must be culturally sensitive, acknowledge the heterogeneity of Indian populations, be grounded in cultural traditions that promote health, and be developed with full participation of the involved communities.     

Influence of human immunodeficiency virus antibody testing on sexual behaviour in a "high-risk" population from a "low-risk" city

A survey was undertaken of homosexual and bisexual men in Brisbane to establish whether knowledge of their human immunodeficiency virus (HIV)-antibody status had influenced any sexual behaviour that was likely to spread HIV type 1 (HIV-1). Of the 318 respondents, 123 respondents knew their HIV serological status, and 13 of these were HIV seropositive. Of the 195 respondents who previously had not been tested, 10 individuals proved to be HIV seropositive. Eighty-two per cent of subjects stated that they had reduced their sexual activity because of their awareness of the acquired immunodeficiency syndrome (AIDS); this reduction was equally common among those who had or had not previously had their HIV serological status checked. Anal intercourse was practised most frequently by those subjects who were HIV seropositive and were not aware of it; nevertheless, unprotected anal intercourse was common among subjects who knew their HIV serological status, including those who knew that they were HIV seropositive. Eighty-nine of 208 subjects who were practising anal intercourse had never used a condom. Usage of a condom was marginally more common among those subjects who previously had been tested for the presence of HIV antibodies (P = 0.06), and this was particularly so for those subjects who knew that they were HIV seropositive (P less than 0.01). Condom usage was no more common among those subjects who knew that they were HIV seronegative, when compared with those subjects who did not know their status. These data show that knowledge of a negative HIV-antibody test-result has no substantial association with safer sexual behaviour and suggest that whereas targeted information programmes have had some impact on behaviour in high-risk groups in Brisbane, by the end of July 1986, these programmes had not yet resulted in safer sexual practices by the majority of homosexual and bisexual men.     

Sexual practices and condom usage in a cohort of homosexual men in relation to human immunodeficiency virus status

Between January 1, and October 31, 1987, 420 homosexual men who participated in a cohort study of infection with the human immunodeficiency virus (HIV) completed a questionnaire that examined their sexual practices during the previous six months. Of the subjects, 205 (48.8%) men were HIV-seropositive and 215 (51.2%) men were HIV-seronegative. Although there was an appreciable level of condom usage in both groups, 13.5% of the HIV-seronegative men had engaged in unprotected receptive anal intercourse and 6.3% of the HIV-seropositive men had engaged in unprotected insertive anal intercourse. Condom breakage was reported on approximately 6% of occasions by a minority of subjects. Among subjects who were in a relationship with a regular male sexual partner, the most commonly reported sexual practices were deep kissing, mutual masturbation and receptive oral intercourse without ejaculation. No HIV-seronegative man engaged in unprotected receptive and/or insertive anal intercourse, receptive oral intercourse with ejaculation or receptive and/or insertive "fisting" with a regular partner who was HIV-seropositive. No HIV-seropositive man engaged in unprotected insertive anal intercourse to ejaculation with an HIV-seronegative partner, although they did so with partners who were HIV-seropositive or of unknown status. On multivariate analyses the subject's antibody status was found to be associated with receptive anal intercourse with a condom (P = 0.007) and mutual masturbation (P = 0.001), with HIV-seronegative men being more likely to practise either; no significant independent effect was associated with the partner's antibody status. These findings provide important information on the types and levels of sexual practices in a group of homosexual men after the recognition of the acquired immunodeficiency syndrome in this country.     

The British Columbia Positive Women''s Survey: a detailed profile of 110 HIV-infected women

OBJECTIVE: To describe the health, social environment, medical care received and satisfaction with medical care of HIV-infected women in British Columbia. DESIGN: Self-administered 75-item questionnaire distributed by mail or in person between March 1994 and February 1996 through community AIDS organizations and physicians' offices. SETTING: British Columbia. PARTICIPANTS: A total of 110 HIV-positive women. OUTCOME MEASURES: Sociodemographic data, risk factors for HIV infection, details about HIV testing, health status and medical treatment, use of health care services, degree of satisfaction with medical care and psychosocial stressors. RESULTS: Most of the women surveyed were aged 25 to 39 years (70.0%), were Canadian born (76.4%) and were white (80.9%). Over one-third did not complete high school, and half had an annual household income of less than $20,000. Of the 110 women 51.8% had children, who were HIV-positive in 12.3% of cases. The most frequently reported risk factor for HIV infection was sex with a man (49.1%); 19.1% reported both sex with a man and injection drug use, and 12.7% reported injection drug use only. Seventy-five women indicated that they had become infected through sex with a man, with or without injection drug use. Of these, 65 indicated whether or not this was the result of sexual assault or rape; 8 (12.3%) answered affirmatively. Of the 81 women who responded to the question regarding prior sexual assault or abuse, 43 (53.1%) reported being sexually assaulted as an adult, 35 (43.2%) reported being sexually abused as a child, and 22 (27.2%) reported being sexually abused or assaulted both as a child and as an adult. Women who were sexually abused as a child were more likely than those who were not abused as a child to have injection drug use as a risk factor (54.3% v. 7.5%). Menstrual cycle changes were reported by 70.1% of the respondents. Most women stated that they had not received adequate pre- or post-test counselling, and 47.0% were not satisfied with their doctor's care. Psychosocial concerns identified to be of greatest importance were financial problems, lack of intimacy or satisfying sexual relationship, and fear of rejection or discrimination. CONCLUSION: Several important concerns for HIV-positive women were identified, including dissatisfaction with medical care, fear of discrimination, violence and abuse, and poverty.     

KAP Survey of Turkish University Students on Sexuality, reproductive Health, Drug Addiction and Violence

Adolescence is a physical phenomenon and, as such, must be recognized as an inevi- table step going to be an adult. The second decade of life is a period of personal development almost as rapid as the first[1]. Adolescents are a very special group as with…     

中国3个直辖市流动育龄妇女人工流产现况及影响因素分析

 目的 了解中国3个直辖市（北京、重庆、上海）流动育龄妇女人工流产现况并分析其影响因素,为针对性预防和减少人工流产提供科学依据。方法 利用国家科技部"十二五"科技支撑计划项目的数据,采用有序多分类Logistic回归,重点探索流动特征等因素与人工流产之间的关联。结果 3 782例研究对象中,944例发生过至少1次人工流产,人工流产比例为24.9%。人工流产主要原因为"避孕失败"和"未采取避孕措施",相当比例的研究对象（10.9%）报告"胎儿质量不好"。有序多分类Logistic回归显示,控制年龄、婚姻状况、文化程度、职业、家庭人均月收入等因素后,首次外出打工年龄较小、首次性行为年龄较小、存在性压抑、有婚前性行为的流动育龄妇女发生人工流产的比例较高。结论 流动育龄妇女人工流产比例较高,应重点针对首次外出打工年龄较小、首次性行为年龄较小、存在性压抑、有婚前性行为的流动育龄妇女展开人工流产干预措施。     

Do adolescents attending Bandar Mas Primary Care Clinic consult health professionals for their common health problems?

The aims of the study were to determine the prevalence of the common health problems namely acne, overweight, smoking and depressive symptoms among adolescents attending a primary healthcare clinic, whether they seek treatment for these problems and the reasons for not consulting health professionals. It was a clinic-based, crosssectional study. All adolescents aged 13 to 20 years who attended the clinic during the study period were included in the study. The respondents were given self-administered questionnaires and their weights were measured to assess if they had the above disorders. A total of 215 adolescents were included in the study. The proportion of adolescents who had acne were 70.7%, overweight 8.9%, smoking 41.9% and depressive symptoms 9.8%. Only 25% of those who had acne, 47% of those who were overweight, 9.5% who had depressive symptoms and none of those who smoked had ever sought treatment for these problems. The common reasons given for not consulting the health professionals were 'did not consider it as a problem', 'shy' and 'thought there was no treatment available'. The majority of the adolescents who attended the clinic did not consult health professionals the above common health problems. It is important to educate them on these disorders and encourage health-seeking behaviour in adolescents.     

Slapping and spanking in childhood and its association with lifetime prevalence of psychiatric disorders in a general population sample

BACKGROUND: Little information is available in Canada about the prevalence of and outcomes associated with a history of slapping and spanking in childhood. The objectives of this study were to estimate the prevalence of a history of slapping or spanking in a general population sample and to assess the relation between such a history and the lifetime prevalence of psychiatric disorders. METHODS: In this general population survey, a probability sample of 9953 residents of Ontario aged 15 years and older who participated in the Ontario Health Supplement was used to examine the prevalence of a history of slapping and spanking. A subgroup of this sample (n = 4888), which comprised people aged 15 to 64 years who did not report a history of physical or sexual abuse during childhood, was used to assess the relation between a history of slapping or spanking and the lifetime prevalence of 4 categories of psychiatric disorder. The measures included a self-administered questionnaire with a question about frequency of slapping and spanking during childhood, as well as an interviewer-administered questionnaire to measure psychiatric disorder. RESULTS: The majority of respondents indicated that they had been slapped or spanked, or both, by an adult during childhood "sometimes" (33.4%) or "rarely" (40.9%); 5.5% reported that this occurred "often." The remainder (20.2%) reported "never" experiencing these behaviours. Among the respondents without a history of physical or sexual abuse during childhood, those who reported being slapped or spanked "often" or "sometimes" had significantly higher lifetime rates of anxiety disorders (adjusted odds ratio [OR] 1.43, 95% confidence interval [CI] 1.04-1.96), alcohol abuse or dependence (adjusted OR 2.02, 95% CI 1.27-3.21) and one or more externalizing problems (adjusted OR 2.08, 95% CI 1.36-3.16), compared with those who reported "never" being slapped or spanked. There was also an association between a history of slapping or spanking and major depression, but it was not statistically significant (adjusted OR 1.64, 95% CI 0.96-2.80). INTERPRETATION: There appears to be a linear association between the frequency of slapping and spanking during childhood and a lifetime prevalence of anxiety disorder, alcohol abuse or dependence and externalizing problems.     

Sexual Behaviour of Rural College Youth in Maharashtra, India： An Intervention Study

Objective To promote healthy sexual behaviour among rural college youth.
Methods The intervention study consisted a sample of 1 500 （800 male and 700female） in baseline and 1 953 （1 022 male and 931 female） college going students in post intervention, in the age groups 15-24 years from 8 colleges in Thane district of Maharashtra. The interventions included dissemination of lEC （Information, Education and Communication）, counselling in colleges and provision of health care services at rural health centers in the experimental area. Male and female teachers and peer leaders were trained to provide IEC. Chi-square test was carried out to find out the association between contributing factors and sexual behaviour.
Results Post intervention results showed that overall any sexual experience （coital/ non-coital） increased by 2.6% and 1.0% among male students and 4.6% and 0.8% among female students in control and experimental groups respectively which suggests that in the control area physical closeness and sexual relationship has increased between sexes. A significant improvement was noted in the usage of condom during their sexual intercourse in experimental group. The provision of IEC in college settings, peer leader training and orientation to teachers helped students and teachers to initiate a dialogue on reproductive health issues. Intervention programs helped college youth to develop the skills, make informed decisions about engaging in sexual intercourse and using contraceptives in a social context that sometimes encourages risky sexual behaviour. The study found that peer interaction was exposure to erotic material; habits and working status among boys and peer interaction and place of study among girls were closely associated with their coital and non-coital sex experience.
Conclusion A scientifically developed, need based and demand driven reproductive health service package for male and female students in colleges can help them to develop their knowledge, skills and attitudes for critical     

On the Metaphysics of Membrane Potential in Islet Cells: Studies with Triphenylmethylphosphonium

A questionnaire was offered to 181 sixteen-year-old boys (n=88) and girls (n=93) in different schools in the city of Uppsala. The questionnaire was introduced to the students by a nurse midwife during a regular lesson and included over 100 questions dealing partly with sexual education, attitudes towards sex and own experience of sex and contraception. Of the girls, 47% and of the boys, 31% answered that they had had intercourse. Twenty-eight per cent of the girls and 21.5% of the boys had had their first intercourse before the age of 15. Contraception was used at the first intercourse by 59% of the girls and by 70% of the boys. At the very first intercourse, the condom was the most commonly used contraceptive method. Increasing sexual experience changed the contraceptive pattern and at their last intercourse 48% of the girls were on the pill and 33% of the boys said that their girl friend was on the pill.     

Foregone health care among adolescents

CONTEXT: No annual national population estimates exist of the numbers of adolescents who think they need but do not receive health care or their risk of health problems. OBJECTIVE: To describe the proportion of adolescents who report foregone health care each year and the influence of sociodemographic factors, insurance status, past health care, and health risks/behaviors on foregone care. DESIGN: Cross-sectional analyses of data from wave 1 of the National Longitudinal Study of Adolescent Health, conducted during 1995. SETTING: In-home interviews conducted throughout the United States. PARTICIPANTS: Of 27000 adolescents in grades 7 through 12 who were invited to participate, 20746 (76.8%) completed the in-home interview. MAIN OUTCOME MEASURE: Reported foregone health care in the preceding year by individual and family characteristics, insurance status, past health care, health/behavior risk factors, and symptoms. RESULTS: On average, 2268 (18.7%) of 12 079 adolescents reported foregone health care within the past year. Factors associated with decreased risk of foregone care included continuous private or public insurance (adjusted relative risk [95% confidence interval], 0.64 [0.50-0.82] to 0.82 [0.70-0.96]), and having a physical examination within the past year (0.87 [0.78-0.97] for male and 0.79 [0.70-0.88] for female adolescents). Factors associated with increased risk of foregone care included older age (1.12 [1.06-1.15] for male), minority race/ethnicity (1.25 [1.06-1.46] to 1.50 [1.30-1.73]), single-parent home (1.31 [1.18-1.46] for female), and disability (2.03 [1.61-2.52] for male and 1.66 [1.20-2.10] for female). Adolescents participating in the following behaviors were more likely to report foregone care than those who did not: daily cigarette use (26.0% vs 16.8%; 1.34 [1.16-1.55]), frequent alcohol use (30.3% vs 18.1%; 1.34 [1.11-1.62] for male), and sexual intercourse (25.1% vs 15.1%; 1.23 [1.09-1.39] for male and 1.39 [1.23-1.56] for female). From 32.4% to 38.2% of adolescents with symptoms suggesting health problems reported foregone care (1.61 [1.13-2.26] to 2.03 [1.81-2.28]). CONCLUSIONS: Our study suggests that adolescents who forego care are at increased risk of physical and mental health problems. Efforts to improve adolescent health through health care should address factors influencing foregone care.     

Physicians' assessment of deficiencies and desire for training in adolescent care

Over the past decade, there has been growing awareness among medical educators and care providers of the deficits in the training of primary care physicians to meet the health care needs of adolescents. The study reported here is the first national survey of primary care physicians' perceptions of their competency in dealing with adolescents' health concerns. In the survey, 351 internists, family practitioners, and pediatricians rated their competency in 19 areas of adolescent health care. Approximately three-quarters or more of the internists indicated deficits in all 19 areas. In areas related to gynecologic concerns, more pediatricians reported deficits than family physicians; but more family physicians than pediatricians reported deficiencies in managing acute conditions of youth (growth and developmental problems, endocrinopathies, school-based problems, and chronic illnesses). All physicians indicated deficiencies in dealing with high-risk health behaviors: eating disorders, drug and alcohol abuse, homosexuality, and delinquency. Finally, more than 45 percent of the physicians overall reported deficiencies in areas related to social and/or emotional concerns, including suicide, depression, and family conflicts. Despite these acknowledged deficits, most of the primary care physicians did not indicate adolescents to be the least desirable age group with which to work. However, few of the physicians expressed a desire to improve their skills. Overall, in none of the 19 areas did more than 30 percent of the physicians who had reported deficiencies in an area express interest in improving their competency.     

High-risk STD/HIV behavior among college students

The current sexually transmitted disease (STD) epidemic in adolescents has led to concern about the potential for spread of the human immunodeficiency virus (HIV). In 1988, a total of 5514 students in first-year community college and university classrooms across Canada were surveyed to assess STD/HIV-related knowledge, attitudes, and risk behavior. The students' mean age was 19.7 years; the male-to-female ratio was 1:1.4. Students knew more about HIV/acquired immunodeficiency syndrome than other STDs. Of the 74.3% of the men and 68.9% of the women who were coitally active, 14.3% of the men and 18.6% of the women had participated in anal intercourse and 5.5% reported a previous STD. Only 24.8% of the men and 15.6% of the women always used a condom during sexual intercourse. Among the 21.3% of the men and 8.6% of the women with 10 or more partners, regular condom use was reported in only 21% and 7.5%, respectively. In this subgroup, anal intercourse was practiced by 26.9% of the men and 34.8% of the women, and previous STD was reported by 10.6% and 24.2%, respectively. Factors associated with not using a condom included number of sexual partners, embarrassment about condom purchase, difficulty discussing condom use with a partner, use of oral contraceptives, insufficient knowledge of HIV/STDs, and the belief that condoms interfere with sexual pleasure. These factors are potentially amenable to change. Effective, behaviorally focused educational programs are needed to improve condom use and reduce STD/HIV risk.