Teenage partners' communication about sexual risk and condom use: the importance of parent-teenager discussions

CONTEXT

Teenagers' communication with their partners about sex and their use of condoms may be influenced by the discussions teenagers have with their parents about sex. However, little is known about the process of parent-teenager communication on this topic. Understanding both what parents discuss with their children and how they discuss it may lead to a greater understanding of teenagers' sexual behavior.

METHODS

Interviews were conducted with 372 sexually active black and Hispanic youth aged 14-17 from Alabama, New York and Puerto Rico. Regression analyses were used to examine parent-teenager discussions about sexuality and about sexual risk, and parental communication skills as predictors of teenagers' discussions about sexual risk with a partner and teenagers' condom use.

RESULTS

Parent-teenager discussions about sexuality and sexual risk were associated with an increased likelihood of teenager-partner discussions about sexual risk and of teenagers' condom use, but only if parents were open, skilled and comfortable in having those discussions. Teenagers' communication with their partner about sexual risk also was associated with greater condom use, but the relationship between parent-teenager communication and teenagers' condom use was independent of this association.

CONCLUSIONS

The influence on teenagers of parent-teenager discussions about sexuality and sexual risk depends on both what parents say and how they say it. Programs that foster parent-teenager communication about sexuality and sexual risk must emphasize both of these aspects.

Prevalence of abnormal Pap smears in rural family practice

The purpose of this study was to examine the prevalence of abnormal Pap smears in rural family practice, to compare this to the published literature, and to determine if the prevalence of abnormalities is higher in the younger age group (<=35 years of age). A retrospective chart audit was performed on all Pap smears from four rural family practice sites during a 12-month period. Data collected were Pap smear result, patient's age, and interval since previous Pap smear. Statistical analysis was used to determine if the prevalence of abnormal Pap smears was consistent among the practices as well as similar to the three larger published studies. Also, chi-square analysis was used to compare the prevalence of abnormal Pap smears in the younger (<=35 years of age) versus the older (>35 years of age) age groups. There were 2,891 Pap smears reviewed, with 782 (27%) recorded as abnormal. The prevalence of cervical intraepithelial neoplasia (CIN) (76 or 2.6%) was compared to the published literature and was found to be statistically significantly higher (chi square=772.194, P=0.000). The prevalence of abnormal Pap smears was higher in the younger than age 35 group when compared to the older than age 35 age group (chi square=20.953, P=0.000). Pap smear interval and age varied between the four practice sites, but the prevalence of CIN was not statistically different (chi square=3.154, P=0.368). The results of this study suggest that rural family physicians may encounter abnormal Pap smears at rates similar to those reported in the literature. This study also suggests that the prevalence of abnormal Pap smears may be higher in the younger groups in this population.

Survival of Anisakis simplex in microwave-processed arrowtooth flounder (Atheresthes stomias)

The purpose of this study was to define the relationship between survival and temperature of nematodes of the species Anisakis simplex in microwave-processed arrowtooth flounder (Atheresthes stomias). Ten fillets (each 126 to 467 g, 0.5 to 1.75 cm thick), with an average of five larvae of Anisakis simplex per fillet, were processed to target temperatures on high (100%) power using a commercial 700-W microwave oven. Fillets were neither covered nor rotated and had a temperature probe inserted to two-thirds depth into the thickest portion. After the fillet was digested using a 1% pepsin solution, the viability of nematodes was determined by viewing them under a dissecting microscope. Survival rates were 31% at 140 degrees F (60 degrees C), 11% at 150 degrees F (65 degrees C), 2% at 160 degrees F (71 degrees C), 3% at 165 degrees F (74 degrees C), and 0% at 170 degrees F (77 degrees C). Microwave processing of standardized fillet "sandwiches," 14 cm long, 4.5 cm wide, and approximately 1.75 cm high, each of which was preinoculated with 10 live nematodes, resulted in no survival at either 160 degrees F or 170 degrees F. Using ultraviolet light to detect both viable and nonviable nematodes in fillet sandwiches as an alternative method to pepsin digestion resulted in survival rates of 1% at 140 degrees F (60 degrees C), 3% at 145 degrees F (63 degrees C), and 0% at 150 degrees F (65 degrees C). Smaller fillet sandwiches, which most likely had fewer cold spots during microwave processing, required 150 degrees F (65 degrees C), whereas larger whole fillets required 170 degrees F (77 degrees C) to kill larvae of Anisakis simplex. The parasites were most likely inactivated by a thermal mechanism of microwave treatment. Damage to the nematodes was often evident from ruptured cuticles that were no longer resistant to digestive enzymes. The high hydrostatic pressure and low chloride content of the pseudocoelomic fluid probably contributed greatly to the damage incurred by the larvae.

Cell surface sialic acid and the regulation of immune cell interactions: the neuraminidase effect reconsidered

It has been known for over a decade that sialidase (neuraminidase) treatment could substantially enhance the capacity of resting B cells to stimulate the proliferation of allogeneic and antigen specific, syngeneic T cells. Thus, cell-surface sialic acid was implicated as a potential modulator of immune cell interaction. However, little progress has been made in either identifying explicit roles for sialic acid in this system or in hypothesizing mechanisms to explain the "neuraminidase effect." Here we show for the first time that cell surface sialic acid on medium incubated B cells blocks access to costimulatory molecules on the B cell surface, and that this is the most likely explanation for the neuraminidase effect. Further, we show that it is likely to be upregulation of ICAM-1 and its subsequent engagement of LFA-1 rather than loss of cell surface sialic acid that in part regulates access to CD86 and other costimulatory molecules. However, we cannot exclude a role for CD86-bound sialic acid on the B cell in modulating binding to T cell CD28. Because sialidase treatment of resting B cells but not resting T cells enables T cell activation, we suggest that sialidase treatment may still be an analogue for an authentic step in B cell activation, and show that for highly activated B cells (activated with polyclonal anti-IgM plus INF-gamma) there is specific loss 2, 6-linked sialic acid. Potential roles for sialic acid in modulating B cell/T cell collaboration are discussed.

Sexually transmitted diseases, unintended pregnancy, and adolescent health promotion

Adolescence is a critical period in the development of sexual behaviors that may lead to acquiring sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV), and to unintended pregnancy. Understanding adolescent sexual behavior is essential for understanding adolescents' risk of pregnancy and STD/HIV infection and for planning and evaluating health promotion activities. This chapter reviews the sexual behaviors and psychosocial factors associated with STDs and unintended pregnancy among adolescents as well as school-, community-, and clinic-based interventions designed to reduce risk behaviors and promote adolescent sexual health.

Patterns of condom use among adolescents: the impact of mother-adolescent communication

OBJECTIVES

The association between the timing of discussions about condoms between mother and adolescent and adolescents' condom use during their first and subsequent sexual encounters was examined.

METHODS

Sexually active adolescents reported whether and when they discussed condoms with their mother and answered questions about their own condom use.

RESULTS

Mother-adolescent discussions about condoms that occurred prior to sexual debut were strongly associated with greater condom use during first intercourse and most recent intercourse, along with greater lifetime regular condom use.

CONCLUSIONS

Discussions about condoms prior to sexual debut are important in promoting condom use among adolescents.

Family communication about sex: what are parents saying and are their adolescents listening?

CONTEXT

Communication between parents and adolescents about sex, particularly in minority families, has been understudied; more information is needed both on which sex-related topics are discussed and on how their content is transmitted.

METHODS

Parent-adolescent communication about 10 sex-related topics was examined in a sample of 907 Hispanic and black 14-16-year-olds. Chi-square analyses were performed to test for significant differences across the 10 topics in discussions reported by the adolescents (with either parent) and by the mothers. The openness of communication, parent-adolescent agreement about communication of topics and differences by gender and ethnicity were also examined.

RESULTS

Significantly higher proportions of mothers and adolescents reported discussions of HIV or AIDS (92% by mothers and 71% by adolescents, respectively) and STDs (85% and 70%, respectively) than of issues surrounding sexual behavior, contraceptive use and physical development (27-74% for these other eight topics as reported by mothers vs. 15-66% as reported by adolescents). The gender of the adolescent and of the parent holding the discussion, but not the family's ethnicity, significantly influenced findings, with adolescents of both sexes more likely to report discussions with mothers than with fathers, and with parents more likely to discuss any of the 10 topics with an adolescent of the same gender than of the opposite gender. The likelihood of a topic being discussed and of mother-adolescent agreement that a topic was discussed both increased with an increasing degree of openness in the communication process.

CONCLUSIONS

Consistent with research among white samples, mothers of black and Hispanic adolescents are the primary parental communicators about sexual topics. To facilitate communication, educational programs for parents should cover not only what is discussed, but how the information is conveyed.

Role of parenting in adolescent deviant behavior: replication across and within two ethnic groups

The role of 2 parenting variables, monitoring and communication, in adolescent deviant behavior was examined within 4 samples; Black Americans living in Montgomery, Alabama, and the Bronx, New York, and Hispanics living in the Bronx, New York, and San Juan, Puerto Rico. The participants comprised 907 14- to 16-year-old adolescents and their mothers recruited through high schools in 3 communities. The results indicated that higher levels of parental monitoring, but not parent--adolescent communication, predicted lower levels of adolescent deviance in each of the samples. The replication of these findings in samples that vary by ethnicity and location provides strong support for the generalizability of the association between parental monitoring and low levels of adolescent deviant behavior.

Role of parenting in adolescent deviant behavior: replication across and within two ethnic groups

The role of 2 parenting variables, monitoring and communication, in adolescent deviant behavior was examined within 4 samples; Black Americans living in Montgomery, Alabama, and the Bronx, New York, and Hispanics living in the Bronx, New York, and San Juan, Puerto Rico. The participants comprised 907 14- to 16-year-old adolescents and their mothers recruited through high schools in 3 communities. The results indicated that higher levels of parental monitoring, but not parent--adolescent communication, predicted lower levels of adolescent deviance in each of the samples. The replication of these findings in samples that vary by ethnicity and location provides strong support for the generalizability of the association between parental monitoring and low levels of adolescent deviant behavior.

Sexual initiation with older male partners and subsequent HIV risk behavior among female adolescents

Data from a 1993-1994 survey of 150 black and Hispanic teenagers were used to examine differences in HIV risk-related behavior between young women who have a first sexual partner three or more years older than themselves and those whose first partner is their age. Compared with teenagers whose first partner had been roughly their age, the 35% of adolescents with an older partner had been younger at first intercourse (13.8 years vs. 14.6) and less likely to use a condom at first intercourse (63% vs. 82%). They also were less likely to report having used a condom at last intercourse (29% vs. 44%) or having used condoms consistently over their lifetime (37% vs. 56%) or in the previous six months (44% vs. 66%). Some 38% of teenagers with an older first partner had ever been pregnant, compared with 12% of those with a peer-age first partner. The mean number of partners and history of sexually transmitted diseases did not differ between the two groups.

Adolescent heterosexual experience: a new typology

PURPOSE

The purpose of this paper is to define a typology that encompasses the full range of adolescent heterosexual behavior; to compare the usefulness of the new typology with that of the traditional dichotomy of "sexually active"/"sexually inactive" for understanding sexual behavior among adolescents; and to determine the implications of the new typology for the design and implementation of HIV prevention programs targeting adolescents.

METHODS

Detailed face-to-face interviews were conducted with a cross-sectional sample of 907 mothers and their adolescents, ages 14-17 years, recruited from public high schools in Alabama, New York, and Puerto Rico. Information from the adolescent survey on precoital sexual behaviors and STD/HIV sexual risk and risk reduction behaviors was examined. A typology of adolescent heterosexual experiences was constructed using four behavioral dimensions.

RESULTS

Ninety-nine percent (n = 894) of the sample was classified into one of the five patterns of sexual experience: Delayers, Anticipators, One-timers, Steadies, and Multiples. Among the participants who were not sexually active, precoital behaviors differed significantly between the 22% who anticipated initiating sexual intercourse in the next year (Anticipators) and those who did not (Delayers). Among those traditionally classified as "sexually active", One-timers and Steadies were significantly older when they first had penile-vaginal intercourse than those who had multiple partners. One-timers were more likely to use condoms than Steadies or Multiples, and only Multiples reported previous STDs.

CONCLUSION

A typology that defines a range of adolescent heterosexual experiences was developed, and it was possible to classify 99% of our sample. The traditional dichotomy between "sexually active" vs. "not active" hides important behavioral intentions and sexual practices. These differences must be taken into account in the development and implementation of HIV prevention programs that target adolescents.

Reports of severe physical punishment and exposure to animal cruelty by inmates convicted of felonies and by university students

A self-report questionnaire designed to assess abusive childhood environments and exposure to animal cruelty was administered to 314 inmates in a prisoner classification center. Although high rates of physical punishment characterized the entire sample, persons charged with violent, but nonhomicidal crimes reported more severely punitive childhood histories than those charged with homicidal crimes, sex offenses, and nonviolent offenses. Some exposure to animal cruelty was widespread in the sample, but there was no association between experiencing animal cruelty and the type of crime committed. Moreover, there were only modest associations between animal cruelty experiences and the aversive childhood histories of the subjects, as well as the subjects' reported use of physical and sexual coercion in dating and intimate relationships. To determine whether the high base rate of exposure to animal cruelty was unique to the incarcerated sample, a follow-up study was completed with university undergraduates. Widespread exposure to some animal cruelty was reported by undergraduates; there were modest associations between reporting animal cruelty and reporting punitive and acrimonious childhood histories. In general, the findings were consistent with the hypothesis that there is an association between punitive childhood histories and antisocial behavior but not consistent with the hypothesis that exposure to animal cruelty is importantly related to antisocial behavior or child maltreatment.

Therapists' experiences with computer-assisted instruction in hand therapy

This pilot study explored therapists' experiences with computer-assisted instruction (CAI) programs as a means of self-study in hand therapy. Qualitative methodology was used to describe the therapists' responses to the CAI programs. Therapists described a number of features that they valued in the CAI programs: the capacity of the CAI to provide multiple sensory input, to gain and hold their attention, to provide feedback, and to provide personalized instruction, as well as the programs' speed and ease of use. Therapists identified the major limitation of the CAI programs as the inability to provide expert guidance for complex problem-solving in hand therapy practice. Future study of the value of CAI and other computer technology for self-study and continuing education is needed so that hand therapists can use these media to optimal advantage.

Behavioral risks for HIV infection associated with HIV-testing decisions

Adolescent and adult women were offered HIV testing as part of a clinic-based research program on HIV/AIDS in New York City. Sixty-four percent consented to testing and 87% of those tested returned to receive their results. This paper uses two-stage regression methods to identify sexual behavioral risk factors for HIV infection associated with the decision to accept the HIV test and subsequently to return for the results. Of the risk factors examined, having more than a single sex partner and never using a condom in the last year were strong predictors of taking the test; three or more sex partners had the strongest effects on the decision to return for the HIV test results. We conclude that voluntary HIV testing in this group can identify women with behavioral risks of HIV infection. Thus, voluntary HIV testing may be effective in targeting persons at high risk because behavioral risks are associated with the decision to take the HIV test.

Glycosylation of native MHC class Ia molecules is required for recognition by allogeneic cytotoxic T lymphocytes

The question whether or not target cell N-linked carbohydrate participates in cytotoxic T lymphocyte (CTL) mediated cytolysis has been in contention for well over a decade. Much of the evidence supporting a role for N-linked carbohydrate stems from the treatment of target cells with the glycosylation inhibitor tunicamycin (TM). In this report, we show that treatment of targets with TM, but not other inhibitors of complex carbohydrate formation (swainsonine, 1-deoxynojirimycin, and 1-deoxymannojirimycin), abrogates the lytic response. We conclude that N-linked complex carbohydrates are not absolutely required for the maturation or function of any target cell glycoconjugate directly involved in the lytic process. However, we show that TM treatment of target cells leads to the loss of an MHC class Ia epitope known to be required for T cell triggering. Further, we show that only target cells expressing class Ia molecules with functional glycosylation sequons are subject to the TM effect. From these results we conclude that while N-linked glycosylation of native MHC class Ia molecules is required for antigen presentation, the exact structural motif of the glycan is not important.

Quantifying cell mono-layer cultures by video imaging

A method is described in which the relative number of adherent cells in multi-well tissue-culture plates is assayed by staining the cells with Giemsa and capturing the image of the stained cells with a video camera and charged-coupled device. The resultant image is quantified using the associated video imaging software. The method is shown to be sensitive and reproducible and should be useful for studies where quantifying relative cell numbers and/or proliferation in vitro is required.

Radiographic assessment of renal trauma: our 15-year experience

PURPOSE

We sought to evaluate the continuing validity of our criteria for radiographic imaging of renal injuries, that is penetrating flank or abdominal trauma, blunt trauma with gross hematuria or microscopic hematuria and shock, deceleration or major associated abdominal injury and pediatric renal trauma.

MATERIALS AND METHODS

We reviewed the records of 2,254 patients who presented to our institution with suspected renal trauma between 1977 and 1992.

RESULTS

Of the 1,588 blunt trauma patients with microscopic hematuria and no shock 3 had significant injury but these cases were discovered during imaging or exploratory laparotomy for associated injuries. Followup in 515 of 1,004 patients (51%) who did not undergo initial imaging revealed no significant complications.

CONCLUSIONS

Adults with blunt renal trauma, microscopic hematuria and no shock or major associated intra-abdominal injuries can safely be spared radiographic imaging.

Penile intracavernous hematoma: diagnosis and surgical considerations

Soft tissue lesions of the penile corporeal bodies are rare and usually represent benign or malignant tumors, or Peyronie's disease. We report a unique case of a deep seated penile mass that at exploration proved to be an encapsulated hematoma of the inter-corporeal septum. Preoperative diagnosis of lesions of the corporeal bodies is facilitated by high resolution Doppler ultrasonography. Surgical exploration to exclude malignancy must be done unless the clinical and/or radiographic findings are unequivocally benign (Peyronie's plaque, simple cyst and so forth). Surgical exploration must be done according to the penile neurovascular anatomy to preserve potency and glanular sensation.

A collaborative approach to meeting the need for quality personnel training in early intervention

No abstract available for this article.

Phenotype and TCR gamma delta variable gene repertoire of intestinal intraepithelial lymphocytes in wild mice (Mus musculus domesticus): abundance of V gamma 1 transcripts and extensive delta gene diversity

In order to study murine intestinal intraepithelial lymphocytes (IEL) independent of factors imparted by conditions of laboratory housing and breeding, and to provide a basis for comparison of IEL studies between inbred and outbred mouse populations, IEL from the domestic house mouse, Mus musculus domesticus, were analyzed by flow cytometric analyses using mAbs to murine lymphocyte markers, and by polymerase chain reaction to study the TCR gamma and delta V gene repertoires. The majority of IEL in wild mice were CD3+, CD8+CD4- T cells. CD4+CD8- also were present in IEL isolates from wild mice, although at low numbers. Among IEL, but not T cells from the spleen or lymph nodes, there was a notable lack of Thy-1 expression, a preponderance of CD8 alpha alpha + T cells, and a relatively high ratio (3:1) of TCR gamma delta + T cells over TCR alpha beta + T cells, suggesting that some IEL in wild mice may develop via an extrathymic pathway similar to that described for laboratory mice. Analyses of the IEL gamma and delta variable genes revealed rearrangements of three of six V region gamma genes (V gamma 1, V gamma 2, and V gamma 5), with an abundance of V gamma 1 transcripts as determined by Northern blot analyses. For the delta gene, rearrangement of five of seven V region elements had occurred (V delta 2, V delta 3, V delta 4, V delta 5, and V delta 6).(ABSTRACT TRUNCATED AT 250 WORDS)