Implications of racial and gender differences in patterns of adolescent risk behavior for HIV and other sexually transmitted diseases

CONTEXT: Sexual and substance use behaviors covary in adolescence. Prevalence of HIV and other sexually transmitted diseases (STDs) differs according to race and gender, yet few studies have systematically investigated risk behavior patterns by subgroup, particularly with nationally representative data. METHODS: A priori considerations and K-means cluster analysis were used to group 13,998 non-Hispanic black and white participants in the National Longitudinal Study of Adolescent Health, Wave 1, according to self-reported substance use and sexual behavior. Multinomial logit analyses examined racial and gender differences by cluster. RESULTS: Among 16 clusters, the two defined by the lowest risk behaviors (sexual abstinence and little or no substance use) comprised 47% of adolescents; fewer than 1% in these groups reported ever having received an STD diagnosis. The next largest cluster-characterized by sexual activity (on average, with one lifetime partner) and infrequent substance use-contained 15% of participants but nearly one-third of adolescent with STDs. Blacks were more likely than whites to be in this group. Black males also were more likely than white males to be in three small clusters characterized by high-risk sexual behaviors (i.e., having had sex with a male or with at least 14 partners, or for drugs or money). Black females generally were the least likely to be in high-risk behavior clusters but the most likely to report STDs. CONCLUSIONS: Adolescents' risk behavior patterns vary by race and gender, and do not necessarily correlate with their STD prevalence. Further investigation of adolescents' partners and sexual networks is needed.     

Investing in surveillance: a fundamental tool of public health

Objectives:WHO Global InfoBase assembles country-level chronic disease risk factor prevalence data from WHOs member states.Methods:The focus of this report is recent, nationally representative data. The risk factors of choice are those that make the greatest contribution to mortality and morbidity from chronic disease, can be changed through primary intervention and are easily measured in populations.     

Clonal analysis of bilateral mammary carcinomas by clinical evaluation and partial allelotyping

Bilateral breast carcinomas may represent contralateral metastases or new primary tumors. The presence of carcinoma in situ, a lower grade, or a different histotype in the second tumor is considered a clinical criterion for a second primary tumor. In this study, 26 bilateral breast carcinomas from 13 patients were analyzed based on clinical criteria, and the results were compared with those obtained by partial allelotyping using 47 markers at 7 chromosomal arms. Of the 8 synchronous tumors, 5 were concluded to be distinct primary tumors using clinical criteria; some were confirmed by partial allelotyping. In the remaining 3 cases, partial allelotyping showed distinct primary tumors. Five patients had metachronous carcinomas with 3 distinct primary tumors, 1 metastasis, and 1 that was uncertain by clinical criteria. Three cases were confirmed by partial allelotyping, and the uncertain case was shown to be distinct primary tumors. No discrepant results were noted. Stringent application of clinical criteria is accurate for differentiating second primary tumors from metastases.     

Lessons learned from telehealth pioneers

Just as American pioneers imagined a future in the West, telehealth visionaries envisioned a new way of delivering healthcare. Four home care telehealth innovators share their experiences including the support and barriers associated with this new technology.Each of the users interviewed in this article were pioneers in using the LifeSigns telehealth monitor, which consists of a monitor that measures a patient's blood pressure, pulse, ECG, and oxygen saturation in the home. Each user adopted the technology in various ways that would meet their specific needs, making their experiences both similar and unique. Their responses will assist home care organizations, clinicians, and clinical managers in recognizing how telehealth can be efficiently implemented in their settings. Survey participants were Baptist Home Care (BHC), New Brunswick Heart Center in Canada (NBHC), University of Tennessee Medical Center (UTMC), and Cardiovascular Home Care (CHC), Fort Worth, TX.     

Insulin resistance in African Americans

Hypertension and diabetes mellitus are the leading contributors to end-stage renal disease. African Americans suffer higher rates of renal failure as well as other vascular morbidities associated with hypertension and diabetes. Insulin resistance is strongly associated with hypertension. Insulin resistance is a component of diabetes and also precedes the clinical expression of type 2 diabetes. The relationship of blood pressure with insulin resistance, or impaired insulin action, occurs in African Americans and can be detected at young ages prior to the clinical expression of hypertension or diabetes. Through its relationship with hypertension, diabetes, and hyperlipidemia, insulin resistance is associated with endothelial dysfunction. The interface of insulin resistance with endothelial dysfunction may begin to explain the role of insulin resistance in vascular and renal pathology. The injury process, subsequent to both hypertension and diabetes, appears to be mediated by alterations tissue regulatory factors, and include vasoactive peptides such as angiotensin II, endothelin, and growth factors. Understanding the determinants that up-regulate the aberrant pathways and the early phases of these processes will be necessary to formulate strategies to effectively achieve renal protection and reduce the rates of renal failure in African Americans.     

Adolescents' attitudes and self-perceptions about anti-tobacco advocacy

Communities are organizing into coalitions with the goal of reducing tobacco use, particularly among youth. Adolescents could make effective and persuasive anti-tobacco advocates in their respective communities, but their attitudes about tobacco advocacy and their perceptions of their own abilities as advocates are unknown. Therefore, the present project assessed attitudes and self-perceptions about anti-tobacco advocacy in 159 high school students attending a tobacco advocacy conference. After the meeting, they completed the Anti-Tobacco Advocacy Questionnaire, which has five factors (Activism, Personal Commitment, Banning Advertisements, Tobacco Morality and Peer Pressure to Use Tobacco). Overall, these high school students were moderately positive about anti-tobacco advocacy; girls more so than boys. Further, they were very positive about their own commitment to avoid tobacco and willingness to speak to others personally, but only moderately positive about their activism abilities. An implication is that community coalitions that include youth might want to focus on building their activism skills as they guide them in managing their youthful energy and enthusiasm.     

Nonprofit organizations versus government agencies to reduce tobacco use

Tobacco settlement money can be allocated to nonprofit organizations or government agencies. Both have advantages and disadvantages. Nonprofit organizations may have relatively (a) more efficiency/flexibility, but less accountability; (b) narrower focus, but less experience; (c) more ability to advocate, but more obligations; (d) more independence from tobacco industry influence, but less funding; and, (e) more public trust, but less visibility. The present case study of the Partnership for a Healthy Mississippi focuses on six interconnected areas: education (school and community), raising awareness, advocacy, service, enforcement, and research. In 1999 and 2000, tobacco use declined in Mississippi, even compared to neighboring states. This unique partnership's multifaceted approach to social change probably facilitated this decline.