If We Make It, Will They Take It? Attitudes Toward the Acceptability of Chlamydia Point-of-Care Testing Among Adolescents and Young Adults.

BACKGROUND: Adolescent women, 15 to 19 years of age, have the highest rate of Chlamydia trachomatis infection in the United States. The objective of this study was to ascertain knowledge and experience of C. trachomatis and acceptance of C. trachomatis point-of-care testing (POCT) if made available over-the-counter (OTC). Currently, there are no tests for C. trachomatis available OTC for purchase. METHODS: Patients attending adolescent clinics at University Hospital of Brooklyn and Kings County Hospital received an anonymous 12-item questionnaire. Both clinics serve predominantly African and Caribbean American urban populations. Questions included demographics, sexual orientation, chlamydia knowledge, testing history, prior infection, partner notification, and acceptance of OTC POCT for C. trachomatis. RESULTS: Surveys from 151 patients (116 women, 35 men) aged 12 to 21 years (mean age, 17.6 years) were analyzed. Only 34 of the 151 (22.5%) respondents understood C. trachomatis transmission; 31 (20.5%) knew its complications. Sixty-seven (44.4%) would purchase an OTC test but 101 (66.8%) would pay no more than $20. All 151 patients reported that they would follow-up with doctor if positive; 143 (94.7%) would notify partners, although 5 of the 31 (16.1%) women with prior infection did not notify partners. CONCLUSIONS: Nearly half (44%) of adolescents in our population would be interested in using a potential OTC test for C. trachomatis. Cost was a major disincentive. Knowledge of infection remains cursory. However, those with a history of C. trachomatis infection and familiar with its complications were more interested in purchasing a home test. Although 100% of the respondents reported that they would follow-up with their physician if they tested positive, past behavior suggests that partner notification might be suboptimal.

Attitudes and Perceptions of the Human Papillomavirus Vaccine in Caribbean and African American Adolescent boys and Their Parents.

STUDY OBJECTIVE: Human papillomavirus (HPV) is the most common sexually transmitted infection in the world. The prevalence of HPV in men ranges from 20% to 65% and is high at all ages. HPV vaccine has high efficacy in preventing HPV infection, cervical cancer, and genital warts. The study objectives were to describe attitudes and perceptions toward acceptability of HPV vaccination among inner-city Caribbean and African American adolescent boys and their parents and to identify and discuss correlates that may be associated with these factors. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional survey, administered in a general adolescent medicine clinic. Participants were recruited from a convenience sample of adolescent boys aged 13 to 19 years currently under care at an adolescent medicine clinic. RESULTS: Responses of 101 adolescent boys and 35 parents were analyzed. Consistent condom use was associated with less interest in HPV vaccination; those reporting consistent condom use had an 88% decreased odds of being interested in HPV vaccination compared with those reporting inconsistent condom uses. Interest in receiving the HPV vaccine was significantly associated with having increased numbers of sexual partners. CONCLUSION: Overall, most adolescent males (65%) were interested in receiving the HPV vaccine and a majority believed their parents would allow the vaccination (77.2%). Parental knowledge that the majority of cervical and rectal cancers are caused by HPV increased the odds of parents believing their sons need HPV vaccination; however, it is not statistically significant.

Hyperandrogenism Does Not Influence Metabolic Parameters in Adolescent Girls with PCOS.

Background. Underlying insulin resistance and/or obesity has clearly been implicated in the development of metabolic syndrome in adolescents and young adults with polycystic ovarian syndrome (PCOS). It is not clear however what role hyperandrogenism has on the development of metabolic syndrome or its role on those metabolic parameters associated with metabolic syndrome. Methods. We studied 107 adolescent girls; 54 had PCOS according to NIH criteria. Data was obtained for systolic and diastolic blood pressure (SBP and DBP), body mass index (BMI), total testosterone (T), luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin, fasting lipid profile, and glucose. The PCOS group was divided initially into subgroups according to BMI (kg/m(2)), then based on T (ng/dL) levels as follows: High Testosterone PCOS (HT), Intermediate Testosterone PCOS (IT), Obese and Normal Testosterone (ONT), and lean and normal T (Control, C). t-test analysis was performed in between all the groups. Results. There was no statistical difference between HT and IT, HT and ONT, or IT and ONT in SBP, DBP, fasting blood glucose, lipid panel, LH, FSH, and prolactin levels. The control group had lower SBP and BMI comparing with ONT, IT, and HT groups. There were no statistical differences found in DBP, fasting blood glucose, lipid panel, LH, FSH, or Prolactin. Conclusion. Metabolic profile in adolescent girls with PCOS is not affected by either the presence of hyperandrogenism or the degree of hyperandrogenism.

Attitudes and perceptions of the HPV vaccine in Caribbean and African-American adolescent girls and their parents.

OBJECTIVE: To describe attitudes and perceptions toward acceptability of human papilloma virus (HPV) vaccination among inner city Caribbean (CA) and African American (AA) adolescents and their parents, and discuss correlates that may be associated with these factors. DESIGN: Questionnaire survey. SETTING: An adolescent medicine clinic. PARTICIPANTS: A convenience sample was recruited of 175 adolescent girls aged 13 to 19 years and 74 parents attending adolescent clinic. INTERVENTION: Participants completed an anonymous confidential 10-minute questionnaire. MAIN OUTCOME MEASURES: Data on knowledge about HPV, cervical cancer (CC), attitudes and acceptance of the HPV vaccine. RESULTS: Responses of 175 adolescent girls and 74 parents were analyzed. Overall, 48.9% of the teens were sexually active (SA) and had a 2.2-fold greater odds (OR = 2.21; 95% CI = 1.13-4.36) of being interested in HPV vaccination versus girls who were not SA. While only 55.8% of girls knew what HPV is, this knowledge was significantly associated with knowing that most CC is caused by HPV (P < 0.001) and with interest in receiving HPV vaccination (P < 0.001). Less than half (44.5%) of adolescent girls were interested in receiving the HPV vaccine and only 37.5% of parents. There were no significant influences in parental acceptance of the vaccine with regard to age, ethnicity and educational level, insurance, and living situation.The majority of parents wanted the vaccine for its role in preventing CC. CONCLUSIONS: Although controversy surrounds HPV vaccine in regard to its supposed role in promoting SA, only a minority of our parents showed concern for that association. The level of acceptance of the HPV vaccine was overall lower than what has been reported among other racial/ethnic populations. Knowledge about HPV and its association with CC were significantly associated with interest in getting the HPV vaccine and both parents and teens seem to accept the HPV vaccine more for its role in CC prevention.

Absence of Chlamydia pneumoniae and signs of atherosclerotic cardiovascular disease in adolescents with systemic lupus erythematosus.

Patients with systemic lupus erythematosus (SLE) have accelerated atherogenesis. A recent study suggested that Chlamydia pneumoniae infection might also be a contributing factor in the development of atherogenesis in patients with SLE. The objective of this study was to investigate the possible association of C. pneumoniae infection with markers of atherosclerosis in adolescents with SLE compared with age-matched healthy controls. History and exam focused on cardiovascular risk factors were obtained from 20 patients with SLE and 20 age- and sex-matched controls. Laboratory studies included serum lipid profile and high-sensitivity C-reactive protein (hsCRP). Detection of C. pneumoniae in peripheral blood mononuclear cells (PBMCs) and in nasopharyngeal swab specimens was performed. Carotid Intima-Media Thickness (CIMT) was determined by sonography in all subjects. C. pneumoniae DNA was not detected in PBMCs of any of the patients or controls. Nasopharyngeal cultures were also negative for C. pneumoniae in all patients. CIMT was slightly higher in the SLE group (0.48 +/- 0.049) compared with controls (0.454 +/- 0.041, p = 0.29). There was no significant difference between the two groups in body mass index, blood pressure, hsCRP, and serum cholesterol (total, LDL and HDL). Serum triglycerides were higher in the lupus group (p = 0.03). Children and adolescents with SLE might have accelerated atherosclerosis; however, we did not observe an association with C. pneumoniae infection in this population.

Risk factors for nonfatal suicide behaviors among inner-city adolescents.

INTRODUCTION: To determine whether a delineation of suicide attempt severity via toxic ingestion distinguishes adolescents in terms of needs for medical and psychosocial support. METHODS: Cross-sectional study performed between 1995 through 1997 in which 92 adolescents, mean age 15.6 years, presented to an urban pediatric emergency department for a nonfatal suicide attempt by ingestion. As defined by the authors, these adolescents were divided into 2 groups. The higher risk or more severe attempt group (n = 54) was defined as those that either ingested a toxic amount of a drug or had a toxic blood level or were admitted to the intensive care unit secondary to abnormal vital signs. The lower risk or less severe attempt group (n = 38) included those that did not meet these criteria. A 50-item confidential questionnaire was administered in the emergency room, which included information on demographic, clinical/laboratory, psychosocial characteristics and review of all psychiatric consultation(s). RESULTS: In accord with our definition, the higher risk or more severe attempt group was more likely than the lower risk or less severe attempt group to have elevated heart rates at intake (96.4 +/- 18.4 vs. 87.0 +/- 18.0, P = 0.023), and to have ingested a drug less than 3 hours prior to the arrival to the emergency room (59% vs. 29%, P < 0.037). These individuals were more likely to have been diagnosed by the consulting psychiatrist as having an adjustment disorder (77% vs. 50%, P < 0.013), and to have fewer than 2 prior suicide attempts (100% vs. 84%, P < 0.019). There were no differences between the 2 groups with regard to family history of suicide behaviors, drug/alcohol use, type of drug ingested (analgesics being the most common), sexual activity, rape, school grade, and pregnancy. CONCLUSIONS: The higher risk or more severe suicide attempt group of these urban adolescents were associated with psychologic adjustment disorder, but was not associated with other known risk factors for suicidal behaviors.

Contraception use, family planning, and unprotected sex: few differences among HIV-infected and uninfected postpartum women in four US states.

To describe pregnancy intentions and contraceptive use among a postpartum sample of women with and at risk for HIV infection, 258 HIV-seropositive and 228 HIV-seronegative women were recruited from prenatal clinics in 4 US states between June 1996-November 1998. Participants completed interviews at 24-40 weeks' gestation and at 6 months postpartum. At the 6-month interview, 78% of women reported vaginal sex, and 2% were pregnant. Among those not pregnant, 86% said that there was no likelihood of a pregnancy in the next 6 months. Condom use was reported by 68% of sexually active women; 65% of users reported consistent use. Those with HIV were more likely to report condom use, more likely to report condom use consistency, and less likely to report use of oral contraceptives than women without HIV (P < 0.05). In multivariate analysis, inconsistent condom use was associated with postpartum alcohol use (odds ratio [OR] 2.80; 95% CI = 1.34-5.84), with the respondent stating that a pregnancy would not be emotionally upsetting (OR 3.06; 95% CI = 1.41-6.59) and reporting an intention to terminate a pregnancy if one were to occur (OR 3.47; 95% CI = 1.58-7.60). HIV-seropositive women who had at least 1 child with HIV infection were less likely than seronegative women to report inconsistent condom use (OR 0.15; 95% CI = 0.03-0.76). Few differences were detected in reproductive behaviors as a function of HIV serostatus, although both cohorts engaged in unprotected sex. Counseling to decrease sexual risk behaviors should begin prior to or early in the postpartum period and include discussion of both reproductive and disease transmission issues.