Female adolescent athletes' awareness of the connection between menstrual status and bone health.

STUDY OBJECTIVE: The aims of this study are to determine among female high school track athletes: (1) knowledge of the association between menstrual irregularity and bone health; (2) attitudes toward amenorrhea, specifically if amenorrhea is seen as a sign of athletic success; (3) the association between knowledge and attitudes based on athlete menstrual status. DESIGN: Cross-sectional survey. SETTING: Five public high schools in Texas. PARTICIPANTS: 103 female high school track athletes ages 14-18 years. INTERVENTION: Participants completed a questionnaire that addressed menstrual history, details of track participation, knowledge of bone mineral density (BMD)/ menstrual status connection, and attitudes about the desirability of oligo/amenorrhea. OUTCOME MEASURES: Frequencies of attitude and knowledge replies, summative knowledge score, and correlations between attitudes, knowledge, and menstrual status. RESULTS: Sixteen subjects (16.7%) met criteria for amenorrhea, 16 for oligomenorrhea (16.7%). Median summative knowledge score was one of six. Menstrual irregularity was associated with lower knowledge (P = 0.035). Incorrect answers about consequences of bone loss and the link to menstrual irregularity were given by ≥90% of respondents. Lower knowledge was associated with a greater number of "don't know" replies to attitude questions (P = 0.002). Among more knowledgeable participants endorsing opinions, menstrual irregularity was not seen as a sign of athletic success. CONCLUSIONS: The prevalence of irregular menses is high among adolescent track athletes and a larger-scale inquiry to clarify adolescent athletes' knowledge of and attitudes about the link between menstrual patterns and BMD is indicated. Education may provide one key to improved health behavior among this at-risk population.

Caring for incarcerated youth.

PURPOSE OF REVIEW: Incarcerated youth are an unusually high-risk cohort with numerous unmet medical and psychiatric needs. Frequently seen medical conditions including sexually transmitted diseases, pregnancy, and psychiatric illness are reviewed along with recommended standards of care for this population. RECENT FINDINGS: The recent realization that two-thirds of juvenile detainees have a psychiatric disorder has sparked renewed interest in screening and treating these high-risk adolescents. The push for increased identification and treatment has been prompted by the hypothesis that treating illness reduces recidivism and therefore improves individual and community public health. Although many facilities perform psychiatric and medical health screening within 24 hours of detention, there are many lacking areas. Examples include limited sexually transmitted disease, HIV and pregnancy testing; given the high rates of asymptomatic sexually transmitted disease infection, universal screening is essential. Also, interpretation of psychiatric screening tools by untrained individuals and utilization of results to incriminate juveniles are other problem areas. SUMMARY: Incarcerated adolescents' time in detention represents a rare opportunity to provide care to this underserved population. Full implementation of recommended screening and assessment protocols could greatly enhance individual as well as community health.

Folk and traditional medicine use by a subset of Hispanic adolescents.

UNLABELLED: Rates of Folk and Traditional Medicine (FTM) use are high among Hispanic adults. No data have been published on FTM use among the rapidly growing Hispanic adolescent population. OBJECTIVES: To determine the prevalence of and personal factors associated with FTM use among Mexican-American adolescents. STUDY GROUP: 182 Mexican-American adolescents (14-19 years) from community-based organizations. METHODS: We conducted a cross-sectional survey using a self-report instrument available in English and Spanish. RESULTS: In the past year, 49 (26.9%) subjects reported FTM use, all prompted by illness: 43 (23.6%) used herbal remedies, and 8 (4.4%) used traditional healers. Five subjects reported using dangerous herbs. Among herbal users, 56.3% did not disclose FTM use to medical providers, largely due to the providers' lack of inquiry. Logistic regression comparing herbal users with non-FTM users found subjects dissatisfied with their most recent medical visit (AOR = 10.6; 95% CI = 2.8-40.7) and subjects endorsing family FTM use (AOR = 8.4; 95% CI = 4.0-30.2) were more likely to use herbal remedies. Acculturation, insurance status, socioeconomic status, and having a personal healthcare provider were not related to herbal use. CONCLUSIONS: The use of practitioner-based FTM modalities was rare among this convenience sample of Mexican-American adolescents. Self-treatment with herbal use was common; harmful herbs were used infrequently. Access to care does not appear to motivate herb use. The high rates of herb use by dissatisfied patients, paired with high rates of non-disclosure and lack of provider inquiry, suggests that efforts to provide more culturally sensitive care, including routine inquiry about FTM use in Mexican-American adolescents, are needed. Patterns of complimentary and alternative medicine (CAM)/FTM use vary between age and ethnic cohorts.

The epidemiology of sexually transmitted infections in adolescents.

This article addresses the epidemiology of several common sexually transmitted infections (STIs) in adolescents. Chlamydia is a common occurrence in adolescents, more so than is gonorrhea, but both are of particular concern because they may cause pelvic inflammatory disease. Many experts recommend screening for chlamydia in sexually active adolescents, particularly females. Trichomonas vaginalis is significant as a marker for risk of contracting other STIs and because of its association with pregnancy complications and with increased risk of transmission of HIV. Genital herpes simplex virus (HSV) infection, which usually has been caused by HSV-2, is a common finding in adolescents, and it now is caused also by HSV-1 in some populations. Human papillomavirus (HPV), though widespread in adolescents, usually is a self-limited infection, and malignancy resulting from HPV is a rare occurrence in this age group. The least common of the diseases discussed below is syphilis, but a recent sharp increase in incidence has occurred in men who have sex with men.