Condom use by adolescents.

The use of condoms as part of the prevention of unintended pregnancies and sexually transmitted diseases (STDs) in adolescents is evaluated in this policy statement. Sexual activity and pregnancies decreased slightly among adolescents in the 1990s, reversing trends that were present in the 1970s and 1980s, while condom use among adolescents increased significantly. These trends likely reflect initial success of primary and secondary prevention messages aimed at adolescents. Rates of acquisition of STDs and human immunodeficiency virus (HIV) among adolescents remain unacceptably high, highlighting the need for continued prevention efforts and reflecting the fact that improved condom use can decrease, but never eliminate, the risk of acquisition of STDs and HIV as well as unintended pregnancies. While many condom education and availability programs have been shown to have modest effects on condom use, there is no evidence that these programs contribute to increased sexual activity among adolescents. These trends highlight the progress that has been made and the large amount that still needs to be accomplished.

Care of the adolescent sexual assault victim.

Sexual assault is a broad-based term that encompasses a wide range of sexual victimizations, including rape. Since the American Academy of Pediatrics published its last policy statement on this topic in 1994, additional information and data have emerged about sexual assault and rape in adolescents, the adolescent's perception of sexual assault, and the treatment and management of the adolescent who has been a victim of sexual assault. This new information mandates an updated knowledge base for pediatricians who care for adolescent patients. This statement provides that update, focusing on sexual assault and rape in the adolescent population.

American Academy of Pediatrics. Committee on Adolescence. Contraception in adolescents.

The risks and negative consequences of adolescent sexual intercourse are of national concern, and promoting sexual abstinence is an important goal of the American Academy of Pediatrics. In previous publications, the American Academy of Pediatrics has addressed important issues of adolescent sexuality, pregnancy, sexually transmitted diseases, and contraception. The development of new contraceptive technologies mandates a revision of this policy statement, which provides the pediatrician with an updated review of adolescent sexuality and use of contraception by adolescents and presents current guidelines for counseling adolescents on sexual activity and contraceptive methods.

Reproductive health risk behavior survey of Colombian high school students.

PURPOSE: To establish rates of potentially risky sexual behaviors among Colombian adolescent students. METHODS: A total of 230 9th and 11th graders at a Colombian high school (69% of enrolled students) were anonymously surveyed about selected reproductive health behaviors using the Centers for Disease Control and Prevention's self-administered Youth Risk Behavior Survey. RESULTS: The response rate was >90%. The group was demographically representative of students. Twenty-nine percent of the group had engaged in intercourse (13% of 9th and 43% of 11th graders). Male gender [beta = 0.7873; odds ratio (OR) = 2.09; 95% confidence interval (CI) = 1.57-3.08] and increasing age (beta = 0.3413; OR = 1.41; 95% CI = 1.02-1.93) were each significantly correlated with prior sexual activity. Compared with females, males initiated intercourse at a significantly earlier age (beta = 0.284; p < .001) but did not report significantly more partners (means 2.1 vs. 1.4; chi2 = 1.25; p = .262). Forty-eight percent of respondents used contraception during their last encounter. Sixty-three percent used oral contraceptives or condoms, while the remainder used less effective methods. Contraceptive use did not correlate with gender or age. Age was significantly and positively correlated with use of alcohol prior to sexual activity (B = 1.28; OR = 3.6; 95% CI = 1.49-8.44). CONCLUSIONS: Compared with U.S. populations of similar ages, the Colombian group surveyed had fewer sexually active members, reported fewer partners, and used contraception with lower frequency.

PIP: A survey on the reproductive health risk behaviors of adolescent students in Colombia was conducted. 230 9th and 11th graders participated in a survey using the Centers for Disease Control and Prevention's self-administered Youth Risk Behavior Survey. The sample was composed of 62% females and 38% males, aged 13-18 years. It was found that 29% had engaged in sexual intercourse; among these, 13% were 9th graders and 43% were 11th graders. Increasing age and male gender were significantly correlated with past sexual activity. Older males have more prevalent sexual activity than older females, while younger adolescents showed no gender differences. Male gender was significantly associated with early age of initiation of intercourse. Furthermore, 48% reported using contraception during their last sexual encounter, of which 63% used an effective method (condom, oral contraception, withdrawal) and 37% used a method of low or unknown efficacy. Use of alcohol prior to the last sexual intercourse accounted for 14%. The majority of the participants had discussed or received information on HIV infection at school (92%) or from family (77%). Results showed unmet health needs of the adolescent groups and lower frequency of contraceptive use.

A comparison study of an elementary school-based health center: effects on health care access and use.

OBJECTIVE: To assess the effects of an elementary school-based health center (SBHC) on access to and the use of physical and mental health services by children aged 4 to 13 years. STUDY DESIGN: A retrospective cohort analysis of parent surveys from a comparable intervention (SBHC) and a comparison of urban elementary schools. INTERVENTION: Elementary SBHC services, including preventive physical health care; the care of minor short-term illnesses, injuries, and stable ongoing medical conditions, dental screenings; and mental health counseling. PARTICIPANTS: All parents of students at both schools were asked to complete a survey. Return rates on the survey were 78.3% (570/728) and 77.0% (440/571) at the intervention and comparison schools, respectively. MAIN OUTCOME MEASURES: The use of health services, access to health services, and health service satisfaction. RESULTS: Compared with respondents at comparison schools, respondents whose children had access to an SBHC had less difficulty (P = .01) receiving physical health care for their children, ie, treatment of illnesses and injuries, immunizations, and physical examinations (odds ratio, 0.66; 95% confidence interval, 0.48-0.91). Access to an SBHC was independently and significantly related to less emergency department use (odds ratio, 0.63; 95% confidence interval, 0.40-0.99; P<.05), a greater likelihood of having had a physician's visit since the school year began (odds ratio, 1.92; 95% confidence interval, 1.39-2.65; P<.01), and a greater likelihood of having had an annual dental examination (odds ratio, 1.36; 95% confidence interval, 1.01-1.83; P<.05). Measured by a 12-item scale, respondents who reported the SBHC as their most-used health service were significantly more satisfied with their service than respondents who mostly used community clinics (z=-5.21; P<.01) or hospital clinics (z=-4.03; P<.01). CONCLUSIONS: Independent of insurance status and other confounding variables, underserved minority children with SBHC access have better health care access and use than children without SBHC access, signifying that SBHCs can be an effective component of health delivery systems for these children.

Adolescent pregnancy--current trends and issues: 1998 American Academy of Pediatrics Committee on Adolescence, 1998-1999.

Although the prevention of unintended adolescent pregnancy is a primary goal of the American Academy of Pediatrics and society, many adolescents continue to become pregnant. Since the last statement on adolescent pregnancy was issued by the Academy in 1989, new observations have been recorded in the literature. The purpose of this new statement is to review current trends and issues on adolescent pregnancy to update practitioners on this topic.

Redesigning a school health workforce for a new health care environment: training school nurses as nurse practitioners.

Diminishing financial resources for school health dictate the most efficient possible deployment of the school health workforce. School nurses trained as nurse practitioners could help resolve the common problems of ready access to and appropriate use of primary care, early detection of potentially costly medical problems, and efficient use of school health staff. To determine how best to use existing resources to meet the increasingly varied and complex health care needs of children and adolescents, a pilot project was conducted in Denver from 1994 to 1996. With physician back-up and health aide support, school nurses were trained as nurse practitioners to provide in-school diagnostic and treatment services. Based on their evaluation study of this pilot project, the authors suggest ways to solve problems in role transition, including well-balanced training; clear role definition and assignment of responsibilities; appropriate back-up and mentoring support; and issues of sustaining long-term programs.

Elementary school-based health center use.

BACKGROUND: The number of school-based health centers (SBHCs) has grown from 40 in 1985 to >900 in 1996. During the 1996-1997 school year there were 914 SBHCs, 32% of which were located in elementary schools. Despite the relatively large number of elementary SBHCs in existence, SBHCs serving elementary-aged students are not adequately represented in the literature. OBJECTIVE: To analyze physical and mental primary health care utilization in a comprehensive elementary SBHC for an underserved Hispanic population. DESIGN: Retrospective analyses of services used at an elementary SBHC during the 1995-1996 school year. We describe physical and mental health services utilization provided by SBHC staff who offered a range of primary medical and mental health services. PATIENTS: The study population was predominately Hispanic, and comprised of 811 elementary school students (grades preschool through fifth) registered for SBHC use. Analyses were conducted on 591 students who used the SBHC. RESULTS: The 591 SBHC users made 2443 visits, ranging between 1 and 54 visits/individual; mean 4 visits/student. Two thirds of visits (1638) were medical provider visits, and 33% (798) were mental health provider visits. Most students (75%) saw a medical provider exclusively, 9% saw a mental health provider exclusively, and 16% of students were seen by both. Mean duration of medical provider visits +/-SD was 15 +/- 13 minutes, mean for mental health provider visits +/-SD, 37 +/- 16 minutes. Of the 3035 diagnoses, 64% were medical and 36% were mental health diagnoses. These diagnostic frequencies are grouped as follows: acute medical (31%), health maintenance (22%), depression (10%), non-Diagnostic and Statistical Manual of Mental Disorders-IV mental health diagnoses (8%), conflict disorder/emotional disturbance (8%), chronic medical (8%), academic/learning disorder (7%), anxiety disorder (3%), and other (4%). CONCLUSIONS: High rates of SBHC utilization by this population and the range of diagnoses recorded suggest health care delivered in a comprehensive, culturally-sensitive SBHC has the potential for impacting the health and well-being of underserved elementary-aged students.

Managed care and school-based health centers. Use of health services.

OBJECTIVE: To explore the use of physical and mental health services for adolescents who are enrolled in managed care and have access to a school-based health center (SBHC), compared with adolescents enrolled in managed care without access to an SBHC. DESIGN: Retrospective cohort designed with age, sex, and socioeconomic status matching to compare the use of health services for adolescent members of Kaiser Permanente of Colorado (who had access to SBHCs) with those with no access. PARTICIPANTS: The study included 342 adolescents, resulting in 3394 visits that occurred during 3 academic years. During the study, 240 adolescents with access to an SBHC were compared with 116 adolescents without access to an SBHC. MAIN OUTCOME MEASURES: The use of primary and subspecialty medical, mental health, and substance abuse treatment services; the use of after-hours (emergent or urgent) care; and comprehensive preventive health supervision visits and documentation of screening for high-risk health behaviors. RESULTS: Adolescents with access to SBHCs were more than 10 times more likely to make a mental health or substance abuse visit (98% of these visits were made at the SBHC) (P < .001). Adolescents with SBHC access had an after-hours (emergent or urgent) care visit rate of 0.33 to 0.52 visits per year less (38%-55% fewer visits) than adolescents without SBHC access, and, overall, made almost 1 additional medical visit per year. A greater percentage, 80.2%, of adolescents with access to SBHCs had at least 1 comprehensive health supervision visit compared with 68.8% of adolescents without access (P = .04). In addition, the adolescents with access were screened for high-risk behaviors at a higher rate. CONCLUSIONS: School-based health centers seem to have a synergistic effect for adolescents enrolled in managed care in providing comprehensive health supervision and primary health and mental health care and in reducing after-hours (emergent or urgent) visits. School-based health centers are particularly successful in improving access to and treatment for mental health problems and substance abuse.

Comprehensive school-based health care: high school students' use of medical, mental health, and substance abuse services.

OBJECTIVES: To explore adolescent students' use of school based health and medical care and mental health and substance abuse counseling services and to compare adolescents' patterns of use of medical, mental health, and substance abuse services located in school-based and traditional settings. DESIGN: Retrospective analysis of computer-stored, standardized data for all student visits during a 4-year period. SETTING: Three high school-based student health centers. SUBJECTS: A total of 3818 adolescent students who used services provided by the school-based health centers (SBHCs). OUTCOME MEASURES: Frequencies of student visits to medical providers and mental health and substance abuse counselors and frequencies of diagnostic assignments. RESULTS: During a 38-month period, 3818 students attending senior high school made a total of 27 886 visits to three SBHCs. They represented 63% of students enrolled in the SBHCs and approximately 42% of the total school population. There were no significant demographic differences between students attending the SBHCs and the overall student body. However, compared with students who were enrolled in the SBHCs but did not use them, users were more likely to be female and Hispanic. Ninety-four percent of students using the services had visits with medical providers; 25% had visits with mental health counselors; and 8% of students had visits with substance abuse counselors. The total annual mean number of student visits was 4.7, and the annual mean numbers of visits for students who used the following services were: medical, 3.3; mental health, 5.8; and substance abuse, 6.8. An average of 1.4 diagnoses were made per visit. The most common major diagnostic categories were emotional problems (29% of all diagnoses), health supervision (13%), respiratory problems (11%), reproductive health problems (11%), and substance abuse problems (8%). Almost one fourth of the students had contact with more than one of the three categories of service provicer. Visit frequency increased significantly for students who used two categories of provider (13 to 15 mean total visits compared with 4 to 5 mean total visits for students who used just one category of provider) and escalated to a mean of 32 total visits if all three categories of service were used. CONCLUSIONS: Adolescents attending SBHCs had higher rates of visits for health and medical care than adolescents using traditional sources of medical care. The proportions of student users of SBHC mental health and substance abuse counseling services were commensurate with the estimated prevalences of these problems in this country's adolescent population. In addition, the mean numbers of visits to mental health counselors in SBHCs compared favorably with adolescent visit rates for mental health services in other settings. Too little information is available about adolescent use of substance abuse services in non-school-based settings to make similar comparisons. In summary, adolescent users of SBHCs seemed to have a higher use of medical, mental health, and probably substance abuse counseling services than did adolescents in the general populations. These findings are consistent with the interpretation that SBHCs do enhance adolescents' access to care for medical, mental health, and substance abuse problems.

Research consent by adolescent minors and institutional review boards.

PURPOSE: A national survey of institutional review boards (IRBs) was conducted to determine: (1) the current practices of IRBs concerning consent for adolescent minors; and (2) the existence of support for changes in the federal regulations for research on adolescents. METHODS: Six hundred surveys were mailed in two waves to all IRB chairs in the United States, with the exception of highly specialized institutions. The survey consisted of three sections. Section 1 assessed demographic data, such as institution type; presence of personnel trained in adolescent health; and number of protocols involving adolescents reviewed annually. Section 2 presented a series of twelve scenarios for which respondents stated whether their IRB would waive parental consent under present federal regulations. These scenarios varied the sensitivity of information and procedural invasiveness, and ranged from simple satisfaction surveys to experimental drug treatment for AIDS. Section 3 assessed whether respondents would recommend changes in current federal regulations that would enable adolescent minors to provide their own consent to research participation. To this end, respondents indicated whether minor consent alone is sufficient or if parental consent should be required for 10 general research categories that paralleled the level of invasiveness of the scenarios presented in Section 2. RESULTS: Two hundred and thirty-three surveys (39%) were returned and 183 (30%) were fully scorable. Within group comparisons for IRBs were conducted using Chi-square statistics. Seventy percent of respondent IRBs required parental consent for all research on minors, and IRBs reviewing more than 10 adolescent protocols per year were less likely to require parental consent (p < .01). Responses did not differ by institution type or presence of personnel trained in adolescent health. Fifty-two percent of respondent IRBs required parental consent for a simple satisfaction survey, and only 29% of IRBs would waive parental consent for an anonymous HIV seroprevalence study. Over one-half of IRBs supported changes in regulations that would enable minors to provide informed self-consent for seven of 10 general research categories: anonymous surveys (supported by 93%), research involving sensitive material if nothing more than survey (89%) or venipuncture (53%) were involved, and research on diseases for which minors may consent to treatment including survey (93%), venipuncture (68%), or medication approved for use in pediatric patients (57%). CONCLUSION: Even though IRBs practice under the same federal regulations there is a broad spectrum of interpretation. Considerable support exists for changing the guidelines for certain categories of research involving adolescents. Federal regulations need to be clarified for meaningful and necessary research on adolescents to take place.

Are adolescents who report prior sexual abuse at higher risk for pregnancy?

Adolescents who report prior sexual abuse are at increased risk for adolescent pregnancy. This may result from earlier, more frequent, less well-protected sexual activity or from a greater desire to conceive. To determine the relative contribution of these two possible explanations to the reported association between sexual abuse and adolescent pregnancy, we studied the reproductive and sexual histories of 200 sexually active 13-18 year old females in relation to self-reported sexual abuse. Anonymous questionnaires revealed that 40 (20%) of the 200 subjects reported sexual abuse. Analyses revealed no group differences in the median age of first voluntary intercourse, the frequency of sexual intercourse, or the consistency of birth control use. Compared to their nonabused peers, however, teenagers reporting abuse were more likely to be trying to conceive (35% vs. 14% p < .01), to have boyfriends pressuring them to conceive (76% vs. 44% p < .01), and to have fears about infertility (38% vs. 16% p < .01). Our findings suggest that childhood sexual abuse may increase the risk of adolescent pregnancy by fostering the desire to conceive. Further study is needed to determine why a disproportionate number of sexually abused adolescents desire pregnancy. The efficacy of adolescent pregnancy prevention programs may be improved by identifying previously abused adolescents and by designing educational interventions that specifically address their desire to conceive.

PIP: Female adolescents who report prior sexual abuse are at increased risk for adolescent pregnancy. Such pregnancy may result from earlier, more frequent, less well-protected sexual activity or from a greater desire to conceive. The authors studied the reproductive and sexual histories of 200 sexually active 13-18 year old females in relation to self-reported sexual abuse to determine the relative contribution of these two possible explanations to the association between sexual abuse and adolescent pregnancy. 20% of the participants reported being sexually abused. There were, however, no differences found between the groups in the median age of first voluntary intercourse, the frequency of sexual intercourse, or the consistency of birth control use. Compared to their nonabused peers, however, teenagers reporting abuse were more likely to be trying to conceive, to have boyfriends pressuring them to conceive, and to have fears about infertility. These findings therefore suggest that childhood sexual abuse may increase the risk of adolescent pregnancy by fostering the desire to conceive. Further study is needed to determine why a disproportionate number of sexually abused adolescents desire pregnancy.

Spectrum of genital human papillomavirus infection in a female adolescent population.

BACKGROUND: Human papillomavirus infection is a sexually transmitted disease associated with cervical dysplasia and carcinoma. GOAL OF THIS STUDY: To determine prevalence rates of cervical human papillomavirus infection compared with other sexually transmitted diseases and risk factors associated with human papillomavirus infection among adolescent women, we evaluated 634 patients attending three urban adolescent clinics. STUDY DESIGN: Patient evaluation included Pap smears; screening for chlamydia, gonorrhea, and trichomoniasis; and testing of cervical swab samples for human papillomavirus DNA. RESULTS: Cervical human papillomavirus was the most common STD in our population (15.6%), followed by infection with Chlamydia trachomatis (11.0%), Neisseria gonorrhoeae (7.1%), and Trichomonas vaginalis (5.4%). The most prevalent human papillomavirus types were 16/18 (7.3%), followed by 31/33/35 (4.7%) and 6/11 (3.5%). When genital warts on exam, low-grade squamous intraepithelial lesions on cytology, or cervical human papillomavirus DNA were considered as indicators of genital human papillomavirus infection, 24% of patients had any manifestation of infection, including 15% with clinically apparent infection (genital warts), 36% with cytologically apparent infection without warts, and 49% with subclinical infection only (cervical human papillomavirus DNA without low-grade squamous intraepithelial lesions or warts). Factors associated with detection of cervical human papillomavirus DNA by multivariate analysis included number of lifetime sexual partners and genital warts on exam. CONCLUSION: Cervical human papillomavirus infection was the most prevalent sexually transmitted disease among an ethnically diverse group of urban adolescent females, with a large proportion of infections neither clinically nor cytologically apparent. The strong association with lifetime sexual partners substantiates that cervical human papillomavirus is acquired predominantly by sexual contact and often soon after the onset of sexual activity.

PIP: The study was conducted at three urban adolescent clinics administered by the Denver Department of Health and Hospitals.The population was derived predominantly from inner city, low-income adolescents 12-18 years old during the period of May 1989 to January 1990. A questionnaire regarding sexual and STD history, contraceptive use, and substance use was administered to each patient. Specimens for laboratory studies included collection of vaginal fluid swabs for pH determination and wet mount microscopy; sequential cervical swabs for testing for Neisseria gonorrhea, Chlamydia trachomatis, and HPV DNA; and endocervical swabs and ectocervical scrapes for cytology. A total of 634 were included. The population was ethnically mixed: 167 (26%) were Black, 287 (45%) were Hispanic, 174 (28%) were White, 1 (0.2%) was Asian, and 3 (10.5%) were of other ethnic groups. The mean age was 16.8 years, with a range of 12-18 years. Cervical HPV infection was the most prevalent STD in the population, detected in 99 (15.6%) subjects, followed by infection with C. trachomatis in 69 (11.0%), N. gonorrhea in 45 (7.1%), and T. vaginalis in 34 (5.3%). Overall, 188 (30.3%) subjects had any of the 4 STDs detected. The most prevalent, higher-risk HPV types were 16/18, either as single or mixed infections, which were detected in 46 (7.2%) patients. Infection with HPV types 31/33/35 or 6/11 occurred in an additional 31 (4.9%) and 23 (3.6%) subjects, respectively. Overall, 152 (24%) patients had any manifestation of genital HPV infection, 23 (15%) with clinically apparent infection (external genital warts), an additional 54 (36%) with cytologically apparent infection (low-grade squamous intraepithelial lesions or LSIL) without warts, and 69 (49%) with subclinical cervical infection (with neither warts nor LSIL). The relative risk of cervical HPV DNA for those with 2 or more partners was 2.7 (p 0.001). By multivariate analysis, the independent predictors of cervical HPV DNA included the number of lifetime sexual partners (2 or more partners: OR, 1.9) and current genital warts (OR, 5.1).

Student opinions of condom distribution at a Denver, Colorado, high school.

Over the past two decades, the reported number of women and men who have had intercourse by age 18 has increased by approximately 20%. Concomitant increases occurred in the incidence of teen-age pregnancies and sexually transmitted diseases (STDs), including HIV. Increasing condom availability within schools has been proposed as one means of preventing the serious potential consequences of unprotected sexual intercourse. Although published surveys report 68% to 75% of adults have supported distributing condoms in schools, little is known about what students think about making condoms available at school. In this survey, high school students in Denver initiated and helped conduct a school-wide survey to assess student opinions about condom distribution in their school. Of 931 high school students responding to the survey, 85% replied that condoms should be distributed in their school, and 76% believed making condoms more accessible would not change the frequency of sexual activity among teens.

PIP: Students at a high school in urban Denver, Colorado, in October 1992 initiated and helped conduct a school-wide survey on student opinions about making condoms available in their school. Students simultaneously and anonymously completed the survey. Only 994 of the school's 1330 enrolled students, however, had the opportunity to complete the survey due to the absenteeism of students, attendance at physical education class during the block, or the teacher's failure to administer the survey. 336 enrolled students simply did not receive a survey. Moreover, only 931 completed surveys figure in the final analysis since 63 were excluded due to illegibility or ambiguities in the responses. A larger percentage of students in the lower grades responded to the survey, corresponding to increased attrition as students advance in school and a higher absenteeism rate for upperclassmen. 85% of the surveyed students replied that condoms should be distributed in their school. 76% noted that making condoms more accessible will neither increase nor decrease the frequency of sexual activity among teens. Proponents of in-school condom distribution pointed to the ability of condom use to prevent the spread of AIDS and other STDs, and unwanted pregnancy as the most important reasons to support condom distribution, followed by the belief that increased condom availability will prompt more students to use them when having sexual intercourse. The embarrassment and financial cost of having to buy condoms were also cited by 24% and 17% of students, respectively, as reasons for making condoms available in school. 45% of students feel that condoms should be distributed from machines in bathrooms, 42% from the school nurse, 8% from other students, and 5% from teachers. 61% of condom distribution opponents were female. 59% of the opponents, while claiming to not be against condoms, believe that school is just not appropriate point of distribution for them. Other opponents believe that condom distribution will stimulate the incidence of sexual activity, that individuals should not have sex until they are older or married, that distributing condoms is religiously wrong, that condom distribution would be wasteful since some people do not use condoms every time they have intercourse, and that it would be embarrassing to procure condoms at school. Students in lower grades tended to be more conservative with their beliefs.

Self-perception of infertility among female adolescents.

OBJECTIVE: To determine the prevalence and correlates of the self-perception of infertility among female adolescents. DESIGN: Cross-sectional survey. SETTING: Urban adolescent clinic in a neighborhood health center in Denver, Colo. PARTICIPANTS: Two hundred sexually active, nulliparous, 14- through 18-year-old female adolescents. MEASUREMENTS/MAIN RESULTS: Concerns about fertility were expressed by 43 (21.5%) of the 200 respondents. Logistic regression analysis revealed that the factors most strongly associated with the self-perception of infertility were as follows (odds ratios; 95% confidence interval): a history of discussing infertility with anyone (4.3; 1.8 to 10.4); desire for pregnancy (3.8; 1.4 to 10.3); boyfriend desiring pregnancy (3.0; 1.1 to 8.3); a history of sexually transmitted disease(s) (3.0; 1.2 to 7.1); and having an older boyfriend (2.6; (1.1 to 6.2). Adolescents who doubted their fertility used contraceptives less frequently than other teens (30% vs 55% of the time; P < .01). CONCLUSIONS: The self-perception of infertility is common among sexually active urban female adolescents and may pose another barrier to contraceptive use. Our findings may help clinicians counsel adolescents about contraceptives more effectively.

Frequent school-based clinic utilization: a comparative profile of problems and service needs.

UNLABELLED: The purpose of this study is to compare frequent users of school-based clinic services with students who have an average rate of utilization. SAMPLE: Of the 1413 students enrolled in a Denver school-based clinic (DSBC) during the 1989-1990 school year, frequent clinic users (n = 73) were defined as those who visited the clinic 15 times or more (range, 15-72 visits per year). Average users (n = 82) were defined as students who visited the clinic three times during the year (the mean and median number of visits per student enrolled). Average users were compared. RESULTS: The average utilizers were found to be representative of the entire student population based on age, race, gender, and grade. The frequent users had more females (71%) and a lower grade point average (GPA) (2.11) than the average users (52% female, 2.54 GPA; p < 0.02). The frequent clinic users differed in their initial primary diagnoses as well as in the types of subsequent visits, having a significantly higher percentage of mental health-related visits than did the average users (61% versus 10%; p < 0.01). The frequent clinic users also demonstrated more high-risk behaviors such as alcohol use, sexual activity, and both family and peer relationships (p < 0.001). CONCLUSION: These data suggest that frequent clinic users have significant health needs that may require a higher rate of utilization.

Factors associated with preterm delivery among pregnant adolescents.

The purpose was to identify characteristics of pregnant adolescents associated with preterm delivery. We studied 126 poor, black, 12 through 18-year-old pregnant adolescents and compared the prevalence of potentially high-risk maternal characteristics and obstetric complications in those who bore preterm and term infants. Of the adolescents studied, 12 (9.5%) delivered prematurely. Five maternal characteristics--conception within 3 years of menarche, a low body mass index, a past history of physical or sexual abuse, a socially deviant father of the baby, and vaginal bleeding during the first 8 weeks of gestation--were associated with preterm delivery. A theoretical model is proposed and the therapeutic implication of the study findings.

PIP: In order to identify the characteristics of pregnant adolescents which are associated with preterm delivery of their babies, data collected from the Rochester Study of Adolescent Pregnancy, a 3-year prospective study of the relationship between maternal age, weight gain, and infant outcome in 195 consecutively enrolled, poor, Black, 12-30 year old women, were used to develop a cohort of 126 pregnant adolescents who were less than 19-years-old at conception. Gestational age was calculated from the date of the last menstrual period and verified by ultrasound and Dubowitz examinations. Infants born prior to the 37th week of gestation were considered preterm. 12 of the study mothers had preterm infants (born at an average of 33+or-4 weeks compared with 39+or-1 week for term infants). Univariate analysis revealed that preterm delivery was significantly associated (por=0.05) with 5 maternal characteristics: 1) conception within 3 years of menarche, when menarche occurred after the population mean of 12 years; 2) a body mass index blow the population mean of 23kg/sq. m; 3) a history of abuse; 4) a sexual partner (the baby's father) involved in socially deviant behaviors; and 5) vaginal bleeding during the first 8 weeks of gestation. These maternal characteristics fit a theoretical framework which suggests that during the first trimester, pregnancy hormonal deficiencies associated with physical immaturity, the additional nutritional requirements of a thin body habitus, and stress-related physiologic changes can adversely affect adaptation to the physiologic demands of pregnancy and compromise the growth of the utero-placental vascular bed. This would predispose a women to early first trimester vaginal bleeding and/or preterm delivery. To test this hypothesis, more research is needed in the area of early maternal physiologic adjustment to pregnancy in larger, more diverse populations. Such research would provide a scientific basis for the allocation of scarce adolescent prenatal services.

A survey of community (out-of-hospital) sites used in pediatric training.

A survey was completed of US pediatric residency programs about the use of community sites in training. A total of 85% of program directors responded and reported a wide use of the 21 identified survey sites. Further study is needed to determine the appropriate contribution that community sites can make to pediatric training.

A comparison of parent and adolescent responses from independent health histories.

This study compared agreement of written responses between parent and adolescent concerning medical and psychosocial information from independent health histories during an initial medical visit. Records with two health histories completed separately by 268 parent/adolescent pairs were studied. The following medical questions were coded and compared: chief complaint, infectious diseases, review of systems, hospitalizations, accidents, allergies, and medications. Psychosocial questions included recreational drug use, sexual behavior, body image, home life, and mental health. Using three-factor repeated measures ANOVA, significant differences (P less than or equal to 0.05) were obtained for gender and age when comparing the mean scores for medical and psychosocial questions. These differences were found primarily in the psychosocial category and chief complaint question. Findings suggest that many adolescents are reliable informants about their medical histories, but private interviewing of the teenager may be necessary to determine high-risk behaviors.