Concordance of human papillomavirus in the cervix and urine among inner city adolescents.

OBJECTIVES: To evaluate concordance for human papillomaviruses (HPVs) between cervix and urine in sexually active adolescents. METHODS: Cervical swabs and urine were collected from 80 adolescents in Baltimore, MD. Specimens were tested for 34 HPVs by PCR and for cancer-associated HPVs by Hybrid Capture (HC II) Probe B. Cervical vs. urine prevalence was evaluated by logistic regression with general estimating equations. Risk factors for prevalence and viral burden were evaluated by Fisher's exact and Kruskal-Wallis tests, respectively. RESULTS: HPV prevalence by PCR, for any HPV, was very high in the cervix (90.0%) and somewhat lower in urine (75.0%) (odds ratio, 1.07; 95% confidence interval 1.07 to 1.34). Only one adolescent was HPV-positive in urine alone. Among HPV-PCR positives at either or both sites, concordance was 82% for presence of any HPV and 40% for specific HPV types. Multiple infections were common at both sites. On an average, HC II viral burden (relative light unit ratio) was 9-fold higher in cervix than in urine (median, 47.3 vs. 4.9; P = 0.005) but correlated poorly between the two sites of the same individual (r = 0.14). Compared with normal adolescents, those with squamous intraepithelial lesions had a much higher prevalence of HPV by HC II in cervix (100% vs. 28.6, P<0.0001) as well as in urine (86.7% vs. 35.4%, P = 0.002) and a significantly higher viral burden in the cervix (median, 141.8 vs. 7.3, P = 0.0045) but not in urine (median, 22.7 vs. 4.38; P = 0.13). CONCLUSION: There was a very high prevalence of HPV in cervix and urine of sexually active adolescents. Testing urine for HPV may be useful in epidemiologic investigations and in monitoring of infected women.

A comparative study of adolescent and adult mothers who intend to breastfeed.

The purpose of this study was to compare reasons for choosing to breastfeed, timing of the infant feeding decision, and intended duration of breastfeeding between adolescent and adult mothers. The study population consisted of primiparous teens and adults who were matched by ethnicity, and interviewed within 48 hours postpartum at the University of California, San Diego Medical Center from August to December, 1989. Of the 48 women in each age group, there were 40 Hispanics, 5 non-Hispanic whites, 2 blacks, and 1 Southeast Asian. Results showed that the teens differed from their adult counterparts in that they cited naturalness or convenience less often as a reason for breastfeeding. The adolescent mothers were also less likely than the adults to make the decision to breastfeed before the pregnancy, than during pregnancy or after birth. There was no difference in intended duration of breastfeeding between these two groups: the majority of women planned to breastfeed for less than 26 weeks. Early introduction of infant feeding education may serve to increase the adolescent's knowledge base from which to make the decision to breastfeed. Even though the adolescents intended to breastfeed for as long as the adults, they may benefit from increased exposure to prenatal care and childbirth classes as well as from a supportive school or work environment in order to achieve success in breastfeeding.

PIP: There has been a downward trend in the initiation and duration of breastfeeding in the US since 1984. This trend is particularly pronounced among adolescent mothers. The authors interviewed primiparous teens and adults matched by ethnicity to compare their reasons for choosing to breastfeed, the timing of the infant feeding decision, and the intended duration of breastfeeding. One group of mothers was of mean age 17.1 years in the range of 14-18 years, while the other group was of mean age 27.9 years in the range of 23-33 years. There were 48 women in each age group; forty Hispanics, five non-Hispanic Whites, two Blacks, and one southeast Asian. The participants were interviewed within 48 hours postpartum at the University of California, San Diego Medical Center during August-December 1989. Adolescent mothers cited naturalness or convenience less often than the older women as reasons for breastfeeding. The younger mothers were also less likely than the adults to make the decision to breastfeed before the pregnancy than during pregnancy or after birth. There was no difference in intended duration of breastfeeding between the two groups, with the majority of women planning to breastfeed for less than 26 weeks. The authors suggest that increased exposure to prenatal care and childbirth classes as well as supportive school and work environments may help younger mothers to successfully breastfeed.

Psychosocial and economic factors associated with infant feeding intentions of adolescent mothers.

The infant feeding intentions of 64 primiparous, adolescent females, ages 14-18 years, were studied to assess factors which differentiated those who chose breastfeeding from those who did not. The study population consisted of 43 Hispanic, 9 black, 7 non-Hispanic white, and 5 Filipino or Southeast Asian subjects interviewed after delivery. Among the Hispanics, 31 primarily spoke Spanish, and 12 primarily spoke English. A total of 72% intended to breastfeed, and 22% planned to exclusively formula feed. Those teens who intended to breastfeed were significantly older, more often married, more likely to be Hispanic and Spanish speaking, and less likely to have been in school during the pregnancy. In addition, teens were more likely to choose breastfeeding if they had been breastfed themselves or exposed to other women who breastfed. These data suggest that the younger, non-Hispanic, single teen who is enrolled in school and lacking exposure to breastfeeding is the most in need of breastfeeding-promotion programs.