The relationship between adolescent depression and a history of sexual abuse

The purpose of this study was to examine the occurrence of depression among adolescents attending family planning clinics, and to determine the relationship among depression, a history of sexual abuse, and other risk behaviors. The sample consisted of 279 minority females. Results of the study indicated that 40 adolescents (14.3%) scored at or above a raw score of 77 for depression based on the Reynolds Adolescent Depression Scale (RADS). This suggests that these adolescents should be identified for further evaluation. Results of the Stepwise Linear Regression indicated that a history of sexual abuse was the most potent factor in predicting depression. These findings highlight the importance of screening concurrently for depression and a history of sexual abuse in family planning and other healthcare settings.

A comparison of neonatal Gram-negative rod and Gram-positive cocci meningitis

OBJECTIVE

Neonatal meningitis is an illness with potentially devastating consequences. Early identification of potential risk factors for Gram-negative rod (GNR) infections versus Gram-positive cocci (GPC) infection prior to obtaining final culture results is of value in order to appropriately guide expirical therapy. We sought to compare laboratory and clinical parameters of GNR and GPC meningitis in a cohort of term and premature infants.

STUDY DESIGN

We evaluated lumbar punctures from neonates cared for at 150 neonatal intensive care units managed by the Pediatrix Medical Group Inc. We compared cerebrospinal fluid (CSF) parameters (white blood cell count, red blood cell count, glucose, and protein), demographics, and outcomes between infants with GNR and GPC meningitis. CSF cultures positive with coagulase-negative staphylococci were excluded.

RESULTS

We identified 77 infants with GNR and 86 with GPC meningitis. There were no differences in gestational age, birth weight, infant sex, race, or rate of Caesarean section. GNR meningitis was more often diagnosed after the third postnatal day and was associated with higher white blood cell and red blood cell counts. GNR meningitis diagnosed in the first 3 days of life was associated with antepartum antibiotic exposure. No difference was noted in either CSF protein or glucose levels. After correcting for gestational age, there was no observed difference in mortality between infants infected with GNR or GPC.

CONCLUSION

Compared to GPC meningitis, GNR meningitis was associated with several aspects of the clinical history and laboratory findings including older age of presentation, antepartum exposure to antibiotics, and elevated CSF white blood cell and red blood cell counts.

New sexual partners and readiness to seek screening for chlamydia and gonorrhoea: predictors among minority young women

OBJECTIVES

To determine (1) level of readiness and (2) demographic and behavioural predictors of readiness to seek chlamydia (CT) and gonorrhoea (NGC) screening in the absence of symptoms after sex with a "new" partner.

METHODS

Baseline data, obtained as part of a larger randomised controlled clinical trial in young women, were analysed. Readiness to seek screening for CT and NGC after sex with a "new" partner was assessed using the stages of change framework from the transtheoretical model of change-precontemplation, contemplation, preparation, and action. Ordinal logistic regression, using the proportional odds model, was used to determine predictors of being in action for or having already been screened for CT and NGC after sex with a "new" partner.

RESULTS

The sample consisted of 376 predominantly African American (67%) young women (mean age 18.5 (SD 1.4) years). The distribution of readiness to seek CT and NGC screening was 4% precontemplation, 11% contemplation, 28% preparation, and 57% action. The best fitting logistic model that predicted being in action for seeking screening after sex with a "new" partner included high perceived seriousness of acquiring a sexually transmitted infection (OR = 2.02, 95% CI 1.05 to 3.89), and having "other" (not steady) partners in the last 6 months (OR = 0.50, 95% C.I. 0.32 to 0.78)

CONCLUSIONS

Many young women report that they were not getting screened for CT and NGC after sex with a "new" partner and therefore may be at increased risk of an untreated STI. Enhancing level of perceived seriousness of acquiring an STI from a "new" partner may increase a young woman's readiness to seek screening after initiating a new sexual relationship.

Enhancing recruitment and retention of minority young women in community-based clinical research

Women are disproportionately affected by the sexually transmitted infections (STI) epidemic, with African-Americans and Latinos at significantly higher risk for STIs than Caucasians. Successful recruitment and retention strategies used with young minority women in community-based STI prevention or intervention research have not been previously reported. This communication presents eight key strategies learned in the recruitment and retention of 16- to 21-year-old urban women participating in a 12-month randomized clinical trial designed to promote STI screening to decrease the duration of untreated chlamydia and gonorrhea infection. Strategies learned include: (1) Educate clinic staff on the rigors of study design; (2) Facilitate a team effort between clinical and research staff; modify recruitment procedures, as needed; (3) Provide prospective participants the option of enrolling by return appointment; (4) Anticipate a diminishing recruitment pool over time; (5) Set positive recruitment tone at the beginning of each clinic session; (6) Consider participants' mothers as important points of contact; (7) Match communication styles to participant contacts; and (8) Consider a variety of retention techniques. Together, these strategies helped to reinforce participant's commitment to the project, facilitated their attendance at interviews, and encouraged them to adhere to the treatment protocol.

HIV testing and counseling among adolescents attending family planning clinics

This study examined whether an assessment tool combining HIV-related risk behaviors and symptoms would increase HIV testing and return for post-test counseling among 466 adolescents attending family planning clinics. The results indicted that high-risk behaviors were common among these adolescents. The majority (78.3%) identified themselves as not using condoms consistently, almost a quarter (24.7%) reported a history of STDs and 129 (27.7%) reported they had pierced their bodies. A total of 214 (45.9%) received HIV testing. Two (0.4%) adolescents, one male and one female, tested positive for HIV. Of the 214 adolescents who underwent testing, 183 (85.5%) returned to the clinic for post-test counseling. The results of this study indicated that adolescents who reported risk behaviors and symptoms were not more likely than those who reported no risk behaviors and symptoms to request testing and return for post-test counseling. In light of these results, the authors review the protocols associated with testing and post-test counseling and propose solutions that can potentially improve these processes. The authors recommend integrating a risk assessment tool with HIV testing in family planning clinics as testing and return for post-test counseling rates were high.

The nature of connections: young fathers and their children

The purpose of this study was to examine the involvement of young fathers with their children at entry to a fatherhood program and at subsequent follow-up. Thirty-eight young fathers participated in this analysis. Using open-ended questions at intake and subsequent follow-up, they were asked to describe in their own words their relationships with their children. A thematic analysis was used to explore their self-reported statements. Three themes emerged from the analysis: Positive Emotionality, Accessibility, and Engagement. A comparison between thematic categories at intake and follow-up revealed that the most dramatic shift occurred in regard to Engagement. A third of the young fathers shifted from describing Positive Emotionality at intake to the more active process of Engagement at follow-up. The area that showed little change between intake to follow-up was related to Accessibility. These findings may suggest that for young fathers, becoming more involved with their children is a process which can be facilitated by participating in a fatherhood program.

Chlamydia and gonorrhea screening in asymptomatic young women

BACKGROUND

Adolescent and young adult minority women are at high risk for chlamydia (CT) and gonorrhea (NGC) cervical infections, which are significant causes of pelvic inflammatory disease, impaired fertility, ectopic pregnancy and chronic pain. The purpose of this article is to review among young women in the United States: (1) the epidemiology of CT and NGC cervical infection and their medical complications; (2) current public health recommendations to promote asymptomatic CT and NGC screening; (3) current screening practices and challenges of implementing public health recommendations; (4) testing and cost issues; and (5) future directions in promoting asymptomatic CT and NGC screening.

METHODS

We conducted a MEDLINE search for articles published over the last two decades relating to CT and NGC screening in young women and then systematically reviewed all relevant articles.

RESULTS

The data indicate that CT and NGC infection are geographically widespread in the U.S. and asymptomatic infection is highly prevalent among economically disadvantaged young females. Public health recommendations promoting CT and NGC screening in asymptomatic young women are directed to both health care providers and clients. However, strategies to promote screening efforts have been primarily directed toward health care providers; there are no published studies on client-initiated screening strategies. Challenges of implementing public health recommendations and future directions for CT and NGC screening are discussed.

CONCLUSIONS

Young sexually active women continue to be at high risk for CT and NGC infection. The data indicate that implementation of health provider-based and client-initiated screening in private and public health care settings is a challenge. However, there is a great need to develop strategies to understand and promote client-initiated screening.

Neural tube defects: knowledge and preconceptional prevention practices in minority young women

OBJECTIVE

To assess 1) knowledge of neural tube defect (NTD) prevention by folic acid, 2) frequency of intake of multivitamins and folate- and folic acid-fortified food, and 3) factors associated with knowledge and prevention practices among sexually active minority adolescent and young adult women.

METHODS

Young minority women were enrolled in a folic acid program at 3 urban Houston, Texas, reproductive health clinics and assessed for NTD knowledge and preventive practices. A 3-month supply of multivitamins was also dispensed at enrollment. A 3-month program follow-up survey of a randomly selected sample at 2 sites was conducted.

RESULTS

Of 387 women (mean age: 18 +/- 1.9 years), 72% were black and 28% were Hispanic. At enrollment, clinics were a major source of information of NTD prevention (44%); 52% had heard of folic acid, 45% had heard of NTDs, and 50% had heard of birth defects prevention by multivitamins. Significantly more Hispanic than black young women had heard of NTDs (59% vs 39%). Pregnancy history, regular birth control use, and education level for age were independently associated with knowledge. In young women with low education level for age, regular birth control use was significantly associated with knowledge. At enrollment, daily multivitamin intake was very low (9%) and folate-rich foods were consumed in inadequate amounts. Adequate folate diet was not associated with knowledge. The program follow-up survey indicated that 88% to 92% had knowledge of NTDs and folic acid, and 67% reported taking a daily multivitamin.

CONCLUSIONS

Publicly funded clinics may be the only source of information on NTD prevention for many minority young women. Preliminary evidence suggests that a promotion program improves knowledge, and dispensing of multivitamins increases multivitamin use. However, clinicians in such programs need to reinforce daily adherence to multivitamins in young women.

Gonorrhea and chlamydia screening among young women: stage of change, decisional balance, and self-efficacy

PURPOSE

To assess perceived sexually transmitted disease (STD) (gonorrhea and chlamdydia) screening behaviors among young women at risk for STDs by evaluating readiness, pros and cons, and self-efficacy to seek STD screening in the absence of symptoms.

METHODS

Two hundred forty young urban women (mean 18.8 years +/-1.59) consecutively attending an urban reproductive clinic voluntarily completed a 67-item questionnaire on STD screening behaviors that included the stages of change (SOCs), decisional balance, and self-efficacy as well as sexual practices and partner relationships. The data were analyzed using descriptive statistics, multivariate analyses of variance, Chi-square tests, and Wilcoxon signed rank test.

RESULTS

Ninety-five percent of the participants would be willing to obtain STD screening for early disease detection. Participants were further along the SOCs for STD screening following unprotected sex with a change in partner than main partner, (p <.001). Pros and cons of STD screening varied according to the SOCs for STD screening with a change in partner and main partner. Self-efficacy increased linearly along the SOCs for STD screening (p <.001).

CONCLUSIONS

Most young women recognize the importance of STD screening but are not currently being tested when at risk for STDs. STD screening behaviors varied according to the partner relationship, which highlights the importance of stage- and partner-matched counseling to promote STD screening particularly when at risk for STDs.

Mental health problems and symptoms among male adolescents attending a teen health clinic

The purpose of this study was to examine the frequency and nature of mental health problems and symptoms among a group of 51 inner-city male adolescents attending a teen health clinic at a large county hospital in the southwestern part of the United States. They were administered a problem area checklist and a problem symptom checklist. The problem area checklist covered a range of mental health issues, including peer/friendship, relationship, and family problems; problems with money, time, and the law; substance use; and eating disorders. The problem symptom checklist queried participants about anger, nervousness, depression, fear, loneliness, suicide, aggression, and self-esteem. The results indicated that these young males experienced significant mental health problems and symptoms, such as relationship problems, problems with time and money, and symptoms of anger, depression, and aggression. Further, scared/afraid feelings correlated with five of the eight problem areas. The authors recommend investigating ways to target young males who present at such clinics in order to address their mental health problems and symptoms, as well as studying how their environment affects their overall health.

Nature over nurture: temperament, personality, and life span development

Temperaments are often regarded as biologically based psychological tendencies with intrinsic paths of development. It is argued that this definition applies to the personality traits of the five-factor model. Evidence for the endogenous nature of traits is summarized from studies of behavior genetics, parent-child relations, personality structure, animal personality, and the longitudinal stability of individual differences. New evidence for intrinsic maturation is offered from analyses of NEO Five-Factor Inventory scores for men and women age 14 and over in German, British, Spanish, Czech, and Turkish samples (N = 5,085). These data support strong conceptual links to child temperament despite modest empirical associations. The intrinsic maturation of personality is complemented by the culturally conditioned development of characteristic adaptations that express personality; interventions in human development are best addressed to these.

Understanding partner notification (Patient self-referral method) by young women

STUDY OBJECTIVE

To understand the communication process involved in the patient-self referral method among adolescent females with chlamydia and gonococcal infection.

DESIGN

A cross-sectional descriptive study using a convenience sample was conducted in 54 predominantly African-American females, 13 to 20 years-old, with gonococcal and/or chlamydia cervicitis at an urban hospital based reproductive health clinic. Subjects interviewed at their treatment visit were asked what method of notification they used to tell their partner(s). Subjects who had not notified their partner were asked about their intended communication method and what they envisioned they would say to their partner. Coding methodology was used to analyze the information. In addition to qualitative information, outcome measures were the proportion of subjects who notified their partner(s), their communication method, style, and barriers to communication.

RESULTS

According to the treatment visit, 57% (31/54) of subjects reported notifying their partner. Most had notified their partner by phone or face-to-face, stated basic facts about the infection, and used a "direct" and "sensitive" communication style. Of the subjects who had not notified their partner (23/54), several barriers to notification were reported, but 82% said they intend to notify their partner(s).

CONCLUSIONS

Strategies to promote the patient-self referral method among young women who do not notify their partner(s) need further assessment.

Nature over nurture: temperament, personality, and life span development

Temperaments are often regarded as biologically based psychological tendencies with intrinsic paths of development. It is argued that this definition applies to the personality traits of the five-factor model. Evidence for the endogenous nature of traits is summarized from studies of behavior genetics, parent-child relations, personality structure, animal personality, and the longitudinal stability of individual differences. New evidence for intrinsic maturation is offered from analyses of NEO Five-Factor Inventory scores for men and women age 14 and over in German, British, Spanish, Czech, and Turkish samples (N = 5,085). These data support strong conceptual links to child temperament despite modest empirical associations. The intrinsic maturation of personality is complemented by the culturally conditioned development of characteristic adaptations that express personality; interventions in human development are best addressed to these.

Young males attending a family-planning clinic: some ideas about consequences of child abuse

33 young males attending a family-planning clinic were asked about the consequences of child abuse as it affects behavioral problems of teens and their interest in programs that deal specifically with these problems. Nine reported they had been victims of abuse. Most believed that drug and alcohol misuse and suicide were the major consequences of child abuse. Fifteen were interested in programs for prevention of child abuse but not for specific problems such as substance misuse and smoking cessation. This study's findings suggest that family-planning clinics with services for males must address their behavioral as well as medical needs.

Assessment of oral contraceptive pill continuation in young women

STUDY OBJECTIVE

To assess oral contraceptive pill (OCP) continuation rates and factors associated with OCP continuation in young women.

DESIGN

A 12-month retrospective cohort study by chart review of 226 young women seen for an initial clinic visit.

SETTING

Urban hospital-based family planning clinic.

PARTICIPANTS

Predominantly African-American, sexually active young women, 12 to 21 years of age (median age, 17.2 years).

MAIN OUTCOME MEASURES

Scheduled OCP-appointment-keeping rates, pregnancy rates, and associated factors were compared between OCP-compliant and -noncompliant groups.

RESULTS

The OCP-appointment-keeping rate declined dramatically over 1 year, from 29% at the 3-month visit to 9% at the 12-month visit. Almost half seeking a postpartum visit checkup (PPVup) did not return after the initial clinic visit. Overall, a higher OCP-appointment-keeping rate was noted in those seeking OCPs vs. PPVup at the initial visit; P < .05 for 12-month visit. There was no difference in the pregnancy rates between OCP-compliant and -noncompliant groups. School enrollment and nulliparity was significantly associated with OCP compliance until the 6-month visit (P < .05).

CONCLUSION

In an urban hospital based clinic, the OCP continuation rate after the initial visit was poor. Continuation of OCPs may be anticipated by type of services sought at an initial visit. Methods to improve OCP continuation in this setting should be implemented.

Legal issues associated with sexual activity between adults and minors in Texas: a review

Recent research on adolescent mothers and the age of their sexual partners has stimulated discussion of whether legal action should be taken against adult men who engage in sexual intercourse with minors. A nonrandom poll that started as casual questions but extended over 6 months to 52 doctors initiated this review. It became apparent that the primary care physicians (pediatrics, family medicine, and internal medicine) had little, if any, understanding of some key legal facts in Texas associated with adolescent sexuality and pregnancy, especially when adult partners are involved. This article provides a legislative overview for practitioners in an attempt to clarify the law, remediate any deficiency of knowledge, and remind physicians of their role in reporting sexual abuse of minors.

Ethnic differences in STD rates among female adolescents

Ethnic differences in rates of sexually transmitted diseases (STDs) were examined in a sample of 205 female adolescents receiving care at two family planning clinics in Houston, Texas. New infection and reinfection rates following treatment were also investigated. Black teens had a higher rate of past STDs than did Hispanic or White teens. However, there were no differences in rates at the time of the clinic visit. Of the 143 (69.8%) teens who returned for follow-up care, 21 (14.7%) had new infections; Black teens had the highest rate. The findings indicated that programs for teens need to address cultural, ethnic, and gender issues.

Incorporating health and behavioral consequences of child abuse in prevention programs targeting female adolescents

A study examining the health and behavioral consequences of child abuse was conducted among 263 parenting and 257 never-pregnant teens attending a reproductive health clinic. Both groups of teens identified the following major consequences: suicide, prostitution, school drop-out, crime and substance abuse. However, only parenting teens expressed interest in prevention programs that would address these consequences. Traditional child abuse prevention programs are focused on parenting issues and rarely address health and behavioral consequences of abuse. These health and behavioral consequences of abuse may make adolescents vulnerable to abuse their own children as well as interfere with their psychosocial development. Therefore, the authors recommend integrating health and behavioral issues into child abuse prevention programs.

Mesiodentes in twins: a case report and a review of the literature

This report describes 7-year-old Afro-Caribbean monozygotic twin boys who both presented with bilateral unerupted mesiodentes palatal to the central incisors. There have been two previous similar reports. From this case and previous reports it was concluded that mesiodentes in monozygotic twins are likely to be concordant with respect to the number of supernumerary teeth. Unilateral mesiodens usually have been mirror imaged in each twin. Minor discordance between monozygotic twins is common with respect to the shape (conical, incisiform or tuberculate) and orientation (inverted or normal) of individual mesiodens within and between each twin.

The role of condom motivation education in the reduction of new and reinfection rates of sexually transmitted diseases among inner-city female adolescents

The purpose of this study was to document the effectiveness of small group condom motivation education in reducing new and reinfection rates of sexually transmitted diseases (STD) among female teenagers. Two hundred and five (205) female adolescents (age 13-20) with a current STD were studied at two sites of a Teen Health Clinic. There were 86 teens in the Study Group and 119 in the Comparison Group. Patients were sampled from December 1992 to July 1993. The patients in the Study Group received a condom motivation class given by the clinic STD educator in small groups of four or more adolescents. The Comparison Group, comparable in age and ethnicity, received treatment for their STD but did not participate in condom motivation classes. All teens were given treatment and condoms. The sample was followed for 6 months. The total number of patients returning with new infections was 21 (14.7%). The total number of patients with reinfections was 14 (9.8%). There were no significant differences between the Study and Comparison Group on return rates, new and reinfection rates or on any socio-demographic variables. The comparison of these groups suggests that a specific condom motivation class has minimal effectiveness in urban teens. However, almost 70% of the teens returned to the clinic for their scheduled visits. It is suggested that adolescent clinics which combine family planning and STD treatment services maintain high client enrollment and therefore may be ideal locations to initiate new and continuous interventions for condom use especially for high risk teens.