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.

Racial differences in vaginal douching knowledge, attitude, and practices among sexually active adolescents.

STUDY OBJECTIVE: The study sought to assess knowledge of, attitude toward, and practices of vaginal douching among adolescent females attending a public family planning clinic, in order to better understand racial influences on douching. DESIGN, SETTING, PARTICIPANTS: In this descriptive, cross-sectional study, a one-page questionnaire was administered to all adolescent females (< or=19 years) presenting to a public family planning clinic in a small southern city between March 1 and May 31, 1999. RESULTS: Of the 169 participants, the mean age was 17.0 years (+/-1.5 years), 53% were Caucasian, and 47% were African-American. Sixty-nine percent of participants reported vaginal douching, mostly for hygienic reasons (68%). Those reporting vaginal douching were more likely to have a history of sexual intercourse (P < 0.01) and a history of one or more sexually transmitted diseases (P < 0.05). Age of first douche correlated positively with age of first sexual intercourse (r = 0.34, P < 0.001). African-Americans did not douche to a greater degree than Caucasians. However, racial differences were noted in knowledge of and attitude toward vaginal douching. CONCLUSIONS: Vaginal douching was a common practice among adolescent females attending a public family planning clinic in a small southern city. Culturally appropriate educational strategies for African-American and Caucasian adolescent females should improve awareness of adverse events associated with vaginal douching, despite family and personal beliefs about this practice.

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.

A case-control study of anatomic changes resulting from sexual abuse.

OBJECTIVE: Our goal was to identify vulvar and hymenal characteristics associated with sexual abuse among female children between the ages of 3 and 8 years. STUDY DESIGN: Using a case-control study design, we examined and photographed the external genitalia of 192 prepubertal children with a history of penetration and 200 children who denied prior abuse. Bivariate analyses were conducted by chi(2), the Fisher exact test, and the Student t test to assess differences in vulvar and hymenal features between groups. RESULTS: Vaginal discharge was observed more frequently in abused children (P =.01). No difference was noted in the percentage of abused versus nonabused children with labial agglutination, increased vascularity, linea vestibularis, friability, a perineal depression, or a hymenal bump, tag, longitudinal intravaginal ridge, external ridge, band, or superficial notch. Furthermore, the mean number of each of these features per child did not differ between groups. A hymenal transection, perforation, or deep notch was observed in 4 children, all of whom were abused. CONCLUSION: The genital examination of the abused child rarely differs from that of the nonabused child. Thus legal experts should focus on the child's history as the primary evidence of abuse.

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.

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.

Leukocyte esterase dipstick as a rapid screening test for vaginitis and cervicitis.

STUDY OBJECTIVE: To assess the ability of vaginal and cervical leukocyte esterase (LE) dipstick to detect vaginitis and cervicitis. DESIGN: A prospective, cross-sectional study to assess the ability of the LE dipstick of vaginal secretions to detect trichomonads, candida, and bacterial vaginosis and the LE dipstick of vaginal and cervical secretions to detect gonococcal and chlamydia infection and polymorphonuclear cells (PMNs). SETTING: An inner-city shelter facility clinic. PARTICIPANTS: 183 sexually active, nonmenstruating females aged 13-21 years (Mean = 17.7, SD = 1.98 years): 47% black, 40% white, and 11% Hispanic. OUTCOME MEASURES: Sensitivity (SN), specificity (SP), positive and negative predictive values (PVP, PVN), with 95% confidence intervals, of vaginal and cervical LE dipstick > or = trace in detecting vaginal and cervical infections. RESULTS: A positive vaginal LE had a moderately high SN and PVN but poor SP and PVP in detecting trichomonas and candida vaginitis and bacterial vaginosis. A positive vaginal and cervical LE had a high SN and PVN but poor SP and PVP in detecting gonorrhea and chlamydia infection. A positive cervical LE had a moderate SN and low SP in detecting PMNs on Gram stain. CONCLUSIONS: The LE dipstick of vaginal and cervical secretions was only a moderately good screening test for vaginal infection but a good screening test for cervical infection.

The uterine cervix: diagnostic opportunities.

Sexually transmitted diseases, inflammatory conditions, and neoplasia occur all too often at the site of the uterine cervix. Multiple diagnostic options are available to clinicians ranging from simple inspection, to easily performed and widely accessible tests, to more complex laboratory procedures. Familiarity with and use of these methodologies by those providing health care for adolescents is likely to result in reduction of both the short- and long-term morbidity associated with these conditions.

Infectious disease of public health significance among children and adolescents in Texas.

In the past decade, many infectious diseases in children that were perceived to have been almost eliminated have returned with a vengeance in Texas. Across the state, vaccination rates are exceptionally low, and outbreaks of measles, mumps, and pertussis have been identified. Tuberculosis cases in children increased 77%, and cases of congenital syphilis increased 578% between 1987 and 1991. The new epidemic of HIV infection has placed additional strain on an already overburdened, inadequate public health system in Texas. This article identifies some of the major infections of public health significance among the children of Texas. A common theme for most of these problems is that they are preventable diseases that are not being prevented. Many children in Texas will suffer now and in the future if these public health problems remain ignored.

Acquired immunodeficiency syndrome and adolescents. Knowledge, attitudes, and behaviors of runaway and homeless youths.

OBJECTIVE: To describe the knowledge, attitudes, and behaviors of runaway and homeless youths regarding infection with the human immunodeficiency virus (HIV). DESIGN: Cross-sectional, descriptive. SETTING: A crisis shelter for runaway and homeless youths. PARTICIPANTS: One hundred one residents, aged 13 to 20 years, of a shelter for homeless and runaway youths in Houston, Tex. INTERVENTION: None. MEASUREMENTS/MAIN RESULTS: A self-administered questionnaire was used to examine the knowledge, attitudes, and behaviors of these youths regarding infection with HIV. Nearly one fourth had injected illegal drugs; one fifth had shared needles for other purposes. Sixteen percent had had anal intercourse, 19% had engaged in prostitution, and 67% of all subjects reported having four or more sexual partners. One fifth reported that they always use condoms. While quite knowledgeable about means of transmission, they held prevalent misconceptions about casual contact and risk reduction. Youths perceive few barriers to condom use, have fairly high intentions to practice preventive behavior, and have high self-efficacy to do so. Most believe they are at little or no risk for acquiring HIV. These findings support the need for medical, educational, and social service programs to reduce the risk of HIV among these youths. CONCLUSION: Runaway and homeless youths practice behaviors that place them at high risk for acquisition of HIV infection. Risk reduction is imperative and will require programs that address the educational, psychological, social, and medical needs of these youths.

Sexually transmitted disease treatment and return for test of cure of adolescents in a family planning clinic.

This retrospective study assessed the return for treatment and test-of-cure rates for gonorrhea and chlamydial infection among 154 adolescents and young adults attending a family planning clinic. Eighty-four percent returned for treatment and 57% of those returned for a test of cure. No statistical differences in race/ethnicity, marital status, gravida, age, presence of symptoms, or type of infection were found between those returning and those not returning for treatment. Issues associated with sexually transmitted disease treatment and follow-up in the family planning clinic setting are discussed.

Contraceptive and sexuality knowledge among inner-city middle school students from minority groups.

PIP: In exchange for a free physical examination, 116 minority group youths from inner-city middle schools in Texas consented to answer open-ended questions about their sexual behavior, contraceptive knowledge, and type and source of knowledge of sexuality. The students ranged in age from 12-15 years (mean age, 13 years); 27% were Hispanic and 73% were black. Sex education was not a part of the curriculum at the 4 schools from which respondents were drawn. When asked what sex meant to them, 37% of female adolescents and 23% of males indicated they did not know or it did not mean anything. Among remaining students, recreation was identified as the central meaning be males (23% of total), while females tended to cite romance (21% of total). Only 47% were able to list at least 1 question they had about sex; most common were questions about the morality of premarital intercourse and the experience of adolescent pregnancy and parenthood. 89% of females and 57% of males were able to name at least 1 contraceptive method, generally condoms (44%), abstinence (36%), and the pill (8%). Hispanic females named the highest number of contraceptive methods on average (2.2), followed by black females (1.9), Hispanic males (1.8), and black males (1.3). Among female adolescents, 53% listed their mother as their primary source of knowledge about sexual matters and 6% listed a friend. Among males, fathers (17%) and friends (17%) were the most frequent knowledge sources. The fact that these young adolescents view their parents as credible and approachable sources of information about sexuality suggests that school counselors should encourage such communication. aT the same time, the expressed need for more information on the moral aspects of sexuality indicates that values should be incorporated into any sex education program developed for this age group.^ieng

Vaginal douching in teenagers attending a family planning clinic.

This study assessed the knowledge and usage patterns of vaginal douching in sexually active teenagers attending a family planning clinic. A questionnaire was administered consecutively to 94 black, 36 Hispanic, and 12 Anglo females ranging in age from 13 to 19 years. The survey showed that vaginal douching is a common practice, with almost two thirds learning about douching from their mother. The technique is primarily used for hygienic reasons with few using it to prevent pregnancy or infection. Age of first douche correlated with age of first intercourse (p less than 0.001). Almost 23% had douched within 2 days of the clinic visit, and 56% reported douching one or more times a week.

PIP: This study assessed the knowledge and usage patterns of vaginal douching in sexually active teenagers attending a family planning clinic in Houston, Texas. A questionnaire was administered consecutively to 94 black, 36 Hispanic, and 12 Anglo females ranging in age from 13 to 19 years. The survey showed that vaginal douching is a common practice, with almost 2/3s learning about douching from their mother. The technique is primarily used for hygienic reasons with few using it to prevent pregnancy or infection. Age of 1st douche correlated with age of 1st intercourse (p0.0001). Almost 23% had douched within 2 days of the clinic visit, and 56% reported douching 1 or more times a week.

Communication and special health care needs of a profoundly hearing impaired adolescent.

This report describes the authors' experience in providing medical and contraceptive care to a profoundly hearing impaired adolescent in a hospital setting. Ways to communicate effectively with the hearing impaired are described.

PIP: According to a 1985 survey, at least 50,000 children and adolescents in the US are hearing impaired. The US Rehabilitation Act, PL 93-112, Section 504, mandates hospitals to establish a protocol for effective communication with hearing impaired persons in need of emergency health care. This requires that the hospital provide an interpreter with sign language skills. The profoundly hearing impaired adolescent should be encouraged to participate in all phases of health management and given a choice of mode of communicating. A parent may serve as a communication link between staff and adolescent, but this may be a barrier in obtaining a history with regard to confidential sexual activity. Hearing impaired adolescents face the same developmental tasks as their hearing counterparts, including sexual identity and expression, but their auditory limitations cause differences in their ability to acquire and transmit information on sexual matters. They generally perceive only the taboos and innuendos regarding sex and are vulnerable to sexual abuse. Many adolescents in residential facilities may need contraceptive services from health care providers who are not aware of the contraceptive needs of the hearing impaired. To increase such awareness, the authors present the case of an 18-year-old hearing impaired black female with pelvic inflammatory disease and a need for contraceptive counseling. Counseling was provided with the aid of a licensed sign language interpreter and included use of a 3-dimensional model of the female reproductive tract and a large flip chart illustrating birth control methods. Oral contraceptives were prescribed, and the patient was given the number of a telecommunication keyboard device for the deaf at the hospital in the event of problems.

Test of cure for gonorrhea in teenagers. Who complies and does continuity of care help?

This study evaluates factors influencing test of cure (TOC) compliance for gonorrhea in teenagers attending a public sexually transmitted disease (STD) clinic. The efficacy of providing continuity of care to improve the TOC rate is also evaluated. Overall, females complied better (54%) than males (33%), and younger males better than older males (greater than 16 years of age). Of patients with a prior history of gonorrhea, the TOC rates were significantly higher for those who had previously kept their TOC appointment. Continuity of care did not improve the TOC rate, but initial contact with a clinician appeared to influence the return rate of female adolescents. Male adolescents will apparently require a different intervention strategy to improve their appointment keeping.

Failure of a lottery incentive to increase compliance with return visit for test-of-cure culture for Neisseria gonorrhoeae.

The impact of the financial incentive of playing a lottery on the rate of return for test-of-cure cultures was evaluated at a clinic for sexually transmitted diseases. All teenagers and young adults treated for gonorrhea (or as contacts of patients with gonorrhea) who were given a test-of-cure appointment were eligible to participate; in order to win, they had to keep the appointment. The return rate was documented during a baseline and a lottery phase for 519 patients. Females were significantly more likely to keep the appointment (47%) than males (27%), regardless of intervention, but there was no improvement in the return appointment rates with the lottery (baseline, 31% vs. lottery, 33%). Although teenaged males were more likely to participate in the lottery than young adult males and all females, only young adult females who participated were significantly more likely to return (68%). Reasons for failure of the lottery are discussed. Thus, despite the successful use of a lottery in previous studies, it is not always helpful in improving compliant behavior in certain populations.

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.

Iron deficiency in black females during late adolescence.

The role of serum ferritin (SF) in detecting early iron deficiency and the associated risk factors in black adolescent females are evaluated. SF less than or equal to 12 ng/mL indicated low iron stores and a Hb less than or equal to 11.3 g/dL (5% ile for black females-Hanes Survey) anemia. Of the 103 females (means = 16.8 yr) screened in a Family Planning Clinic (FPC), 20.4% (21/103) had a low SF. Of these 21, 72% had a Hb greater than 11.3 g/dL. Chronologic age, gynecologic age, history of pregnancy, Tanner stage IV and V, and birth control method did not appear to be risk factors. However, longer rather than shorter use of oral contraceptives appeared to protect against iron deficiency. This study suggests that routine screening of iron status by hemoglobin and serum ferritin is warranted during annual FPC visits.

PIP: The role of serum ferritin (SF) in detecting earlyiron deficiency and the associated risk factors in black adolescent females are evaluated. SF or=12 ng/mL indicated low iron stores and a Hb or= 11.3 g/dL (5%ile for black females--Hanes Survey) anemia. Of the 103 females (chisquare=16.8 years) screened in a Family Planning Clinic (FPC), 20.4% (21/103) had a low SF. Of these 21, 72% had an Hb 11.3 g/dL. Chronologic age, gynecologic age, history of pregnancy, Tanner 4 and 5, and birth control method did not appear to be risk factors. However, longer rather than shorter use of oral contraceptives appeared to protect against iron deficiency. This study suggests that routine screening of iron status by hemoglobin and SF iss warranted during annual FPC visits.