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.

Clinician agreement on physical findings in child sexual abuse cases.

OBJECTIVE: To measure agreement among experienced clinicians regarding the interpretation of physical findings in child sexual abuse cases and to determine whether knowledge of clinical history affects the interpretation of the physical findings. DESIGN: Experienced clinicians rated colposcopic photographs on a scale of 1 to 5 with 1 being normal and 5 being clear evidence of penetrating injury. To answer an additional study question of whether clinical history affected interpretation, 4 clinicians rated 69 cases in which they were blinded to the patients' histories and 70 cases in which the patients' histories were available. The other 3 clinicians then rated the same cases with the presence or absence of history reversed. SETTING: All clinicians involved perform child sexual abuse examinations at tertiary care centers. PATIENTS: A total of 139 girls with Tanner stage 1 or 2 genitalia who were referred to a general pediatric clinic at an academic medical center for examination of possible sexual abuse. RESULTS: Half of the photographs were interpreted as indicating little or no evidence of abuse. Of those photographic sets that both readers could interpret, 39% were in perfect agreement and 77% disagreed by 1 category or less. Perfect agreement across all possible pairs of readers was 34.5%. Agreement was better when the patient's clinical history was unknown (29.3% vs 38.9%, P = .005). The kappa, a measure of interrater reliability, indicated poor agreement among clinicians. The combined kappa for the first group of clinicians was 0.22 without knowledge of clinical history and 0.11 with knowledge of clinical history. For the second group of clinicians, the kappa was 0.31 without knowledge of clinical history and 0.15 with knowledge of clinical history. The overall kappa across all 7 clinicians disregarding clinical history was 0.20. Agreement was best for categories 1 (normal, kappa = 0.28) and 5 (clear evidence of a penetrating injury, kappa = 0.39). CONCLUSIONS: Clinicians educated and experienced in assessing child sexual abuse do not agree perfectly on the interpretation of photographs of genital findings in girls with Tanner stage 1 or 2 genitalia. Clinicians agree less when a patient's clinical history is available. Efforts should be directed at standardizing physical findings and avoiding overemphasis on physical findings in child sexual abuse cases.

Development of a vaccine tracking system to improve the rate of age-appropriate primary immunization in children of lower socioeconomic status.

We conducted a randomized, controlled trial to determine the effectiveness of an immunization tracking system designed to increase the number of infants of lower socioeconomic status who receive their primary series of vaccinations at age-appropriate times. By 7 months of age, 91% (274/301) of the infants in the intervention group were up-to-date on their primary series of vaccinations versus 72% (214/296) of the infants in the control group (p < 0.0001). The estimated cost of follow-up for each infant in the intervention group was $18.05.

Infant positioning and SIDS. Acceptance of the nonprone position among clinic mothers.

In April 1992, the American Academy of Pediatrics recommended that healthy infants not be placed prone to sleep because of the association between the prone sleeping position and sudden infant death syndrome (SIDS). We determined the awareness and acceptance of this recommendation among 190 mothers attending a community health center pediatric clinic in the first year after the recommendation. Ninety-seven women (51.1%) had heard the recommendation. The compliance with the recommendation among women who had heard it was 63.9% (62 of 97). Fifty-three percent of all the mothers worried that their infant would choke in the supine position. More education is necessary in this population to improve acceptance of this new recommendation and to correct misinformation about the supine position.

Self-injurious behavior in acquired sensory neuropathy.

Self-abusive behavior, noted frequently in congenital sensory neuropathy, was observed in two children with acquired peripheral nerve dysfunction. In one case a laceration over the median nerve was followed by self-induced trauma to the fingers distal to the cut, while the other patient developed self-mutilation in all the extremities following insecticide poisoning and presented with signs of diffuse peripheral neuropathy. Improvement of the self-injurious behavior in each case seemed temporally related to the use of anticonvulsant medications, a treatment that is often suggested for older patients with paresthesias related to peripheral neuropathy. The apparent improvement in these two patients suggests that a trial of these drugs in additional patients with self-abusive behavior associated with peripheral neuropathy would be justified.

Health problems during the first year of life in infants born to adolescent mothers.

The role of maternal age at birth was investigated to determine its impact on an infant's health status during the first year of life. A sample population of 112 healthy term infants born to young primiparous mothers (less than or equal to 17 years) was compared using a chart audit with a population of 92 infants born to older primiparous mothers (greater than or equal to 18 years). There was no significant difference between the two groups in the number of missed clinic appointments, number of emergency room visits, number of hospitalizations, number of infants fully immunized, or incidence of child abuse. Poor weight gain and fewer outpatient visits for medical problems were more frequent in the infants of the younger population. Education programs designed for pregnant adolescents should stress the proper use of health professionals and appropriate methods of infant feeding.

Urinary tract infection in infants with unexplained fever: a collaborative study.

Nine centers collaborated to determine the rate of urinary tract infection in infants with unexplained fever, to determine whether the rate is higher in febrile infants than in asymptomatic infants, and whether the yield justifies urine cultures in febrile infants. Urine cultures were done in 501 infants 0 to 2 years of age. The rate of confirmed urinary tract infections in the 193 febrile infants was 4.1%. All infections were in girls, with a rate of 7.4%. The rate of confirmed urinary tract infections in the 312 asymptomatic infants was 0.3%; again, all infections were in girls, with a rate of 0.7%. The rate in febrile girls was significantly higher than the rate in asymptomatic girls (P less than 0.01). The data support the advisability of culturing the urine of infant girls with unexplained fever.

Rubella susceptibility in sixth graders: effectiveness of current immunization practice.

Rubella hemagglutination inhibition antibody titer was determined for 702 sixth grade students from nine randomly chosen schools in a community served well medically. Rubella immunization had been given by private physicians, the health department, hospital clinics, and through a mass immunization effort in 1970. The overall susceptibility rate, as defined by a rubella hemagglutination inhibition titer of less than 1:8, was 15%. Susceptibility did not differ significantly in regard to sex, race, or source of vaccine. Of 469 children with a documented rubella immunization, 13.2% were susceptible or vaccine failures. Menarche was reported by 30% of the girls. To increase the level of protection against rubella during the childbearing years, continued emphasis on early childhood immunization combined with consideration of a booster rubella immunization for preadolescents is recommended.