Recurrent genitourinary chlamydial infections in sexually active female adolescents.

To determine the recurrence rate of chlamydial infections, we initially screened an urban population of 1308 sexually active female adolescents for chlamydial infection at the urethral and endocervical sites; these young women were followed and had additional examinations for infection. Chlamydial infection was documented by tissue culture in 31.1% (407) of them at some time during the study. After appropriate antibiotic treatment, 68.3% (278/407) returned for test-of-cure cultures within 3 months of their initial infection; of those 278, a total of 254 had sterile cultures. These patients were followed to determine the recurrence rate of chlamydial infections. Of these 254 patients, 177 (69.7%) had one or more follow-up visits; 38.4% (68/177) had a recurrent chlamydial infection. The majority of recurrent infections were documented within 9 months of the initial infection. Recurrent infections with the same serovar were frequent, suggesting reinfection by untreated partners or possible relapse of the initial chlamydial infection. This high rate of recurrent infection suggests that female adolescents should be rescreened frequently for genitourinary chlamydial infections.     

Use of chaperones during pelvic examinations of female adolescents. Results of a survey

The male membership of the Society for Adolescent Medicine was surveyed regarding the use of a chaperone during pelvic examination of female adolescents. Five hundred seven questionnaires were mailed, and 292 physicians (58%) responded. One hundred eight (37%) reported performing pelvic examinations without a chaperone present. This was usually done because of patient preference. There was no difference between academic and private practice physicians. There were many categories listed as necessitating the presence of a chaperone. Here again, patient preference was the most frequent. Other reasons for using a chaperone included a patient with emotional problems, a history of rape or sexual abuse, a seductive patient, an uncomfortable patient or physician, a first pelvic examination, and medicolegal issues. Although it has been traditionally recommended that a chaperone be present during a pelvic examination, our data suggest that this is not sometimes the case for about one third of the male physicians in the Society for Adolescent Medicine.     

Analysis of contraceptive behavior of sexually active female adolescents in the United States

Drawing on a theoretical model of adolescent contraceptive behavior, we examined the relationships between various social and behavioral variables and contraceptive use by sexually active female adolescents. Hypotheses were tested with the use of a national random sample of sexually active female adolescents (n = 1426), aged 15 to 20 years, from Cycle III of the National Survey of Family Growth. The data were analyzed with Pearson correlation coefficients and multiple regression analysis. Noncompliance with the initial birth control method was the strongest predictor of the adolescents' contraceptive behavior at the time of the interview. Not acquiring birth control at the initial family planning visit and the frequency of family planning visits during the previous 12 months were the second and third best predictors of subjects' contraceptive use. Coital frequency and the length of time between first coitus and the initiation of birth control each explained a small amount of additional variation in the regression model. When combined, these five variables explained 40% of the variation in the contraceptive behavior of this representative sample of sexually active female adolescents. The findings could be useful for clinicians in providing more effective birth control counseling to adolescent patients.     

Prevalence and correlates of poor sleep among adolescents

The Stanford Sleep Inventory was given to 639, 11th- and 12th-grade students to assess the prevalence and correlates of poor sleep among an adolescent population. Of the sample reported, 49.8% had no sleep problems, whereas 37.6% reported occasional sleep disturbance and 12.6% reported chronic and severe sleep disturbance. Students complaining of disturbed sleep were more likely than good sleepers to describe negatively their physical and personality characteristics. The clinical implications of these data for developing educationally-based nondrug treatment of the complaint of insomnia among adolescents are discussed.     

Body dissatisfaction in female adolescents: extent and correlates

This study aimed to assess the extent, patterns, and predictors of feelings of body dissatisfaction experienced by female German adolescents. Using 3D-avatar software, a sample population of 144 girls between 14 and 17 years of age was asked to estimate their actual body image, their desired body image (individual ideal), and the body image they believed their parents and their best female friend considered to be the ideal body image for them. The participants estimated their actual body mass index (BMI) to be 18.82?±?3.01. The individual ideal body shape reported was significantly thinner, with a BMI score of 16.84?±?2.51. Given a girl who stands 1.65 m and weighs 55 kg, this corresponds to a difference in weight of about 5.5 kg. After adjustment for the participant’s self-reported BMI, participating in an esthetic sport was correlated with a significantly lower body dissatisfaction. Conversely, low socio-economic status and the amount of time spent watching TV was correlated with a significantly higher body dissatisfaction. Negative body image-related comments made by parents were significantly associated with body dissatisfaction. The girls who participated in this study would like to be an average of 1.97 BMI units thinner. The findings presented here suggest that future intervention measures should focus on the risk groups of physically inactive girls, those who smoke, and those with a lower social status and high rates of TV consumption. Intervention measures would be especially effective in German schools which offer lower education levels and should include the pupils’ parents, who should be informed about the negative effects weight- and diet-related comments have on their children’s body images.     

Prevalence and correlates of psychopathology in a sample of deaf adolescents

AIMS: To examine prevalence and correlates of psychopathology in deaf adolescents using a multi-method multi-informant approach. METHODS: Data for the study came from checklist assessments by parents (Child Behavior Checklist (CBCL)) and teachers (Teacher's Report Form (TRF)) of 70 deaf adolescents aged 13 to 21 years, from semi-structured clinical interviews of the adolescents (Semi-structured Clinical Interview for Children and Adolescents (SCICA)), and from expert ratings of dossier data. RESULTS: The percentages of Total Problems scores in the borderline clinical range in this population as found with the CBCL, TRF and SCICA are 28%, 32% and 49-63% respectively. Expert dossier ratings identified psychiatric caseness in 49% and DSM-classifications in 46% of the adolescents (primary classifications: emotional disorder 27%, behavioral disorder 11%, other disorder 7%). Cross-informant agreement between single ratings and expert dossier ratings was better than agreement between single ratings. Logistic regression analyses revealed that low IQ, a signing mode of communication and a history of three or more physical disorders were associated with psychiatric caseness. CONCLUSIONS: Findings suggest a high prevalence of psychopathology in the population studied and argue for a special focus on the early detection of significant emotional and behavioral problems as well as a multi-informant approach to the assessment of disorder in deaf children and adolescents. The correlational findings support the view that it is not deafness per se that contributes to psychiatric problems.     

Harmful lifestyles' clustering among sexually active in-school adolescents in Zambia

Background  

HIV is a leading cause of morbidity and mortality in Zambia. Like many other African nations with high HIV burden, heterosexual intercourse is the commonest mode of HIV spread. The estimation of prevalence and factors associated with sexual intercourse among in-school adolescents has potential to inform public health interventions aimed at reducing the burden of sex-related diseases in Zambia.     

Prevalence and correlates of partner violence among South African adolescents

BACKGROUND: Little is known about the prevalence of partner violence among adolescents, nor of the factors with which it is associated. The objectives of this study were to document prevalence rates for partner violence among high school students in Cape Town, and to explore factors that are associated with such violence. METHOD: The sample consisted of 596 Grade 8 and 11 students attending public high schools in Cape Town, who were selected using a multistage cluster design. They completed an anonymous and confidential questionnaire. The dependent variable was whether they had ever perpetrated partner violence, or intended to do so. The independent variables, which were derived from a modified version of the Theory of Planned Behaviour (TPB), included attitudes, subjective norms (general and peer social influence and outcome expectancy) and self-efficacy. Separate multiple logistic regression models were developed of partner violence intentions or behaviours on the scales derived from the TPB and demographic variables. Regression coefficients from adjusted models were used to examine the potential mediating role of partner violence intentions in the association between each scale and partner violence behaviours using the Sobel test. RESULTS: Among participants who reported being in a relationship, 20.7% reported perpetrating partner violence, and 16.4% reported intending to do so. After adjusting for demographic characteristics and other predictor scales, perpetration of partner violence was significantly associated with attitudes and outcome expectancy, while intention to perpetrate partner violence was significantly associated with attitudes and general social influence. The influence of attitude and general social influence on violent behaviours were each partially mediated by partner violence intentions. CONCLUSIONS: There are high levels of partner violence among high school students in Cape Town. Interventions to address this problem should focus on violence-related attitudes and outcome expectancy.     

Prevalence of Chlamydia trachomatis cervical infection in female adolescents

To determine the prevalence of infection with Chlamydia trachomatis in young girls with the same socioeconomic background from New York City, 186 sexually active female adolescents (age range, 12 to 17 years; mean age, 15.5 years) were screened. One third of the patients were pregnant. Papanicolaou smears, endocervical cultures for C trachomatis and Neisseria gonorrhoeae, and syphilis serologic tests were obtained prospectively. Chlamydia trachomatis was isolated from 10.2% of the subjects, and N gonorrhoeae was isolated from 9.7% of the subjects; 3.2% of the subjects had syphilis. At least one sexually transmitted disease was found in 17.2% of the subjects. Eight (44%) of 18 patients with N gonorrhoeae also harbored Chlamydia. The high rate of multiple infection should have significant implications with regard to treatment. High isolation rates of C trachomatis and other sexually transmitted pathogens suggested that routine screening may be warranted in even the very young, sexually active female adolescent, and especially in pregnant girls.     

Prevalence and impact of dysmenorrhea on Hispanic female adolescents

BACKGROUND: Dysmenorrhea is the leading cause of short-term school absenteeism. It is associated with a negative impact on social, academic, and sports activities of many female adolescents. Dysmenorrhea has not previously been described among Hispanic adolescents, the fastest growing minority group in the United States. OBJECTIVE: To determine the prevalence of dysmenorrhea among Hispanic female adolescents; its impact on academic performance, school attendance, and sports and social activities; and its management. PARTICIPANTS AND METHODS: A total of 706 Hispanic female adolescents, in grades 9 through 12, completed a 31-item questionnaire about the presence, duration, severity, treatment, and limitations of dysmenorrhea at a local urban high school. RESULTS: Among participants who had had a period in the previous 3 months, 85% reported dysmenorrhea. Of these, 38% reported missing school due to dysmenorrhea during the 3 months prior to the survey and 33% reported missing individual classes. Activities affected by dysmenorrhea included class concentration (59%), sports (51%), class participation (50%), socialization (46%), homework (35%), test-taking skills (36%), and grades (29%). Treatments taken for dysmenorrhea included rest (58%), medications (52%), heating pad (26%), tea (20%), exercise (15%), and herbs (7%). Fourteen percent consulted a physician and 49% saw a school nurse for help with their symptoms. Menstrual pain was significantly associated with school absenteeism and decreased academic performance, sports participation, and socialization with peers (P<.01). CONCLUSIONS: Dysmenorrhea is highly prevalent among Hispanic adolescents and is related to school absenteeism and limitations on social, academic, and sports activities. Given that most adolescents do not seek medical advice for dysmenorrhea, health care providers should screen routinely for dysmenorrhea and offer treatment. As dysmenorrhea reportedly affects school performance and attendance, school administrators may have a vested interest in providing health education on this topic to their students. Arch Pediatr Adolesc Med. 2000;154:1226-1229.     

Prevalence and psychological correlates of occasional and repetitive deliberate self-harm in adolescents

OBJECTIVE: To determine the prevalence and the associated psychological and social factors of occasional and repetitive deliberate self-harming behavior in adolescents. DESIGN: Cross-sectional self-report survey. SETTING: One hundred twenty-one schools in Germany. PARTICIPANTS: A representative sample of 5759 ninth-grade students was studied between 2004 and 2005. OUTCOME MEASURES: Deliberate self-harm (DSH) and suicidal behaviors, emotional and behavioral problems (Youth Self-Report), living standard, family composition, parental conflict and illness, school type and performance, relationship to peers, bullying, body satisfaction and dieting, media consumption, smoking, and alcohol and drug use. RESULTS: Occasional forms of DSH within the previous year were reported by 10.9% of the ninth-grade students. Four percent of the students reported repetitive forms of DSH. Suicidal behavior was strongly associated with repetitive DSH, an association that held for both subtypes of DSH. The findings also indicated that social background factors were important concomitants of occasional DSH but were not related to an increased likelihood of repetitive DSH. Symptoms of depression/anxiety and delinquent/aggressive behavior were associated with self-harming behavior in both adolescent girls and boys. CONCLUSIONS: The data suggest that there is a link between social factors and occasional DSH and, especially in repetitive DSH, that there is a strong association between DSH and suicidal behavior as well as DSH and emotional and behavioral problems. These findings indicate a different pathway in the development of DSH in adolescents. The results support a need to investigate the possible neurobiological underpinnings of DSH within a longitudinal model to enhance the knowledge of this poorly understood behavior.     

Chlamydia trachomatis infection in sexually active adolescents: prevalence and risk factors

The prevalence of Chlamydia trachomatis genital infection was studied in a sexually active urban Baltimore adolescent population. Possible risk factors such as age, past history of sexually transmitted disease, number of sexual partners, contact with sexually transmitted disease, oral contraceptive use, and concomitant gonococcal infection were also evaluated. The prevalence of chlamydial infection in the 280 adolescents studied was 26%: 35% in male adolescents, 27% in pregnant female adolescents, and 23% in nonpregnant female adolescents. Chlamydia was almost three times as prevalent as gonorrhea in the same population. Age, past history of sexually transmitted disease, oral contraceptive use, and concomitant gonorrhea were not significantly associated with chlamydial infection. However, multiple current sexual partners, contact with sexually transmitted disease, genitourinary symptoms, and cervical ectopy were significantly associated with chlamydial infection. Testing for chlamydial infection in sexually active urban teenagers is recommended for those with genitourinary symptoms, those with cervical ectopy, or those who are contacts of persons with sexually transmitted disease. Considering the reservoir of infection in the asymptomatic female adolescents, screening for chlamydial infections in family planning clinics warrants consideration.     

Prevalence and correlates of environmental tobacco smoke exposure among adolescents in Mangolia

Objective To estimate the prevalence and identify correlates of environmental tobacco exposure (ETS) among adolescents in Mongolia. Methods A cross-sectional study was carried out in 2003 in Mongolia within the framework of the Global Youth Tobacco Survey. Information was obtained on exposure to Environmental tobacco smoke (ETS) in the home and outside home, parental and peer smoking. Demographic characteristics such as age and sex were also obtained. Data were analyzed to obtain frequencies of characteristics. Logistic regression analysis was conducted to assess the association between ETS and relevant predictor variables. Results 73.9% (71.6%–76.1%) males and 71.7% (69.7%–73.7%) females reported being exposed to ETS either in the home or elsewhere. The odds of exposure were 5.85 (3.83–8.92) if both parents were smokers, 3.65(3.10–4.30) if only father smoked and 6.54 (3.48–12.32) if only mother smoked. Older adolescents were more likely to be exposed to ETS than younger adolescents. Prevalence of exposure to ETS within the home was similar between males and females but males had a higher prevalence of exposure outside of the home than females (50.7% and 42.4% respectively (p <0.001). Overall proportion of adolescents exposed to ETS in the home was higher than those exposed outside suggesting that domestic exposure was the main form of ETS among adolescents in Mongolia. Conclusion Exposure to environmental tobacco smoke is high among school going adolescents in Mongolia. Public health interventions aimed to reduce morbidity from tobacco among adolescents should also accord particular attention toward environmental tobacco smoke.     

Dysmenorrhea and pelvic pain in adolescents.

Dysmenorrhea and pelvic pain are common complaints in the adolescent population. Although most cases are primary dysmenorrhea and easily treated with NSAIDs or OCPs, pathologic causes should be considered, especially in cases not responding to standard medical management. Endometriosis is the most common finding in teenagers who do not respond to this regimen, but müllerian anomalies and musculoskeletal causes must also be considered.     

Prevention and intervention of sexually transmitted diseases in adolescents.

Adolescents are the age group at greatest risk for acquiring sexually transmitted diseases. Sexually transmitted disease intervention programs based on behavioral change theories that emphasize self-efficacy and motivational enhancement may provide adolescents with skills to change risk behavior patterns. School-based sexually transmitted disease programs can reach the majority of the at-risk adolescent population. Community-based programs attempt to change community norms for a targeted high-risk population and are particularly helpful in reaching adolescents who are not in school. Finally, clinic-based interventions serve adolescents seeking health care, not only encouraging abstinence and safer sex practices for prevention of sexually transmitted disease but also providing opportunities for early detection and treatment. All three have their advantages, but each may neglect a significant portion of the population at risk. Development of structured sexually transmitted disease intervention programs utilizing school, community, and clinic settings merits further study.     

Prevalence,correlates of and perceptions toward cigarette smoking among adolescents in South Korea

Objective  To estimate the prevalence of current smoking, correlates of smoking and assess exposure to and perceptions towards smoking by gender. Methods  We used data from the South Korea Global Youth Tobacco Survey (GYTS). Frequencies of selected characteristics and their 95% confidence were obtained. Current cigarette smoking was defined as having smoked, even a single puff, within the last 30 days. Logistic regression analysis was conducted to assess the factors that were considered to be associated with current cigarette smoking in bivariate and multivariate analyses. Results  Of the 5615 respondents, 7.4% males and 5.0% females reported being current smokers (p = 0.003). Having smoking friends was strongly associated with smoking after controlling for age, gender, parental smoking status, exposure to anti-smoking media messages, and perception of risks of smoking (OR=69.92; 95% CI [41.24, 118.57] for most friends and OR=11.86; 95% CI [7.26, 19.36] for some friends). Male gender and having one or both smoking parents were associated with smoking (OR=1.43; 95% CI [1.09, 1.89] and OR=1.29; 95% CI [1.00-, 1.71] respectively). Exposure to antismoking media messages was negatively associated with smoking (OR=0.52; 95% CI [0.36, 0.77]. Conclusion  Prevalence of smoking among adolescents in South Korea is lower than in many other Asian countries. There is however, need to strengthen anti-tobacco messages especially among adolescents.     

Infrequent parental monitoring predicts sexually transmitted infections among low-income African American female adolescents

OBJECTIVE: To prospectively determine (using an 18-month follow-up period) the association between African American female adolescents' perceptions of parental monitoring and their acquisition of biologically confirmed infection with Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis. DESIGN: A prospective cohort study of 217 African American female adolescents enrolled in the control arm of a randomized trial of a human immunodeficiency virus prevention intervention program. SETTING AND PARTICIPANTS: A volunteer sample of adolescents (aged 14-18 years) recruited from low-income neighborhoods characterized by high rates of unemployment, substance abuse, violence, and sexually transmitted diseases. MAIN OUTCOME MEASURES: Adolescents provided 2 self-collected vaginal swab specimens. One was tested for C. trachomatis and N. gonorrhoeae DNA with ligase chain reaction. The other was used to inoculate culture medium for T. vaginalis. Identical assay procedures were repeated at the 6-month, 12-month, and 18-month follow-up intervals. RESULTS: Adjusted odds ratios indicated that adolescents who perceived infrequent parental monitoring at baseline were 1.8 (95% confidence interval, 1.01-3.21) and 2.4 (95% confidence interval, 1.22-4.87) times more likely to acquire chlamydia or trichomoniasis, respectively, compared with their counterparts who perceived greater levels of monitoring. Similarly, adolescents who perceived infrequent parental monitoring were 2.1 (95% confidence interval, 1.16-3.74) times more likely to test positive for a sexually transmitted infection during the course of the 18-month follow-up period. CONCLUSIONS: Adolescents' perceptions of their parental-monitoring levels predicted subsequent acquisition of biologically confirmed chlamydia and trichomoniasis infections. These findings suggest that expanded efforts leading toward effective clinic- and community-based sexually transmitted infection intervention programs involving parents may be warranted.