Adolescents in the age of AIDS: myths, misconceptions, and misunderstandings regarding sexually transmitted diseases.

The purpose of this study is twofold: to evaluate the extent of knowledge possessed by young people residing in an urban sexually transmitted disease (STD) and AIDS epicenter about STDs, including AIDS; and to determine whether knowledge levels varied by age, gender, race/ ethnicity, and/or previous health instruction. A total of 867 adolescents (472 females and 395 males) attending a large public high school in New York City completed a self-administered survey. Levels of knowledge about AIDS transmission and prevention were high (mean percentage correct = 91.8%). Nonetheless, adolescent respondents locked awareness about the prevalence of common STDs, had limited understanding of the ways in which these diseases can be transmitted and prevented, and were unaware of potentially serious sequelae resulting from exposure to infectious agents (e.g., infertility from chlamydial infections). Young people who had taken a health education course in which STDs were discussed did slightly better on the knowledge survey than did their peers. While the prevention of HIV infection is, and should be, a national priority, more concerted efforts are needed to better educate young people about other STDs in the overall context of sexual health.

The adolescent years: an academic-community partnership in Harlem comes of age.

Much has been written about the potential benefits in health promotion that are possible through partnerships between academic institutions and community-based organizations, but little practical advice has been provided on how to sustain these relationships when the original grant funds have been exhausted. Here we document our experiences in Harlem, New York City, a community with grave social, structural, and physical environmental inequities, and describe the successes and failings of a partnership now in its "adolescence" between researchers at the Joseph L. Mailman School of Public Health of Columbia University and community activists at West Harlem Environmental Action (WE ACT).

Love shouldn't hurt: strategies for health care providers to address adolescent dating violence.

Estimates of the prevalence of dating violence among adolescents range from 9% to 60%. Teens in all ethnic groups, socioeconomic strata, and geographic regions report involvement. The spectrum of abuse includes verbal, physical, and sexual violence. Young men and women are involved as both victims and perpetrators. Female teens inflict more minor physical injuries than male teens, but are also likely to receive more significant physical injuries and are more likely to be sexually victimized. Contextual (aggressive personalities, acceptance of dating violence, exposure to familial violence) and situational factors (relationship problems, alcohol and drug use, jealousy) contribute to aggressive behavior. Effective prevention, early detection, and treatment strategies require coordinated school, community, legal, and health care provider interventions.

Involving men in reproductive health: the Young Men's Clinic.

OBJECTIVES: This report describes the population of young men who use the Young Men's Clinic in New York City, presents a profile of their reproductive behaviors, and describes the clinic's model of service delivery. METHODS: Data were gathered through a routine clinic visit form administered by clinic staff. RESULTS: The clinic sees approximately 1200 predominately Dominican young men each year for a wide range of clinical and mental health services. Two thirds of clients had ever been sexually active, three quarters had ever used birth control, and 69% had used birth control at their last sexual encounter. CONCLUSIONS: The Young Men's Clinic may serve as a model for health care delivery to adolescent and young adult males.

Cross-cultural issues in prevention, health promotion, and risk reduction in adolescence.

The important roles that culture, race, and poverty play in contributing to health beliefs and health behaviors are reviewed in this chapter. It also outlines strategies for working with young people, their parents, and their communities in order to deliver "culturally effective" health care services, with an emphasis on prevention, health promotion, and risk reduction.

Inner-city adolescents' awareness of emergency contraception.

OBJECTIVES: To assess the awareness of emergency contraception (EC) among inner-city adolescents attending a general primary health care clinic. METHOD: 197 patients filled out an anonymous 28-item survey on sexual activity, experience with contraceptives, attitude toward pregnancy, experience with pregnancy, awareness of and intent to use EC. RESULTS: 71% of the sample was sexually experienced; 90% had been active within six months of the clinic visit. While 81% of the sexually experienced segment of the sample had ever used contraceptives, 53% reported having had sex at least once during the past six months without using contraception. Fifty-seven percent "worried" following unprotected intercourse about a potential pregnancy; 32% of the sample had been involved in a pregnancy. Only 30% of the sexually experienced had heard of EC, but more than 87% stated they would use it if the need arose in the future. CONCLUSIONS: Urban adolescents are at high risk for unintended pregnancy due to inconsistent contraceptive use and/or method failure. Level of awareness of EC was low in our sample, particularly as compared to adult women in the United States, and to women of all ages (including teenagers) in European countries. Intent to use EC was high, however, indicating a strong desire to avoid unintended pregnancy. Attention should be focused on increasing both adolescent awareness of and access to EC.

Adolescents and violent crime.

Violent crime is a key social and public issue that significantly contributes to the morbidity and mortality of adolescents and places a significant economic burden on society. Overall, juveniles (legally described as adolescents under 18) are responsible for only 19% of all violent crime committed in the United States. However, the peak age incidence for violent offenders is 18, well within the spectrum of the adolescent age grouping. Over the past 10 years, arrests for juvenile crime have increased by 67%, leading some experts to worry that, given the expected increase in the size of the juvenile population by the year 2010, the number of arrests for juvenile crime will double. Fortunately, there has been a decline in the rates of juvenile violent crime over the past 2 years. This article reviews statistical trends, contributing factors and innovative approaches to prevention and intervention.

Prevalence and correlates of AIDS-related behavioral intentions among urban minority high school students.

Using data from a cross-sectional survey of 926 predominantly black and Hispanic ninth through twelfth graders in three New York City public high schools, the explanatory power of theoretically and empirically derived predictors (i.e., demographic, contextual, and cognitive) of intentions to engage in sexual intercourse, to be sexually monogamous, to use condoms during intercourse, and to ascertain intercourse partners' sexual and drug-use histories was compared. One-third of sampled students "definitely" intended to have sexual intercourse in the next year, one-half "definitely" intended to be sexually monogamous, two-thirds "definitely" intended to use condoms during intercourse, and three-quarters "definitely" intended to ascertain intercourse partners' sexual and drug-use histories. In a predictive model including all investigated variables, those variables derived from the cognitive set (i.e., beliefs about susceptibility to getting AIDS, and beliefs about barriers, self-efficacy, norms, and values pertaining to AIDS-preventive actions) were most strongly associated with the four investigated behavioral intentions. However, certain variables derived from the demographic set (i.e., age, gender, race/ethnicity) and contextual set (i.e., previous behavioral involvement, cues, academic failure, substance use) also contributed explained variance to all four intentions.

PIP: Cross-sectional survey data on 926 ninth-twelfth graders in three New York city public high schools were used in a comparison study of the explanatory power of theoretically and empirically derived predictors of intentions to engage in sexual intercourse, to be sexually monogamous, to use condoms during intercourse, and to ascertain intercourse partners' sexual and drug-use histories. Survey participants were of mean age 16.4 years in a range of 13-21, 41.4% male, 58.9% black, and 33.9% Hispanic. One-third definitely intended to have sexual intercourse within the next year, 50% definitely intended to be sexually monogamous, 66% definitely intended to use condoms during intercourse, and 75% definitely intended to get intercourse partners' sexual and drug-use histories. Compared to females, a far greater proportion of males planned to have sex within the next year, and a far smaller proportion intended to be monogamous. Beliefs about susceptibility to getting AIDS, and beliefs about barriers, self-efficacy, norms, and values pertaining to AIDS-preventive actions were most strongly associated with the four investigated behavioral intentions. Age, gender, ethnicity, previous behavioral involvement, cues, academic failure, and substance use also contributed to the explained variance in the four intentions.

Prevalence and correlates of AIDS-risk behaviors among urban minority high school students.

BACKGROUND: To guide the development of an AIDS prevention program for urban minority high school students, the authors investigated the prevalence of AIDS-risk behaviors, and the relative explanatory power of demographic, contextual, and cognitive correlates of these behaviors, among black and Hispanic students in three New York City public high schools. METHODS: A survey was administered to a randomly selected sample of classrooms in the 9th through 12th grades of three public academic high schools in a New York City borough. Survey participants (n = 926) were 59% black and 34% Hispanic; the mean age was 16.4 (sd 1.4) years. RESULTS: Two-thirds of students reported having had sexual intercourse. Of the more than one-half of students who reported past-year intercourse, three-quarters had never or had inconsistently used condoms, one-third had multiple intercourse partners, one-tenth had a sexually transmitted disease, and one-twentieth had intercourse with a high-risk partner. Demographic (i.e., age, race/ethnicity) and contextual (i.e., academic failure, substance use, adverse life circumstances, cues to prevention) factors were most strongly associated with involvement in AIDS-risk behaviors; in contrast, cognitive factors (i.e., knowledge and beliefs about AIDS and AIDS-preventive actions) had little explanatory power. CONCLUSIONS: Addressing demographic and contextual risk factors for involvement in AIDS-related behaviors may prove to be a more powerful AIDS-prevention strategy among adolescents than simply teaching facts about AIDS and fostering prevention-related beliefs.

Comparison of three theoretical models of substance use among urban minority high school students.

OBJECTIVE: This study compares the relative explanatory power of three theoretical models of substance use among urban minority high school students. METHOD: A substance use survey was administered in the spring of 1991 to a randomly selected sample of classrooms in the ninth through twelfth grades of three public academic high schools in a New York City borough. Survey participants (N = 919) were 59% black and 34% Hispanic; the mean age was 16.4 years. RESULTS: Substantial proportions of this sample of students reported experimental or occasional alcohol and cigarette use in the past year, and approximately one-tenth reported frequent use of these substances. Only small proportions of students reported past-year marijuana use, and few or no students reported past-year use of cocaine, crack or intravenous heroin. The socialization model of substance use was much more powerful than either the stress/strain or disaffiliation models in explaining past-year use of alcohol, cigarettes, and marijuana. However, certain variables derived from the stress/strain and disaffiliation models were important risk factors for the frequent use of these substances. CONCLUSIONS: These findings suggest that the further elucidation of the social influence process among adolescents, and the development, implementation, and evaluation of especially intensive programs aimed at high-risk youths, should become adolescent substance use prevention research priorities.

A report card to the nation on adolescents and sexually transmitted diseases.

During this 10-min presentation, at least 50 adolescents across the United States will acquire one or more sexually transmitted diseases. Some of these diseases can fortunately be treated and cured; however, other diseases will remain with these young people for the rest of their lives, causing dramatic physical and psychological repercussions. During the brief time allotted to me, I will discuss some of the pertinent statistics related to sexually transmitted diseases among adolescents, review the Health Objectives for the Year 2000, and suggest means for realizing these objectives.

Factors associated with AIDS-related behavioral intentions among high school students in an AIDS epicenter.

Using data from a cross-sectional survey of 531 predominantly black and Hispanic 10th graders in two New York City schools, the explanatory power of predictors of intentions to engage in sexual intercourse, to have multiple intercourse partners, and to use condoms was compared. Theoretically derived predictor variables (i.e., susceptibility, severity, benefits, barriers, self-efficacy, values, norms) were derived from the health belief model, social cognitive theory, and a model of social influence. One half of sampled students definitely intended to have sexual intercourse in the next year, one tenth definitely intended to have multiple partners, and two thirds definitely intended to use condoms. In multivariate analyses, variables derived from the model of social influence and from social cognitive theory were most strongly associated with the three investigated behavioral intentions; however, certain background and health belief variables also contributed to the explained variance in intercourse and multiple partner intentions.

Factors associated with AIDS risk behaviors among high school students in an AIDS epicenter.

BACKGROUND: A greater understanding of the determinants of risky behaviors is an essential precursor to the development of successful AIDS prevention programs for adolescents. METHODS: A survey measuring AIDS-related behaviors, beliefs, and knowledge was administered to a sample of 531 10th-grade students residing in an AIDS epicenter. RESULTS: Of the 56.8% of students reporting past-year involvement in sexual intercourse, 67.3% reported unprotected intercourse with low-risk partners, 1.3% reported unprotected intercourse with high-risk partners, and 6.6% reported a past-year history of a sexually transmitted disease. Students whose friends had intercourse and never or inconsistently used condoms, who personally sanctioned intercourse involvement, who believed that the majority of their peers had intercourse, and who perceived low preventive action self-efficacy, were 5.1, 3.0, 2.1, 3.7, and 2.8 times more likely, respectively, to score in the riskier categories of an AIDS behavior index. CONCLUSIONS: These findings suggest that addressing socioenvironmental influences on risky and preventive behaviors may prove to be the most effective AIDS prevention strategy among adolescents.

Psychosocial influences on acquired immunodeficiency syndrome-risk behaviors among high school students.

A survey measuring acquired immunodeficiency syndrome (AIDS)-related behaviors and selected psychosocial factors was administered to 1091 tenth grade students residing in or near an AIDS epicenter. The purpose of the survey was to identify salient risk factors that could be targeted in AIDS prevention programs. By 15 years of age, one quarter of students reported engaging in behaviors that placed them at higher risk for acquiring infection with human immunodeficiency virus, and 3% of students reported engaging in very high-risk behaviors. Students exposed to certain psychosocial stressors (ie, adverse life circumstances and poor parental support), who engaged in other problem behaviors (ie, substance use and academic problems) and who had higher self-esteem, were more likely to engage in higher risk behaviors. Pediatricians and other clinicians, particularly those working in or near AIDS epicenters, who encounter adolescents with multiple psychosocial problems, should be alert to the possibility that these youths also are engaging in behaviors that place them at risk for AIDS. Comprehensive care for these teenagers must include an assessment of involvement in AIDS-risk behaviors and appropriate behavioral counseling.

Risk factors for substance use among high school students: implications for prevention.

To identify salient risk factors for drug use that could be targeted for modification in prevention programs, a survey was administered to a sample of 1,091 urban and suburban 10th grade students. Substantial proportions of students reported alcohol alcohol and cigarette use in the past year, and around 10% reported heavy use of these substances. In general, the measured risk factors most strongly associated with the use of alcohol, cigarettes, and marijuana were those derived from the socialization model of substance use; however, certain factors derived from the stress/strain and disaffiliation models also were related to increased drug use risk.

Persistent vaginal discharge in a sexually active adolescent female.

With the high prevalence of unprotected sexual activity among adolescents, health-care providers are frequently called upon to evaluate patients with abnormal vaginal discharges. Usually, thorough pelvic and laboratory examinations will identify offending organisms which can be promptly eradicated with the judicious use of antibiotics. Occasionally, however, an abnormal discharge may persist despite these interventions. Health-care providers need to be aware of the fact that anal intercourse may be a common practice among sexually active teenagers. Penile-vaginal contact after anal intercourse may cause vaginal discharge due to contamination. Health-care providers should make it a routine part of their history-taking of adolescent patients to inquire about anal intercourse. Not only might it reveal useful clinical information, but it may indicate the need for additional health education and counseling.

Acquired immunodeficiency syndrome and adolescents: knowledge, attitudes, beliefs, and behaviors in a New York City adolescent minority population.

In this survey, the knowledge, attitudes, beliefs, and behaviors concerning acquired immunodeficiency syndrome (AIDS) in a group (N = 196) of innercity adolescents in New York City were assessed. Sexual activity was the major risk factor for AIDS in this population; 58% of the adolescents had engaged in sexual intercourse; 12% of these had never used contraception. There were small reported rates of homosexuality, anal intercourse, and prostitution. Of respondents, 22% reported alcohol use and 22% had tried recreational drugs. None had ever taken drugs intravenously. Knowledge of human immunodeficiency virus (HIV) transmission was generally good, although there were prominent misconceptions. For example, 52% of the adolescents believed that donating blood could transmit HIV. Of respondents, 47% "never" or "rarely" worried about the disease. Of the total group, 39% reported behavior changes because of concern about AIDS in the previous 6 months. Those who changed behaviors tended to have a greater perceived risk, worry more frequently about the disease, and have a better knowledge of means of HIV transmission. Of those reporting behavior changes, 66% (25% of the total study group) claimed to be using condoms currently, and 16% (6% of the total study group) claimed to be abstemious. More black adolescents than Hispanic adolescents instituted behavior changes. Of black female adolescents, 71% were sexually active, as compared with 30% of Hispanic female adolescents.(ABSTRACT TRUNCATED AT 250 WORDS)

Chronic abdominal pain and homesickness in an adolescent male.

Recurrent abdominal pain is a frequent presenting complaint for adolescents under stress. For many, this symptom provides legitimate access to a medical provider, where other, "hidden" psychosocial agendas may be safely explored. However, providers should be cautious and not neglect the physical examination and diagnostic work-up. In this case report, we describe the discovery of underlying parasitic infections in an adolescent with multiple psychosocial stressors and abdominal pain.