Managing adolescent acne.

Acne vulgaris, more commonly termed acne, is the most common skin disease treated by physicians. It affects an estimated 17 million people in the United States, including 85% or more of adolescents and young adults. Acne is a chronic condition that may last for years and cause emotional distress and permanent scarring. Although there is no cure, medications can control the disease and limit or prevent scar formation.

Evaluation of a peaceful conflict resolution and violence prevention curriculum for sixth-grade students.

PURPOSE: To evaluate a Social Cognitive Theory-based violence prevention curriculum among sixth-grade students. METHODS: The evaluation was conducted using a quasi-experimental pretest-posttest control group design. Students were pretested 2 weeks before the intervention started and were posttested 2 weeks after it ended. The study was conducted in four middle schools serving children and adolescents living in or around public housing in a southeastern city. The participants included all sixth-grade students who were predominantly African-American (88.7%), 41% lived in public housing, and 80% lived in homes with an employed head of household. The intervention schools had 292 students, and the control schools 412 students. The Peaceful Conflict Resolution and Violence Prevention Curriculum is a 13-module skills-building curriculum based on Social Cognitive Theory. It taught identification of situations that could result in violence; avoidance, confrontation, problem-solving, and communication skills; conflict resolution skills; the conflict cycle; the dynamics of a fight; and how to express anger without fighting. MAIN MEASURES: The primary outcome variable was a five-item scale assessing the frequency of fighting and weapon carrying behaviors (alpha =.72) and a scale measuring intentions to use violence in 11 hypothetical situations (alpha = .81). Levels of exposure to violence and victimization (alpha = .82) and depression (alpha = .86) were also assessed. The data were analyzed with general linear modeling with repeated measures. RESULTS: At pretest, the intervention and control groups did not differ in gender, age, depression, exposure to violence, or any other demographic variable. A group x time interaction effect (p = .029) was found in the use of violence scale. From pretest to posttest there was a decrease in the use of violence by students in the intervention group and an increase in the use of violence in the control group. Most of the changes were accounted for by changes in the frequencies of carrying concealed guns and fighting resulting in injuries requiring medical treatment. A group x time interaction effect (p = .002) was also found for the intention to use violence scale. Students in the intervention group did not change their mean scores from pretest to posttest, whereas students in the control group increased in their mean intention to use violence scale scores. Neither interaction effect was influenced by gender, exposure to violence, or level of depression. CONCLUSION: The Peaceful Conflict Resolution and Violence Prevention curriculum appears to have positive short-term effects on self-reported use of violence and intentions to use violence by these middle-school students.

Characterization of diaper dermatitis in the United States.

BACKGROUND: Diaper dermatitis is the most common dermatologic disorder of infancy. This study evaluates the frequency of outpatient visits resulting in this diagnosis, specialties of physicians providing services, demographics of patients, and leading agents used in treatment. DESIGN: Records of 272,841 encounters from the National Ambulatory Medical Care Survey (1990-1997) were examined for visits in which diaper dermatitis was diagnosed in children. The likelihood of diagnosis in the general pediatric population was calculated and the leading treatment agents were ranked. RESULTS: There were approximately 8.2 million visits in which diaper dermatitis was diagnosed. For the pediatric population in the at-risk age range, there was a 1 in 4 likelihood of being diagnosed with the skin disorder. Pediatricians provided 75% of services for the treatment of diaper dermatitis; the demographics of patients were similar to those of comparably aged individuals in the general population. Nystatin was the leading treatment agent prescribed (27% of visits), followed by clotrimazole (16%), a combination product of nystatin and triamcinolone (16%), hydrocortisone (8%), and a combination product of clotrimazole and betamethasone dipropionate (6%). CONCLUSIONS: Visits for diaper dermatitis are frequent, and pediatricians are the physicians most often called on to provide treatment. No portion of the pediatric population is disproportionately diagnosed. The frequent use of potent corticosteroids contained in combination agents is a potential target for improving the management of diaper dermatitis.

Treating acne. A practical guide.

Acne is the most common skin disorder affecting adolescents. Although there is no cure for acne, most patients benefit from currently available medications, and most can be managed effectively by the primary care provider. By offering this care, the clinician can reduce the emotional burden of acne and help prevent the permanent scarring commonly seen in the past.

Managing acne in adolescents.

Acne is the most common skin disorder affecting adolescents. Although no cure exists for acne, most patients benefit from currently available medications, and most can be managed effectively by their primary care providers. By offering this care, pediatricians can reduce the emotional burden of acne and help to prevent the permanent scarring so commonly seen in the past.

Confidential billing accounts for adolescents in private practice.

The purpose of this study was to determine how individual confidential billing accounts for adolescents in private practice would be received, and to assess the impact of these accounts on practice reimbursement. Adolescents wishing to keep confidential any part of the charges for an office visit were offered individual billing accounts. Enrollees agreed to pay whenever and whatever they could. One attempt was made to contact nonpayers at least 3 months after starting their accounts. The mean charge for 40 confidential accounts was $42 (total charges $1489) and all of the charges were for laboratory testing. Participants reimbursed 38% of the total charged ($565/$1489). Confidential accounts were well-received by study participants and may improve access to confidential care.

Gender differences in risk behaviors among adolescents who experience date fighting.

OBJECTIVE: Although dating violence frequently begins during adolescence, few studies have focused on date fighting in middle and high school students. Fewer studies have studied gender differences in date violence. This study examines whether gender-specific patterns of risk behaviors exist among adolescents who report date fighting. DESIGN: The study was conducted on data collected from 21 297 students in grades 8 through 12 participating in the Vermont 1995 Youth Risk Behavior Survey. Data were analyzed on 20 724 students (females = 50.1%) who reported: 1) never having been involved in a physical fight (n = 8737); 2) that their last physical fight was with a girlfriend, boyfriend, or other dating partner (n = 432); and 3) that their last fight was with someone other than a dating partner (n = 11 555). Indicators of violence (weapon carrying, being threatened, and fighting), suicide attempts, substance use, sexual behavior, and pregnancy were analyzed with chi(2) tests. Significant variables were analyzed with stepwise logistic regression. RESULTS: Of the males, 1.8% and of the females, 4.2% reported that their last fight was with a boyfriend, girlfriend, or dating partner. Risk behaviors significantly associated among females who only experienced date fighting included the number of male sexual partners in the past 3 months (adjusted odds ratio: 1. 48; 95% confidence interval: 1.26-1.74), number of suicide attempts in the past 12 months (1.55; 1.30-1.85), riding in a car with a drinking driver (1.23; 1.10-1.37), injection of illegal drugs (2.87; 1.10-7.50), use of alcohol before last sexual encounter (1.53; 1. 27-1.86), number of pregnancies (1.66; 1.26-2.21), forced sex (2.92; 2.18-3.91), and inhalant use (1.19; 1.06-1.34). Risk behaviors significantly associated among males who experienced only date fighting were sexual activity (4.11; 2.24-7.53), number of male partners in the past 3 months (1.40; 1.12-1.75), number of times of getting someone pregnant (1.68; 1.17-2.40), experiencing forced sex (2.38; 1.11-5.13), and the number of times threatened with physical violence in past 12 months (1.82; 1.53-2.17). When compared with adolescents who reported fighting with someone other than a date, risk factors significantly associated with date fighting among females were the number of male sexual partners in the past 3 months (1.21; 1.10-1.34), older age (1.21; 1.10-1.34), carrying a weapon in the past 30 days (.77;.66-.90), experiencing forced sex (1.70; 1. 30-2.22), condom non-use (1.96; 1.60-2.41), and number of times of being threatened with physical violence in past 12 months (1.11; 1. 01-1.22). The risk factors among males were the number of male sexual partners in the past 3 months (1.43; 1.28-1.60), experiencing forced sex (1.91; 1.02-3.60), and older age (1.34; 1.14-1.57). CONCLUSIONS: The patterns of risk behaviors differed among male and female adolescents reporting dating violence. Females who reported date fighting were more likely than were nonfighters to have attempted suicide, to engage in sexual and human immunodeficiency virus risk behaviors (use of injectable drugs), to have been pregnant, experienced forced sex, and to have ridden in a car with a drinking driver. Sexual behaviors, including same-gender sexual partners, forced sex, and having been threatened with physical violence, were associated with date fighting among males. These findings are important in screening adolescents at risk for date violence.date fighting, adolescence, risk behaviors, gender.

Middle school students' sources of acquiring cigarettes and requests for proof of age.

OBJECTIVES: To identify where and how middle school students acquire cigarettes and to describe factors associated with being asked for identification during their purchase. METHODS: A modified version of the Centers for Disease Control and Prevention's Youth Risk Behavior Survey was administered to 2227 sixth- through eighth-grade students attending 53 randomly selected middle schools in North Carolina in 1995. Data were analyzed with Chi-square tests, Cramer V, Kruskal-Wallis nalysis of variance, and multiple logistic regression using the likelihood ratio approach. RESULTS: Of the students who had smoked during the previous 30 days, 497 (22.8%) were the focus of the analyses. Fifty-eight percent of current smokers were male and 69% were white. The most frequent source of cigarettes was borrowing (32.1%). Only 16.9% of the students had purchased cigarettes from a store, and 3.9% had purchased cigarettes from a vending machine. Females were more likely (p < .006) than males to borrow or to have someone else buy cigarettes for them. Males were more likely (p < .006) than females to buy cigarettes from a store or vending machine or to steal them. Students who purchased cigarettes from a store or vending machine were more likely (p < .032) than other smokers to be 21 year older than expected for their school grade. Among the 197 students who had purchased cigarettes during the previous 30 days, only 14.2% had been asked for proof of age. Students who acquired cigarettes from a store were more likely than students who acquired them by other means not to have been asked for proof of age; while having been asked for proof of age was associated with acquiring cigarettes by other means (V = .44, p < .0001). Having been asked for proof of age was associated with earlier age of onset of smoking (V = .34, p < .0001), greater number of smoking days, and number of cigarettes smoked per day (V = .35, p < .0001). When analyzed with multiple logistic regression, only earlier age of onset of smoking remained a significant correlate of not having been asked for proof of age. CONCLUSION: In North Carolina, it was easy for young adolescents to purchase cigarettes illegally, especially for more experienced smokers. However, being asked for proof of age forced these youth to acquire cigarettes using other methods, and this was associated with less smoking. Prevention efforts should include enforcing existing laws requiring youth to provide proof of age when attempting to buy cigarettes.

Sexually transmitted diseases in adolescents: an update.

Sexually transmitted diseases are a significant cause of morbidity for U.S. adolescents. Recent advances in diagnosis may lead to enhanced recognition of infected individuals, particularly those who lack symptoms. New approaches to therapy have simplified treatment and may enhance compliance.

The relationship between early age of onset of initial substance use and engaging in multiple health risk behaviors among young adolescents.

BACKGROUND: Previous research based on problem-behavior theory has found that early age of onset of substance use is associated with engaging in multiple health risk behaviors among high school students. It is unknown whether these relationships begin during early adolescence. OBJECTIVE: To examine the relationships between early age of onset of cigarette, alcohol, marijuana, and cocaine use and engaging in multiple risk behaviors among middle school students. METHODS: A modified version of the Centers for Disease Control and Prevention Youth Risk Behavior Survey was administered to 2227 sixth through eighth grade students attending 53 randomly selected middle schools in North Carolina. A Health Risk Behavior Scale was constructed from 16 behaviors, including indicators of violence and weapon carrying; current substance use; nonuse of helmets when biking, in-line skating or skateboarding; not wearing a seat belt; riding with a driver who had been drinking; and suicide plans. Among this sample of middle school students, the scale had a mean (SD) of 4.1 (2.7) (range=O-15), and had a high internal reliability coefficient (alpha(=0.74). The independent variables included first time use of cigarettes, alcohol, marijuana, and cocaine at age 11 years or earlier; actual age of onset of each substance; race and ethnicity; family composition; sex; school grade; academic ranking; and older age for school grade. These data were analyzed with analysis of variance, Spearman r, and multiple linear regression. RESULTS: All the independent variables were found to be associated (P<.005) with the Health Risk Behavior Scale during the bivariate analyses. When each of these significant variables were entered into a multiple regression model, having smoked at age 11 years or younger accounted for 21.9% of the variation in the Health Risk Behavior Scale. Male sex, early marijuana or cocaine use, older age, lower academic rank, white race, and living in a 1-parent family explained an additional 19.1% of variation in the model (adjusted R2=0.41, P<.001). When the actual ages of onset of the use of substances were analyzed, in order of magnitude; age of onset of smoking; male sex; age of onset of alcohol and marijuana use; age; lower academic ranking; age of onset of cocaine use; white race; and lower academic rating accounted for 52.8% (P<.001) of the variation in the Health Risk Behavior Scale. CONCLUSION: Even when considering sociodemographic factors, early age of onset of cigarette use was the strongest correlate of the number of health risk behaviors in which these young adolescents had engaged. Early onset of use of other substances was also associated with a clustering of health risk behaviors among this sample of middle school students. The findings suggest that screening for early experimentation with tobacco and other substance use will help identify young adolescents at increased risk for engaging in multiple health risk behaviors.

Weapon carrying on school property among middle school students.

OBJECTIVE: To examine the association between carrying a weapon at school and the age of onset of substance use, other indicators of violence, and other health risk behaviors among middle school students. DESIGN: In 1995, a modified version of the Centers for Disease Control and Prevention Youth Risk Behavior Survey was administered to 2227 students (49% were female) attending 53 (of 463) randomly selected middle schools in North Carolina. Weapon carrying on school property during school hours was measured with 2 questions assessing carrying a gun and carrying other weapons such as knives or clubs. The Youth Risk Behavior Survey also assessed other indicators of violence, drug use, suicide plans and attempts, and being threatened with a weapon at school. Variables significantly (P< or =.001) associated with gun and other weapon carrying by chi2 tests were analyzed with stepwise logistic regression using the likelihood ratio approach. Odds ratios (ORs) were adjusted for all other variables in the model and 95% confidence intervals (CIs) were computed. RESULTS: Our study showed that 3% of students had carried a gun and 14.1% had carried a knife or club to school. Gun carrying was associated with increased age (OR, 1.57 [95% CI, 1.15-2.14]); male sex (OR, 5.62 [95% CI, 2.42-13.03]); minority ethnicity (OR, 3.30 [95% CI, 1.55-5.05]); and earlier age of onset of cigarette (OR, 0.85 [95% CI, 0.74-0.97]), alcohol (OR, 0.81 [95% CI, 0.71-0.94]), marijuana (OR, 0.81 [95% CI, 0.71-0.92]), and cocaine use (OR, 0.73 [95% CI, 0.62-0.86]). Knife or club carrying was associated with age (OR, 1.32 [95% CI, 1.14-1.53]); male sex (OR, 2.39 [95% CI, 1.77-2.32]); and ear-lier age of onset of cigarette (OR, 0.88 [95% CI, 0.84-0.94]), alcohol (OR, 0.81 [95% CI, 0.76-0.86]), and marijuana use (OR, 0.77 [95% CI, 0.72-0.83]). Gun carrying was also associated with frequency of cigarette (OR, 1.34 [95% CI, 1.14-1.57]), alcohol (OR, 4.59 [95% CI, 1.27-16.58]), cocaine (OR, 2.96 [95% CI, 1.29-6.82]), and marijuana use (OR, 3.66 [95% CI, 1.67-8.06]) after adjusting for male sex and minority ethnicity. Carrying a knife or club was associated with carrying a gun (OR, 1.83 [95% CI, 1.31-2.55]); being threatened with a weapon at school (OR, 1.65 [95% CI, 1.10-2.49]); fighting (OR, 4.62 [95% CI, 2.56-8.37]); frequency of alcohol (OR, 2.91 [95% CI, 1.88-4.50]) and cigarette use (OR, 1.20 [95% CI, 1.10-1.31]); and a suicide plan (OR, 1.54 [95% CI, 1.07-2.20]). CONCLUSIONS: Middle school students are more likely to carry a knife or club (14.1%) than a gun (3%) to school. Young adolescents who initiate substance use early and engage in it frequently are more likely to carry guns and other weapons to school, after adjusting for age, sex, and ethnicity. Being threatened with a weapon at school and fighting were only associated with knife or club carrying at school. These findings suggest that school-based prevention programs targeting both violence prevention and substance use should be introduced in elementary school.

Problem dieting behaviors among young adolescents.

OBJECTIVE: To examine dieting, eating and exercise behaviors, use of diet pills, and vomiting or use of laxatives to lose weight among younger adolescents. DESIGN: Analysis of data from a modified version of the Youth Risk Behavior Survey administered to middle school students in North Carolina in 1995. SETTING: Fifty-three randomly selected middle schools in North Carolina. SUBJECTS: Two thousand three hundred thirty-one students in the sixth, seventh, and eighth grades. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Responses to questions regarding weight control practices, including vomiting or laxative use, dieting, exercise, or diet pill use. RESULTS: Of the students surveyed, 110 (9.7%) of the girls and 46 (4.0%) of the boys reported vomiting or using laxatives to lose weight. Among the girls, vomiting or laxative use was associated with feeling overweight, other weight loss practices, older age, being a poor student, smoking, eating more salads or vegetables, and eating more candy or other sweets (P< or =.01). A logistic regression model consisting of diet pill use, dieting to lose weight, lower academic achievement, and currently trying to lose weight correctly classified 92% of female students who had or had not vomited or used laxatives. Among boys, vomiting or laxative use was associated with feeling overweight, other weight loss practices, minority racial status, smoking, frequency of eating hamburgers or other high-fat meats, and frequency of eating french fries or potato chips (P< or =.01). A model consisting of diet pill use, minority race, dieting to lose weight, smoking, feeling overweight, and number of servings of hamburgers, hot dogs, or barbecue correctly classified 97% of the boys who had or had not vomited or used laxatives. CONCLUSION: Younger adolescents trying to lose weight engage in a variety of problem dieting and weight loss behaviors that can compromise health and may be associated with eating disorders.

Victimization, use of violence, and drug use at school among male adolescents who engage in same-sex sexual behavior.

OBJECTIVE: To examine the relationship between the number of male sexual partners of adolescent males and the frequency of victimization at school, missed school because of fear, used drugs at school, and engagement of fighting and weapon carrying both in and out of school. STUDY DESIGN: Sexually active male adolescents (N = 3886) in 8th through 12th grades were administered the 1995 Vermont Youth Risk Behavior Survey. RESULTS: A total of 8.7% of male adolescents reported one or more male sexual partners. Alcohol, marijuana, and smokeless tobacco use at school, not attending school because of fear, having been threatened or injured with a weapon at school, and weapon carrying at school accounted for 15.8% of the variation in the number of male sexual partners (p < 0.0001). Suicide attempts, school absence because of fear, cigarette smoking, alcohol use, and smokeless tobacco use at school, frequency of fighting requiring medical treatment, carrying a weapon,aand carrying a weapon at school accounted for 17.2% out of 100% of the variation in the number of male sexual partners (p < or 0.00001). CONCLUSION: The number of male sexual partners reported by sexually active male adolescents correlated with a higher frequency of victimization, use of violence and drug use at school. Frequency of suicide attempts and fighting outside of school were also correlated with the number of same-sex sexual partners.

Sexually transmitted diseases in adolescents: what's new?

BACKGROUND: Sexually transmitted diseases (STDs) are an important cause of morbidity and, potentially, mortality for adolescents in the United States. Each year, 2.5 million teenagers in this country will contract an STD. An understanding of recent advances in risk factors, epidemiology, diagnosis, and treatment of these important infections is vital for clinicians providing care for adolescents. METHODS: To identify topics for review, a MEDLINE search for the years 1993 to 1997 was conducted, using the general term sexually transmitted diseases. Separate searches were performed for individual infections, including chlamydia, gonorrhea, herpes simplex virus (HSV), human papillomavirus (HPV), human immunodeficiency virus (HIV), and Trichomonas vaginalis. Relevant publications addressing risk factors for STD acquisition, as well as the epidemiology, diagnosis, and treatment of these infections were reviewed. RESULTS: Information derived from the search that was considered relevant and important for the care of adolescents is presented. Risk factors for STD acquisition, including sexual activity, condom use, and substance use are discussed. Recent information about the epidemiology of bacterial (eg, chlamydia, gonorrhea), viral (eg, HSV, HPV, HIV), and protozoal (T vaginalis) infections is presented. Novel diagnostic techniques and advances in treatment of specific infections are reviewed. CONCLUSIONS: Sexually transmitted diseases represent a significant health problem for adolescents in the United States. Recent advances in the area of diagnosis likely will lead to enhanced recognition of infected individuals, particularly those who lack symptoms. In addition, new drugs and novel approaches to therapy have simplified treatment and may lead to enhanced compliance.

Lymphomatoid papulosis: successful weekly pulse superpotent topical corticosteroid therapy in three pediatric patients.

Lymphomatoid papulosis is a T-cell proliferation that occurs primarily in adults but has been well described in children. Lesions may regress spontaneously but often leave residual scarring and, as a result, intervention frequently is considered. Therapeutic modalities commonly employed for adults with lymphomatoid papulosis may be poorly tolerated by pediatric patients. We present a series of three children with lymphomatoid papulosis treated with superpotent topical corticosteroids (halobetasol or clobetasol propionate). When applied twice daily for 2 to 3 weeks followed by weekly pulsed application, this treatment resulted in complete resolution of nearly all cutaneous lesions. Three ulcerated lesions, occurring in two patients, required adjuvant therapy with intralesional triamcinolone. To date one patient remains free of cutaneous disease and two children experience occasional new lesions that respond to renewed treatment with topical clobetasol propionate. None of the children have evidence of systemic disease. We conclude that pulsed application of a superpotent topical corticosteroid is efficacious and safe in the management of cutaneous lesions of lymphomatoid papulosis and avoids the risks often associated with more aggressive interventions. Since these agents do not alter the risk of subsequent malignancy, careful ongoing surveillance of children with lymphomatoid papulosis is imperative.