HPV vaccination in female children with special health care needs.

STUDY OBJECTIVE: Potential barriers between parents of children with special health needs (CSHCN) and their health care providers in regards to the patient receiving a full course of the human papillomavirus (HPV) immunization are explored in this study. STUDY DESIGN: Parents of female CSHCN between ages of 9-26 years completed a questionnaire asking about personal receptivity of vaccines and potential barriers to vaccinating their child against HPV. A separate survey was completed by members of the Wisconsin and Illinois chapters of the American Academy of Pediatrics about HPV vaccination practices provided to patients with special health care needs. SETTING: Outpatient urban health clinic and the Children's Hospital of Wisconsin's Adolescent Medicine and Neurology clinics from January 2009-2010. RESULTS: Seventeen parents completed the survey. Forty-seven percent of parents answered that their child's pediatrician had offered the HPV vaccine; 17% reported that their child was vaccinated against HPV. Most parents knew that HPV is a sexually transmitted infection, causes genital warts, and can cause abnormal pap smears. For the provider survey, 77 out of 130 respondents offer HPV vaccine as part of their practice and see CSHCN. Ninety percent have vaccinated CSHCN against HPV. CONCLUSIONS: This study suggests that acceptability of the HPV vaccine is high for health care providers, but acceptability in parents of CSHCN is lower than in the general population. This study raises awareness that health care providers need to be aware of the possibility that parents of CSHCN may not perceive their child as needing or being offered the HPV vaccine.

Communication with our teens: associations between confidential service and parent-teen communication.

PURPOSE: Many recent attempts have been made to eliminate health services minors can receive without parental consent or notification. One argument is that these "confidential" services undermine the parent-teen relationship. The objective of this study was to evaluate whether confidential services impact adolescent's communication with parents about their health. METHODS: This cross-sectional study included 59 adolescents (ages 12-21) seeking health services at an urban teen clinic in Minneapolis, MN. Participants were divided based on reasons for presenting at the clinic; confidential or non-confidential services. The main outcome variables were the following: discussion of clinic visit with parent, discussion of reason for clinic visit with parent, and communication with parent if diagnosed with a potentially serious health condition. RESULTS: The two groups were equally divided; 42.4% came for non-confidential services and 57.6% came for confidential services. Of the 59 participants, 69.5% told their parents they were coming to clinic. However, only 43.1% reported they would not tell their parent if they had a serious health problem; there was an equal split between the confidential services and non-confidential services groups. A statistical difference was not found between the confidential services and non-confidential services groups for any of the outcome variables. CONCLUSIONS: Obtaining confidential services was not a barrier to discussion with parents about clinic visit, reasons for coming to clinic, or telling their parent if they had a serious health care problem. Clinicians should continue to advocate for confidential services while encouraging open communication between adolescents and their parents.

Individual and environmental impacts on sexual health of Caribbean youth.

Individual health risk behaviors among Caribbean youth account for the majority of adolescent morbidity and mortality in that area. This study explores the associations between individual factors, socioenvironmental factors, and sexual health-related behaviors in Caribbean youth. Data from the 1995 Caribbean Youth Health Survey, a nine-country, cross-sectional study completed by 15,695 in-school youth 10-18 years of age were analyzed. One-third of the sample (n = 5,060) reporting sexual activity was analyzed. This study examined age at first sexual intercourse, number of sexual partners, history of pregnancy, and condom use. The predictor variables were rage, depressed mood, expectation of early death, self-reported school performance, parental mental health or substance abuse problems, and family connectedness. Bi- and multivariate analyses were done separately for males and females, controlling for age, to examine associations between individual and socioenvironmental factors and sexual health behaviors. In the multivariate model, there were associations between rage, abuse, family mental health and substance use, anticipation of early death, and many of the outcome variables in males and females. Family connectedness and positive self-reported school status were correlated with greater condom use at last intercourse in males. Family connectedness was correlated with older age at first sexual intercourse. Depressed mood was not correlated with any of the outcome variables. The findings of the study demonstrate an association between individual and socioenvironmental factors and sexual health behaviors in the lives of Caribbean youth. Strong associations between rage and physical/sexual abuse and risky sexual behaviors are of notable concern.

Prevalence and risk factors for hepatitis C virus infection among adolescents in detention.

OBJECTIVE: To assess the prevalence and correlates of hepatitis C virus infection in a sample of detained adolescents. DESIGN/SETTING/PARTICIPANTS: Cross-sectional prevalence study with 10- to 18-year-old adolescents who were consecutively admitted to a juvenile detention center in San Antonio, Tex. MAIN OUTCOME MEASURES: The prevalence of hepatitis C virus infection and associated risk factors. RESULTS: Of the 1002 participants, 75% were Hispanic and the mean age was 15 years. Twenty adolescents had laboratory data consistent with hepatitis C virus infection, giving an overall prevalence of 2.0% (95% confidence interval, 1.2-3.1). All adolescents infected with hepatitis C virus were Hispanic (13 boys and 7 girls). Although a high proportion of the participants reported having had intranasal drug use (55.6%), tattooing (50.5%), or body piercing (25.3%), the only factor significantly associated with hepatitis C virus infection was having a history of injection drug use. Injection drug use was reported by 5.3% of the participants but by 95% (19/20) of those infected with the hepatitis C virus. CONCLUSIONS: This study indicates that injection drug use was linked with the majority of hepatitis C virus infections in this population of detained adolescents, similar to findings in adults. These adolescents reported a high frequency of other behaviors that could potentially pose a risk for contracting bloodborne infections. Effective prevention and awareness programs in a detention setting need to be comprehensive and include screening, hepatitis A and B immunizations, and risk-reduction counseling.