Journal of Adolescent Health

Published by Elsevier BV

Print ISSN: 1054-139X


What to do about negative results
  • Article

May 1997


22 Reads


African-American adolescents' stress responses after the 9/11/01 terrorist attacks
  • Article
  • Full-text available

April 2005


86 Reads

To examine the impact of indirect exposure to the 9/11/01 attacks upon physical and emotional stress-related responses in a community sample of African-American (AA) adolescents. Three months after the 9/11/01 terrorist attacks, 406 AA adolescents (mean age [SD] of 16.1 +/- 1.3 years) from an inner-city high school in Augusta, GA were evaluated with a 12-item 5-point Likert scale measuring loss of psychosocial resources (PRS) such as control, hope, optimism, and perceived support, a 17-item 5-point Likert scale measuring post-traumatic stress symptomatology (PCL), and measures of state and trait anger, anger expression, and hostility. Given the observational nature of the study, statistical differences and correlations were evaluated for effect size before statistical testing (5% minimum variance explained). Bootstrapping was used for testing mean differences and differences between correlations. PCL scores indicated that approximately 10% of the sample was experiencing probable clinically significant levels of post-traumatic distress (PCL score > 50). The PCL and PRS were moderately correlated with a r = .59. Gender differences for the PCL and PRS were small, accounting for 1% of the total variance. Higher PCL scores were associated with higher state anger (r = .47), as well as measures of anger-out (r = .32) and trait anger (r = .34). Higher PRS scores were associated only with higher state anger (r = .27). Scores on the two 9/11/01-related scales were not statistically associated (i.e., less than 5% of the variance explained) with traits of anger control, anger-in, or hostility. The majority of students were not overly stressed by indirect exposure to the events of 9/11/01, perhaps owing to the temporal, social, and/or geographical distance from the event. Those who reported greater negative impact appeared to also be experiencing higher levels of current anger and exhibited a characterologic style of higher overt anger expression.

Prognostic Value of Early Therapeutic Alliance in Weight Recovery: A Prospective Cohort of 108 Adolescents With Anorexia Nervosa

August 2012


76 Reads






Purpose: To determine whether patients' perception of early therapeutic alliance (TA) could predict time to achieve a target weight among adolescents undergoing treatment for anorexia nervosa. Method: TA was assessed in a prospective cohort recruited from both inpatient and outpatient settings by self-administered and validated questionnaires. Kaplan-Meier survival curves were compared by log rank test, and Cox regression was used to test whether patients' perception of early TA predicted time to achieve a target weight. Results: In total, 108 patients were included, and 79.6% achieved a target weight. Better patient perception of early TA increased the hazard ratio (HR) of achieving a target weight (HR = 2.7, 95% confidence interval: 1.7-4.4, p < .001) such as being in the inpatient setting by 6.7. Being very severely underweight at admission decreased the HR of achieving the target weight. Conclusion: Patients' perception of early TA is a good predictor of achieving a target weight. Because TA is a modifiable construct, it could be a target for intervention.

Prevalence and correlates of illicit methylphenidate use among 8th, 10th, and 12th grade students in the United States, 2001

January 2005


47 Reads

The prevalence and correlates of illicit methylphenidate use were examined within a nationally representative U.S. sample of 8th, 10th, and 12th graders. The annual prevalence of illicit methylphenidate use was 4%. Race, grade level, geographical region, grade point average, and substance use were all significantly associated with illicit methylphenidate use.

Do negative life experiences predict the health-care-seeking of adolescents? A study of 10th-year students in Oslo, Norway

September 2005


60 Reads

To analyze associations among the negative life experiences and health-care-seeking of adolescents during the 12 months before the study. Cross-sectional questionnaire study among 10th-year students at all secondary schools in Oslo. In 2000 and in 2001, 7329 (88%) of Oslo's 8316 secondary-school students responded to the questionnaire. Some contacts with primary health care during the previous year were reported by 71% of respondents, and 6% had seen a mental health practitioner (psychologist or psychiatrist). Health care utilization was not correlated with the family's financial situation as reported by the student (boys = 1019; girls = 1258), or with a parent's unemployment (boys = 253; girls = 325). The 2112 boys (59% of all) and 2378 girls (64%) who reported feeling strong pressure from others to succeed, had more contacts with all primary health care services. Girls, but not boys, who reported being bullied by others reported more psychologist or psychiatrist visits than did their nonbullied peers. Exposure to physical violence was associated with a significant increase in visits to the School Health Service, family physician, and emergency medical service, and was related to more than doubling the probability of visiting a mental health practitioner. Being sexually violated during the previous year increased the likelihood of boys visiting mental health practitioner more than four times (odds ratio [OR] 4.6; 95% confidence interval [CI] 1.7-12.2); and visiting School Health Service by nearly four times, (OR 3.7; 95% CI 1.0-13.5). Variation in adolescent health care seeking can, by and large, be predicted by negative life experiences.

Figure 1. Item probability for each latent class in the four-class model and associations with depressive and somatic symptomatology. SE ¼ standard error.  
Table 1 Sample characteristics of NEXT Generation Health Study (N ¼ 2,524)
Table 3 Model fit statistics for models with one to five latent classes
Table 4 Results of LCA with covariates: sociodemographic differences (n ¼ 2,350)
Prevalence and Patterns of Polysubstance Use in a Nationally Representative Sample of 10th Graders in the United States

February 2013


143 Reads

Purpose: The current study examines the prevalence and demographic correlates of self-reported substance use and identifies subgroups of polysubstance users among a cohort of United States 10th-grade students. Methods: A nationally representative school-based cohort of United States 10th-grade students completed the NEXT Generation Health Study baseline survey in spring 2010 (N = 2,524). Results: Past-year use of marijuana was most common among illicit drugs (26%), followed by misuse of medication (9%) and use of other illicit drugs (8%). During the past month, alcohol use was reported by more than one third (35%), binge drinking by 27%, and cigarette smoking by 19%. Results further show that substance use varied somewhat by demographic characteristics. Results from the latent class analysis of polysubstance use indicated a four-class solution as the best-fitting model; class 1 (59%) included the nonuser group; class 2 (23%) comprised the predominant alcohol user group; class 3 (11%) formed the predominant marijuana user group; and class 4 (8%) was characterized as the predominant polysubstance user group. Somatic and depressive symptoms varied significantly by class membership, with predominant polysubstance users reporting elevated levels of somatic and depressive symptoms. Conclusions: The findings from this national study of 10th-grade students indicate high rates of substance and polysubstance use. The high level of depressive and somatic symptoms among polysubstance users indicates the need for mental health screening and referral.

Adolescent Vaccination: Coverage Achieved by Ages 13-15 Years, and Vaccinations Received as Recommended During Ages 11-12 Years, National Health Interview Survey 1997-2003

January 2009


34 Reads

To present progress toward Healthy People 2010 vaccination objectives for adolescents aged 13-15 years, and to determine how much catch-up and routine vaccination was administered at the recommended ages of 11-12 years. Data from the 1997-2003 National Health Interview Survey were evaluated. In the first analysis, vaccination coverage levels for adolescents aged 13-15 years were determined for each survey year. Main outcome measures include the percent of adolescents who had received the three-dose hepatitis B vaccine (Hep B) series, the two-dose measles/mumps/rubella vaccine (MMR) series, the tetanus and diphtheria toxoids (Td) booster, and one dose of varicella vaccine. In the second analysis, data from all survey years were combined and vaccination dates were analyzed to determine the percentage of adolescents who were missing any vaccines at ages 11-12 and received them at that age. Data for varicella vaccine were sufficient only for the first analysis. Among the approximately 15%-20% of respondents who reported vaccination history from records in the home and who were reporting on a 13-15-year-old, coverage with three doses of Hep B increased significantly during 1997-2001, from 15.2% to 55.0%. Coverage with MMR and Td fluctuated, with no significant increase; highs were 76.7% for MMR in 2003 and 36.2% for Td in 2002. Examination of vaccination dates for all surveyed adolescents showed that among 11-12-year-olds who needed catch-up vaccine, 0.6%-31.3% were brought up to date for Hep B and 22.1%-31.8% were brought up to date for MMR. For Td, 2.6%-15.4% of 11-12-year-olds who had not previously received Td received the vaccine. Vaccination coverage among adolescents aged 13-15 years was below the Healthy People 2010 goals of 90%, but generally increased over the survey years. However, the suboptimal delivery of needed vaccines during ages 11 and 12 is concerning in light of recent vaccine recommendations targeted at this age. Continuing to focus on strategies to make adolescent preventive care, including vaccination, a new norm is essential.

Masculine Boys, Feminine Girls, and Cancer Risk Behaviors: An 11-Year Longitudinal Study

April 2014


41 Reads

Cancer risk behaviors often begin in adolescence and persist through adulthood. Tobacco use, indoor tanning, and physical inactivity are highly prevalent, socially patterned cancer risk behaviors, and their prevalence differs strongly by sex. It is therefore possible that these behaviors also differ by gender expression within the sexes due to social patterning. We examined whether five cancer risk behaviors differed by childhood gender expression within the sexes and whether patterns of media engagement (e.g., magazine readership and trying to look like media personalities) explained possible differences, in a U.S. population-based cohort (N = 9,435). The most feminine girls had higher prevalence of indoor tanning (prevalence risk ratio [pRR] = 1.32, 95% confidence interval [CI] = 1.23-1.42) and physical inactivity (pRR = 1.16, 95% CI = 1.01-1.34) and lower prevalence of worse smoking trajectory (prevalence odds ratio = .75, 95% CI = .65-.88) and smoking cigars (pRR = .61, 95% CI = .47-.79) compared with least feminine girls. Media engagement accounted for part of the higher prevalence of indoor tanning. The most masculine boys were more likely to chew tobacco (pRR = 1.78, 95% CI = 1.14-2.79) and smoke cigars (pRR = 1.55, 95% CI = 1.17-2.06) but less likely to follow a worse smoking trajectory (prevalence odds ratio = .69, 95% CI = .55-.87) and be physically inactive (pRR = .54, 95% CI = .43-.69) compared with least masculine boys. We found some strong differences in patterns of cancer risk behaviors by gender expression within the sexes. Prevention efforts that challenge the "masculinity" of smoking cigarettes and cigars and chewing tobacco and the "femininity" of indoor tanning to reduce their appeal to adolescents should be explored.

Self-reported organic and nonorganic sleep problems in schoolchildren aged 11 to 15 years in Vienna

November 2002


67 Reads

To estimate the prevalence of self-reported sleep problems, to examine associations among demographic characteristics, familial factors, and sleep problems, and to investigate the association between the symptoms of obstructive sleep apnea (OSA) and nonorganic sleep disorders. An anonymous questionnaire with 22 questions was designed. 332 schoolchildren (aged 11-15 years, mean age 12 years and 9 months; median, 12 years; 56% female, 44% male) from two high schools in Vienna were investigated with regard to self-reported symptoms characteristic for obstructive sleep apnea and for parasomnia/insomnia. Data were analyzed by definition of three groups (problem, occasional problem, and nonproblem sleepers, and by calculation of an insomnia/parasomnia sum score). Statistical analysis included nonparametric tests (Mann Whitney-U and Kruskal), Pearson correlation test, and multiple regression analysis. Twelve percent reported at least one sleep problem every night, 76% reported occasional sleep problems, and 12% had no sleep problems. Girls were affected more frequently than boys (p <.01). Children with sleep problems suffered more often from concentration difficulties (p <.05), daytime fatigue (p <.001), and daytime naps (p <.05). Children who snored had nightmares (10% vs. 2%, p <.01), night terrors (4% vs. 1.5%, p <.001), sleepwalking (1.4% vs. 1%, p <.05), and nocturnal awakening (16% vs. 5%, p <.01) more frequently. On multiple regression analysis, 23% of the variability of a defined parasomnia/insomnia sum score had the characteristic OSA symptoms of nocturnal sweating, dryness of the mouth, snoring, hyperactivity, and daytime fatigue. 12% of schoolchildren aged 11-15 years reported sleep problems almost every night. The children suffer from daytime fatigue, naps, and concentration difficulties. Nearly one-fourth of the symptoms of parasomnia/insomnia were associated with characteristic signs of OSA, suggesting the importance of a routine clinical investigation in children with so-called nonorganic sleep disorders.

Longitudinal Impact of Substance Use and Depressive Symptoms on Bone Accrual Among Girls Aged 11–19 Years

November 2012


34 Reads

Purpose: Osteoporosis is primarily evident in postmenopausal women, but its roots are traceable to periods of growth, including during adolescence. Depression, anxiety, and smoking are associated with lower bone mineral density (BMD) in adults. These associations have not been studied longitudinally across adolescence, when more than 50% of bone accrual occurs. Methods: To determine the impact of depressive and anxiety symptoms, smoking, and alcohol use on bone accrual in girls 11-19 years, 262 healthy girls were enrolled in age cohorts of 11, 13, 15, and 17 years. Using a cross-sequential design, girls were seen for three annual visits. Outcome measures included total body bone mineral content and BMD of the total hip and lumbar spine using dual energy x-ray absorptiometry. Depressive and anxiety symptoms and smoking and alcohol use were by self-report. Results: Higher-frequency smoking was associated with a lower rate of lumbar spine and total hip BMD accrual from ages 13-19. Higher depressive symptoms were associated with lower lumbar spine BMD across 11-19 years of age. There was no effect of depressive symptoms on total body bone mineral content, and there was no effect of alcohol intake on any bone outcome. Conclusion: Adolescent smokers are at higher risk for less than optimal bone accrual. Even in the absence of diagnosable depression, depressive symptoms may influence adolescent bone accrual. These findings have import for prevention of later osteoporosis and fractures.

Dieting behavior among 11–15-year-old girls in Merseyside and the Northwest of England

July 1999


36 Reads

To examine the general dieting behavior and characteristics of adolescent girls in the United Kingdom, and in particular, the Northwest of England. A total of 569 girls, ages 11-15 years, from six schools in the Merseyside and Lancashire area, representing a cross-section of social status, completed a nonstandardized questionnaire concerning general dieting behavior. Data were analyzed using SPSS (p < .05 was considered significant). The incidence of dieting was 35.3%. The earliest reported age of starting to diet was 8 years. Significantly more girls from the independent schools (45.2%) had started to diet by the age of 10 years, compared to girls from the comprehensive schools (24%) (p = .03). Of those who had dieted, 30.3% had dieted up to two times during the previous 12 months, 17.4% had dieted up to four times, and 6% had dieted for most of the time. Most girls (33%) dieted for 2-4 weeks at a time, and 66% thought that dieting was good for their health. Only 52% said their parents did not approve of them dieting. Most girls (42.1%) dieted because they felt they were too fat. This study has shown that many young girls are engaging in potentially harmful dieting practices from a very early age, and are of the opinion that dieting is a healthy activity. This would suggest that many misconceptions are held with regard to nutritional advice and education, and that such information should be reviewed and changed accordingly.

Clinical Trial Experience With Prophylactic Human Papillomavirus 6/11/16/18 Vaccine in Young Black Women

August 2012


83 Reads

Purpose: Human papillomavirus (HPV) is the causative agent of cervical cancer. Black women are disproportionally diagnosed and have higher mortality from cervical cancer in the United States. Here we describe the prophylactic efficacy and safety of a quadrivalent HPV-6/11/16/18 vaccine in black women. Methods: A total of 700 black women from Latin America, Europe, and North America (aged 16-24 years) received the vaccine or placebo in one of two studies. Analyses focused on the efficacy and safety of the vaccine. Results: Baseline rates of Chlamydia trachomatis infection and history of past pregnancy were more than twice as high in black women compared with the non-black women who were enrolled in these trials. HPV-6/11/16 or 18 DNA was detected in 18% of black women versus 14.6% in non-black women at day 1. For black women, vaccine efficacy against disease caused by HPV-6/11/16/18 was 100% for cervical intraepithelial neoplasia (0 vs. 15 cases; 95% confidence interval, 64.5%-100%) and 100% for vulvar and vaginal intraepithelial neoplasia and condylomata acuminata (0 vs. 17 cases; 95% confidence interval, 69.3%-100%). There were no serious vaccine-related adverse experiences. A similar proportion of pregnancies resulted in live births (75.8% vaccine; 72.7% placebo) and fetal loss (24.2% vaccine; 27.3% placebo). Conclusions: Prophylactic quadrivalent HPV-6/11/16/18 vaccination of young black women demonstrated high efficacy, safety, and tolerability. HPV vaccination has the potential to reduce cervical cancer-related health disparities both in the United States and around the world.

Sexual intercourse, contraception, and risk-taking behavior among unselected French adolescents aged 11–20 years

December 1992


60 Reads

An epidemiological study was carried out among 4,255 adolescents, aged 11-19 years, randomly selected from secondary schools in a northern urban area of France. The questionnaire concerned sexual activity, contraception, health status, licit and illicit drug consumption, and other risk-taking behavior. A total of 31% of the adolescents had had sexual relations (43% of the boys, 20% of the girls). Sexual activity increased with age. A large majority (70%) of the sexually active adolescents used some form of contraception. The study confirms the relationship between smoking, drinking, illicit drug consumption, and sexual activity, but shows that contraceptive behavior is not related to problem behavior.

Preventing the spread of AIDS in youth: Principles of practice from 11 diverse projects

December 1997


19 Reads

The purpose of this study was to identify the factors that contributed to intervention effectiveness in acquired immunodeficiency syndrome (AIDS) prevention projects targeting youth. Eleven AIDS prevention projects funded by the Robert Wood Johnson Foundation whose target populations consisted of at least 60% youth were studied. A blended methodology resulted in quantitative data (i.e., survey responses) from all 11 projects supplemented with qualitative data (i.e., open-ended interviews) drawn from in-depth site visits to six projects. Projects reported using a mean of 16.6 intervention activities (selected from a list of 30). Six activities were used by all 11 projects. Small group discussions were rated as one of three most effective activities by 72.7% of the projects that used them. Project staff identified three elements of effective interventions: involvement of peer educators, recognition of the role of adults (e.g., parents, teachers), and use of structured settings to gain access to the target population (e.g., schools, clubs). The most powerful strategies described by project staff for reaching adolescents at risk for human immunodeficiency virus (HIV) transmission also bring considerable challenges. Opportunity costs associated with using peer educators, gatekeeper support, and structured settings may include limited control of the message, impaired credibility, and failure to reach those youth at greatest risk of HIV infection, respectively. Health educators will do well to consider the advantages and disadvantages of these factors when developing, implementing, and evaluating AIDS prevention programs for youth.

The Mental Health Impact of 9/11 on Inner-City High School Students 20 Miles North of Ground Zero

August 2006


233 Reads

To determine the rate of post-traumatic stress disorder (PTSD) after 9/11 in a sample of New York City high school students and associations among personal exposure, loss of psychosocial resources, prior mental health treatment, and PTSD. A total of 1214 students (grades 9 through 12) attending a large community high school in Bronx County, 20 miles north of "Ground Zero," completed a 45-item questionnaire during gym class on one day eight months after 9/11. Students were primarily Hispanic (62%) and African American (29%) and lived in the surrounding neighborhood. The questionnaire included the PCL-T, a 17-item PTSD checklist supplied by the Office of Behavioral and Social Science Research of the National Institutes of Health (NIH). The PCL-T was scored following the DSM-IV criteria for PTSD requiring endorsement of at least one repeating symptom, two hyperarousal symptoms, and three avoidance symptoms. Bivariate analysis comparing PTSD with personal exposure, loss of psychosocial resources, and mental health variables was done and multiple logistic regression was used to identify significant associations. There were 7.4 % of students with the PTSD symptom cluster. Bivariate analysis showed a trend for females to have higher rates of PTSD (males [6%] vs. females [9%], p = .06] with no overall ethnic differences. Five of the six personal exposure variables, and both of the loss of psychosocial resources and mental health variables were significantly associated with PTSD symptom cluster. Multiple logistic regression analysis found one personal exposure variable (having financial difficulties after 9/11, odds ratio [OR] = 5.27; 95% confidence interval [CI] 2.9-9.7); both the loss of psychosocial resources variables (currently feeling less safe, OR = 3.58; 95% CI 1.9-6.8) and currently feeling less protected by the government, (OR = 4.04; 95% CI 2.1-7.7); and one mental health variable (use of psychotropic medication before 9/11, OR = 3.95; 95% CI 1.2-13.0) were significantly associated with PTSD symptom cluster. We found a rate of PTSD in Bronx students after 9/11 that was much higher than other large studies of PTSD in adolescents done before 9/11. Adolescents living in inner cities with high poverty and violence rates may be at high risk for PTSD after a terrorist attack. Students who still felt vulnerable and less safe eight months later and those with prior mental health treatment were four times more likely to have PTSD than those without such characteristics, highlighting the influence of personality and mental health on development of PTSD after a traumatic event.

Pediatricians' Intention to Recommend Human Papillomavirus (HPV) Vaccines to 11- to 12-Year-Old Girls Postlicensing

November 2008


28 Reads

We surveyed 105 pediatric clinicians following Human papillomavirus (HPV) vaccine licensure to identify factors associated with intention to recommend the vaccine to 11- to 12-year-old girls. Pediatricians who were early adopters of medical technologies had fewer concerns about HPV vaccine safety/efficacy, and who anticipated parental vaccine safety/efficacy concerns reported higher intention to recommend the vaccine.

The Efficacy and Safety of the Quadrivalent Human Papillomavirus 6/11/16/18 Vaccine Gardasil

November 2011


48 Reads

Human papillomavirus (HPV) infection causes cervical cancer, a significant portion of anal, genital, and oropharyngeal cancers, genital warts, and recurrent respiratory papillomatosis. In June 2006, a quadrivalent HPV-6/11/16/18 vaccine (Gardasil/Silgard) was licensed in the United States, and subsequently in the European Union (September 2006). It has since been approved in 121 countries, with >74 million doses distributed globally as of March 2011. As the incidence of HPV infection peaks 5-10 years after the onset of sexual activity, preadolescents and adolescents represent an appropriate target group to implement HPV vaccination programs so as to achieve the maximal public health benefit. In this article, we provide an overview of the prophylactic efficacy of the vaccine in young women who were found to be negative to at least one of the four vaccine HPV types, thus approximating sexually naive adolescents. Because adolescents are also at high risk for other infections which are preventable by currently available vaccines, the development of concurrent immunization strategies may lead to better compliance, thereby contributing to the overall goal of protection against preventable diseases. We also summarize concomitant administration studies with meningococcal, diphtheria, tetanus, and pertussis vaccines, which were conducted in adolescents aged 9-15 years. Prophylactic efficacy in other populations (males aged 16-26 years) is also summarized along with long-term safety and efficacy studies.

Problems in conceptualizing adolescent risk behaviors:International comparisons. Journal of Adolescent Health, 21, 116-127

September 1997


19 Reads

Adolescence is a period considered to be characterized by a high frequency of risk behaviors. Recently several articles and books have reviewed the state of knowledge about these behaviors and the possibility of their prevention. Within clinical and public health circles the conclusion that risk is a characteristic of adolescence is based primarily on statistical data. Mortality and morbidity linked to certain risk behaviors seem particularly high at that age. For example accidents are the principal factor and the primary cause of death in children and adolescents with a peak in mortality for the 15-24-year-old group. (excerpt)

“Reducing the Odds” at what cost: will routine testing of pregnant adolescents decrease perinatal transmission of HIV?11For the Principal Investigators of the Adolescent Medicine HIV/AIDS Research Network

December 2000


14 Reads

In 1998 a report was released by the Institute of Medicine noting that substantive progress had been made in limiting HIV perinatal transmission. Based on this positive outcome the Public Health Service (PHS) guidelines were created which attempt to identify HIV-infected women through routine prenatal HIV testing after appropriate counseling. However soon after its implementation it became clear that the biggest impediment to further reducing the risk of perinatal transmission was the continued difficulty in fully implementing the PHS guidelines for universal testing of all pregnant women. Reasons for this included financial and access barriers time constraints language and cultural barriers and financial and logistical problems. To this effect it is stated that the most direct way to ensure that all pregnant women would be tested for HIV antibodies during their pregnancies would be to make it part of the standard battery of prenatal tests that women would receive. The key elements of this recommendation are that it would be universal and HIV antibody testing would be routine with notification (at which time a patient could refuse the test). In addition it is also urged that providers need to acknowledge and embrace universal programs of education and prevention for adolescents which will increase the likelihood that they will enjoy their adolescent and adult years without the threat of HIV infection and AIDS.

Social cognitive correlates of sexual experience and condom use among 13- through 15-year-old adolescents

October 2001


389 Reads

To examine the role of self-efficacy, outcome expectancies, and perception of peer attitudes in the delay of onset of sexual activity among 13- through 15-year-old adolescents. We also explored the role of self-efficacy, outcome expectancies, and perception of friends' condom use behavior in explaining the use of condoms among sexually active adolescents. This study was part of a larger cross-sectional study to evaluate personal characteristics and maternal factors associated with early initiation of sexual intercourse. Mothers and adolescents were recruited from a community-based organization that offered afterschool and summer programs for youth. Enrollment was limited to adolescents aged 13-15 years and their mothers. Mothers and adolescents completed separate interviews. For adolescents, the interviews included the assessment of the variables in the present study. Each interview lasted about 60 min and was conducted by a trained interviewer. Data were analyzed using descriptive statistics and regression analysis. The average age of the 405 adolescent participants was 13.86 years, and approximately 30% of them had engaged in sexual intercourse. Slightly more than half (56%) of participants were male, and 82% were African-American. Participants who were less likely to believe that their friends favored intercourse for adolescents and who held more favorable attitudes about the personal benefits of abstaining from sex were less likely to have initiated sexual intercourse. Among sexually active adolescents, those who expressed confidence in putting on a condom, and in being able to refuse sex with a sexual partner, and who expressed more favorable outcome expectancies associated with using a condom were more likely to use condoms consistently. Human immunodeficiency virus and pregnancy prevention programs should emphasize peer influences in both the initiation of sexual intercourse and the use of safer sex practices among sexually active adolescents, as well as personal attitudes about consequences to self and confidence in negotiating safer sex practices with one's partner.

Influences on Adolescents’ Decision to Postpone Onset of Sexual Intercourse: A Survival Analysis of Virginity Among Youths Aged 13 to 18 Years

February 2000


1,213 Reads

Previous research has focused on risk factors associated with early onset of sexual intercourse among adolescents. This study hypothesizes that protective factors identified for other health compromising behaviors are also protective against early onset of sexual intercourse. The study sample included 26,023 students in grades 7-12 (87.5% white, 52.5% male) who did not report a history of sexual abuse in a statewide survey of adolescent health in 1988. Bivariate analyses were stratified into early (13-14 years), middle (15-16 years) and late (17-18 years) adolescence and by gender. Cox proportional hazards survival analysis, stratified by gender, was used to determine risk and protective factors associated with delayed onset of sexual intercourse. Variables showing a significant bivariate association with lower levels of sexual activity across all age groups and genders were: dual-parent families, higher socioeconomic status (SES), better school performance, greater religiosity, absence of suicidal thoughts, feeling adults or parents cared, and high parental expectations. High levels of body pride were associated with higher levels of sexual activity for all age and gender groups. In the multivariate survival analyses, variables significantly associated with delayed onset of sexual activity for both males and females included: dual-parent families, higher SES, residing in rural areas, higher school performance, concerns about the community, and higher religiosity. High parental expectations were a significant protective factor for males but not for females. While many protective factors are not subject to intervention, the present analyses indicate that teen pregnancy prevention may be enhanced by addressing family and educational factors.

Smoking, Alcohol Use, and Physical Activity: A 13-Year Longitudinal Study Ranging from Adolescence into Adulthood

October 2004


113 Reads

To assess the associations among smoking, alcohol use, and physical activity, and to assess how the health behaviors predict changes in other health behaviors from adolescence to adulthood. Subjects were the participants of the North Karelia Youth Project study from six schools in Eastern Finland. At the baseline in 1978 they were 13-year-olds (n = 903) and in the last of the six surveys in 1993 they were 28-year-olds. This study uses the data from three surveys in which the participants were 15-, 21-, and 28-year olds. The response rate was 71% in the last survey. Data were analysed by SPSS software. Smoking prevalence was highest at the age of 21 years and alcohol use at the age of 28 years. The prevalence of leisure-time physical activity did not change much over time. Smoking and alcohol use correlated positively for each survey. Smoking correlated negatively with leisure-time physical activity. The best predictors for each health behavior were the same behaviors measured before, but smoking had the strongest level of continuity. In addition, alcohol use at the age of 15 years predicted smoking at the ages of 21 years and 28 years, but smoking in adolescence did not predict alcohol use in adulthood. Smoking was associated with both alcohol use and physical activity and therefore has a central role among health behaviors. Smoking and alcohol use were particularly clearly related from adolescence to adulthood. Smoking behavior was the most constant behavior.

Asynchronous bilateral adnexal torsion in a 13-year-old adolescent: Our experience of a rare case with review of the literature

October 2005


20 Reads

Adnexal torsion is a serious condition and delay in surgical intervention may result in loss of the tube and/or ovary. Children and adolescents who have suffered from uterine adnexal torsion may be at risk for asynchronous torsion of the contralateral uterine adnexa. We report the case of sequential bilateral torsion of uterine adnexa in a 13-year-old girl, resulting in right and subsequently left salpingo-oophorectomy because of gross evidence of total necrosis in both uterine adnexa. After the castration the patient was started on hormone replacement therapy. Families of children who suffered from ovarian torsion and unilateral ovarian loss should be educated about the risk of the contralateral ovary for future torsion and should be encouraged to seek immediate medical help with the recurrence of abdominal pain.

The Impact of State Policies on Vaccine Coverage by Age 13 in an Insured Population

June 2007


21 Reads

To determine the impact of state policies on vaccine coverage among adolescents with managed care insurance. We used the 2003 Health Plan Employer Data and Information Set to determine state-specific hepatitis B and varicella vaccine coverage among children with managed care insurance who turned 13 years in 2002. Our outcomes of interest were receipt of hepatitis B and varicella vaccines by age 13. Utilizing weighted least-squares methods, multiple linear regression models were developed to evaluate the relationship between hepatitis B and varicella vaccine coverage and state policies, while controlling for state sociodemographic variables. Across 28 states, adolescent hepatitis B vaccine coverage ranged from 35.3% to 80.5% (mean = 55.3%) and varicella vaccine coverage ranged from 22.9% to 7.6% (mean = 42.3%). In separate multiple regression models, after adjusting for potentially confounding sociodemographic variables, middle school mandates were significantly associated with hepatitis B vaccine coverage (p = .002) and varicella vaccine coverage (p = .024). Other policies, including universal purchase of vaccines and availability of philosophic exemptions, were not associated with vaccine coverage in this insured population. In this population of insured adolescents, middle school vaccine mandates were the only state policy associated with improved hepatitis B and varicella vaccine coverage. Mandates are an effective method for promoting adolescent immunization.

Anorexia in a 14-Year-Old Girl: Why Won't She Eat?

January 2007


78 Reads

This is a clinical presentation of a 14-year-old female who had weight loss and vomiting following spinal fusion surgery. Her case was complicated by social and behavioral issues. After an initial diagnosis of atypical eating disorder, an upper gastrointestinal study revealed superior mesenteric artery syndrome. Her course continued to be complicated until consistent follow-up with a nutritionist was established.

Risk factors for violence and violence-related injuries among 14- to 18-year-old Finns

June 2006


21 Reads

A random sample of 14- to 18-year-old Finns (3319 boys, 3890 girls) were sent a questionnaire on the occurrence of violence and violence-related injury. Altogether, 76% responded. Weekly stress symptoms, depressive mood, smoking, drunkenness, peer drug use, previous unintentional injury, and not living with both parents predicted both incidents.

Unrealistic Fatalism in U.S. Youth Ages 14 to 22: Prevalence and Characteristics

March 2008


125 Reads

To estimate the proportion of U.S. youth that exhibits unrealistic fatalism about its future (not expecting to live past age 30), and to test predictions about risk factors for this expectation. Four waves of a nationally representative telephone survey from 2002 to 2005 with youth ages 14 to 22 (N = 4201) were analyzed using logistic regression to identify correlates and predictors of unrealistic fatalism. Approximately 1 out of every 15 youth interviewed (6.7%, 95% confidence interval [CI] = 5.9%, 7.5%) responded that they agreed they would not live much past the age of 30. Compared to other youth, fatalists were significantly more likely to be older, male, to identify as Hispanic, and have completed the interview in Spanish. As predicted, recent experience of hopelessness was a strong predictor of fatalism. In addition, nonwhite youth who had experienced hopelessness reported increasing rates of fatalism as they aged. Fatalistic youth engaged in greater suicidal planning, had more accepting attitudes toward suicide, were less attached to religion, and were more impulsive than other youth. Approximately 43% of fatalists forecast a likely death by suicide, whereas the rest anticipated death by an outside source. Fatalists were also more likely not to stay in school. Because youth exhibiting fatalism are at risk for not staying in school and suicidal planning, they should be identified at an early age for referral to programs that are effective in treating youth with hopelessness and suicidal tendencies.

Changes in self-esteem in black and white girls between the ages of 9 and 14: The NHLBI growth and health study (NGHS)

July 1998


911 Reads

We examined changes in self-esteem and feelings of competence with physical appearance and social acceptance over approximately 5 years in 1166 white and 1213 black girls, aged 9 and 10 years at baseline. Maturation stage and body mass index (BMI) were assessed annually. Biennially girls completed Harter's Self-Perception Profile for children. Changes were analyzed in the context of race, sexual maturation, BMI, and household income. Longitudinal regression models were used to compare trends with age in global self-worth, physical appearance, and social acceptance. Mean global self-worth showed little change over ages 9-14 years in blacks (p = 0.09) but decreased in whites (p < 0.001). Mean physical appearance scores for both races declined between ages 9 and 14 years (blacks, p < 0.001; whites, p < 0.001). Mean social acceptance scores increased for both races between ages 9 and 14 years (blacks, p < 0.001; whites, p < 0.001). For all three scores, these changes differed between blacks and whites (all three p values, < or = 0.002). Adjustment for maturation stage, BMI, and household income did not alter the significance or direction of racial differences in the changes with age in global self-worth and physical appearance scores. Self-worth, physical appearance, and social acceptance scores decreased with increasing BMI. Decreases in physical appearance and social acceptance scores with increasing BMI were smaller in blacks than in whites (p < 0.05). After adjustment for maturation stage and household income, racial differences in social acceptance scores depended on BMI (p < 0.05) but not on age (p = 0.008). This article reports the first data on self-esteem scores by age for a large population of black girls aged 9 and 14 years and concludes that self-esteem does not follow the same developmental pattern in black as in white girls. A reason for black girls' higher and more stable self-worth and their greater satisfaction with their physical appearance compared to white girls may be racial differences in attitudes toward physical appearance and obesity.

Table 2 . Maternal Reports of Communication About Sex, Relationship Satisfaction, and Values, by Gender of Adolescent (n 2006) a 
Table 3 . Coefficients From Cox Proportional Hazards Models for Predicting Initiation of First Sex for Males and Females, Aged 14 to 15 years a 
Mothers' influence on the timing of first sex among 14- and 15-year-olds

October 2002


1,654 Reads

To better understand maternal influence on the timing of first sex for adolescents. Using data from the National Longitudinal Study of Adolescent Health, Cox proportional hazard models were used to assess the association between maternal characteristics and the timing of first sex. Matched dyads of mothers and their adolescent children were used. Of the 2,006 adolescents aged 14 and 15 years who reported to be virgins, 95 males (10.8%) and 162 females (15.8%) indicated they had initiated sex within the follow-up period, 1 year later. For males, few variables beyond the controls used in the models were predictive of timing of first sexual intercourse. For females, mother's satisfaction with her relationship with her daughter (hazard ratio =.62), mother's strong disapproval of her daughter having sex (hazard ratio =.56), and frequency of communication with the parents of her daughter's friends were associated with later sexual debut (hazard ratio =.88). Based on the variables in the model, mothers' values and beliefs and relationship satisfaction have more influence on daughters than on sons.

A self-administered rating scale for pubertal development. Journal of Adolescent Health, 14, 190-195

June 1993


593 Reads

The purpose of this study was to assess the reliability and validity of a new self-rating scale to measure children's pubertal status without pictorial representations or interviews. The scale is an adaptation of an interview-based puberty-rating scale by Petersen, and included scores for each of five items rating physical development, an overall maturation measure, and a categorical maturation score designed to be similar to Tanner staging categories. Each measure was obtained from independent ratings by students and parents, and a 3-point categorical scale was also obtained from teachers. Subjects included 698 5th- and 6th-grade students (323 boys and 375 girls) from 61 schools and their parents and teachers. Fifth-grade students rated themselves and were rated by parents as less mature than 6th graders; 6th-grade girls were consistently rated more mature than boys of the same age. Significant correlations were found between parents and students for all of the measures for 6th-graders and 5th-grade girls and several measures for 5th-grade boys. This new scale is a useful tool for assessing pubertal status in settings that require noninvasive measures.

Four-Year Follow-up of the Immunogenicity and Safety of the HPV-16/18 AS04-Adjuvanted Vaccine When Administered to Adolescent Girls Aged 10-14 Years

February 2012


55 Reads

Long-term immunogenicity and safety of the human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine when administered to adolescent girls was evaluated. This open-label, follow-up study (NCT00316706) was conducted in 31 centers in Taiwan, Germany, Honduras, Panama, and Colombia. In the initial study (NCT00196924), 1,035 girls aged 10-14 years received the HPV-16/18 AS04-adjuvanted vaccine at 0, 1, and 6 months. Here, geometric mean titers (GMTs) of antibodies against HPV-16, HPV-18, and monophosphoryl lipid A (MPL), a component of the AS04 Adjuvant System, were reported up to month 48. In the according-to-protocol immunogenicity cohort (N = 563), GMTs at month 48 in initially seronegative participants were 2,374.9 (95% confidence interval: 2,205.7-2,557.0) EL.U/mL for anti-HPV-16 and 864.8 (796.9-938.4) EL.U/mL for anti-HPV-18, that is, six- and threefold higher than the plateau level in a reference study demonstrating vaccine efficacy in young women (age, 15-25 years). All participants remained seropositive for anti-HPV-16 and anti-HPV-18 at month 48. Most participants (81.8%) were seropositive for anti-MPL antibodies before vaccination. Anti-MPL antibody titers in initially seropositive participants increased initially, and then declined. Most initially seronegative participants for anti-MPL seroconverted; 69.6% remained seropositive at month 48, with anti-MPL antibody titers similar to the natural background level. The vaccine was generally well tolerated. No serious adverse events were considered related to vaccination. In adolescent girls, the HPV-16/18 AS04-adjuvanted vaccine produces anti-HPV-16 and anti-HPV-18 antibody titers that are maintained for up to 4 years at higher levels than those in young women in whom vaccine efficacy against cervical lesions was demonstrated.

144. Factors Associated With Provision of Long-Acting Reversible Contraception Among Adolescent Health Care Providers

March 2013


64 Reads

To identify provider and practice characteristics associated with long-acting reversible contraception (LARC, either progesterone contraceptive implants or intrauterine devices [IUDs]) provision among adolescent health care providers. We used data from a previously conducted survey of US providers on reproductive health to predict provision of any form of LARC as well as progesterone contraceptive implants or IUDs specifically using Chi-square and multivariate logistic regressions. One third of providers reported any LARC provision. In logistic regressions, residency training in obstetrics/gynecology or family medicine (rather than internal medicine/pediatrics) was the strongest predictor of LARC provision, particularly for IUDs. A minority of providers reported offering IUDs or contraceptive implants, most of whom had received procedural women's health training. Increasing the number of providers offering this type of contraception may help to prevent adolescent pregnancies and may be most easily accomplished via training in contraceptive implant provision.

Safety and Immunogenicity of the HPV-16/18 AS04-Adjuvanted Vaccine: A Randomized, Controlled Trial in Adolescent Girls

May 2010


172 Reads

Immunization of girls against oncogenic human papillomavirus (HPV) types before sexual debut is important for cervical cancer prevention. This phase III blinded, randomized, controlled trial in adolescent girls assessed safety of the HPV-16/18 AS04-adjuvanted vaccine. Girls (mean age 12 years) in 12 countries received the HPV-16/18 L1 virus-like particle AS04-adjuvanted vaccine (N = 1,035) or hepatitis A virus vaccine as control (N = 1,032) at 0, 1, and 6 months. The primary objective was to compare the occurrence of serious adverse events (SAEs) between groups. HPV-16 and HPV-18 antibody titers were assessed by enzyme-linked immunosorbent assay post-vaccination. Up to study month 7, 11 girls in the HPV-16/18 vaccine group reported 14 SAEs and 13 girls in the control group reported 15 SAEs. The difference in SAE incidence between groups was .20% (95% CI, -.78, 1.20). No SAE in the HPV-16/18 vaccine group was considered related to vaccination or led to withdrawal. The incidence of solicited local and general symptoms up to 7 days post-vaccination was moderately higher with the HPV-16/18 vaccine than with control. The incidence of unsolicited symptoms, new onset of chronic diseases, and medically significant conditions was similar between groups. All girls seroconverted for both antigens after three doses of the HPV-16/18 vaccine; geometric mean titers were 19,882.0 and 8,262.0 EU/mL for anti-HPV-16 and -18 antibodies, respectively, in initially seronegative girls. The HPV-16/18 AS04-adjuvanted vaccine was generally well tolerated and immunogenic when administered to young adolescent females, the primary target of organized vaccination programs.

Gender, Mature Appearance, Alcohol Use, and Dating as Correlates of Sexual Partner Accumulation from Ages 16–26 Years

July 2008


100 Reads

To determine growth in sexual partnering from age 16-26 years, and to test whether biological and social factors launched these growth patterns. A prospective design was used. Participants were 176 young people (47% female) followed from birth to age 26 years. Sexual partnering was measured as the accumulated number of different sexual intercourse partners at ages 16, 19, 23, and 26 years. Physical appearance of maturity, alcohol use, and dating were measured at ages 13-16 via observations, interviews, and questionnaires. Mature appearance at age 13 years, use of alcohol more than monthly at age 16, and a history of a steady romantic partner before age 16 were each associated with a greater number of sexual intercourse partners by age 16. However a more mature appearance, more frequent alcohol use, and greater dating involvement did not foreshadow a steeper accumulation of sexual partners between ages 16 and 26. Only gender had such a "growth" influence, with males accruing sexual partners more rapidly from the ages of 16-26 years when compared with females. Adolescents had accumulated a higher number of sexual partners by age 16 years when they looked older, drank alcohol more frequently, and were more involved with dating in early to middle adolescence. Also male gender was associated with accumulation of sexual partners more rapidly between ages 16 and 26 years, and there was little indication that the accumulation of different sexual partners had begun to slow by age 26 for the average participant.

Randomized Trial: Immunogenicity and Safety of Coadministered Human Papillomavirus-16/18 AS04-Adjuvanted Vaccine and Combined Hepatitis A and B Vaccine in Girls

January 2012


27 Reads

This randomized, open, controlled, multicenter study (110886/NCT00578227) evaluated human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine (HPV-16/18 vaccine) coadministered with inactivated hepatitis A and B (HAB) vaccine. Coprimary objectives were to demonstrate noninferiority of hepatitis A, hepatitis B, and HPV-16/18 immune responses at month 7 when vaccines were coadministered, compared with the same vaccines administered alone. Healthy girls (9-15 years) were age-stratified (9, 10-12, and 13-15 years) and randomized to receive HPV (n = 270), HAB (n = 271), or HPV + HAB (n = 272). Vaccines were administered at months 0, 1, and 6. Immunogenicity was evaluated at months 0 and 7. The hepatitis A immune response was noninferior for HPV + HAB, versus HAB, for seroconversion rates (100% in each group) and geometric mean antibody titers (GMTs) (95% CI) (4,504.2 [3,993.0-5,080.8] and 5,288.4 [4,713.3-5,933.7] mIU/mL, respectively). The hepatitis B immune response was noninferior for HPV + HAB, versus HAB, for anti-HBs seroprotection rates (98.3% and 100%); GMTs were 3,136.5 [2,436.0-4,038.4] and 5,646.5 [4,481.3-7,114.6] mIU/mL, respectively. The HPV-16/18 immune response was noninferior for HPV + HAB, versus HPV, for seroconversion rates (99.6% and 100% for both antigens) and GMTs (22,993.5 [20,093.4-26,312.0] and 26,981.9 [23,909.5-30,449.1] EL.U/mL for HPV-16; 8,671.2 [7,651.7-9,826.6] and 11,182.7 [9,924.8-12,600.1] EL.U/mL for HPV-18, respectively). No subject withdrew because of adverse events. No vaccine-related serious adverse events were reported. Immune responses and reactogenicity were similar in girls aged 9 years compared with the entire study population. Results support coadministration of HPV-16/18 vaccine with HAB vaccine in girls aged 9-15 years. The HPV-16/18 vaccine was immunogenic and generally well tolerated in 9-year-old girls.

Left-handedness as an injury risk factor in adolescents. The Journal of Adolescent Health, 16(1), 50-52

February 1995


8 Reads

Left-handedness has been suggested as a risk factor for unintentional trauma. The objective of this study was to determine if left-handedness was associated with an increased frequency and severity of injury among adolescent school athletes. A questionnaire was administered to 634 junior and senior high school athletes during preparticipation examinations. The questionnaire consisted of a four-item handedness determination and history of past injury. Left-handers more frequently reported having seen a physician in the previous year for treatment of an injury than did right-handers. A higher proportion of the left-handers than right-handers reported having been previously hospitalized for injury treatment. A higher proportion of left-handers than right-handers reported having previously had surgery for treatment of an injury. Left-handedness appears to be a risk factor for injury among adolescent school athletes.

Table 1 Percentage a of suicide decedents aged 10 -17 years, by sex and associated circumstances-National Violent Death Reporting System, 16 states, b 2005-2008 Associated circumstances c Male% Female% Total% p value M/F 
a and percentage b of suicide decedents aged 10 -17 years who had received a diagnosis of a current mental health problem, by diagnosis-National Violent Death Reporting System, 16 states c , 2005-2008 
Precipitating Circumstances of Suicide Among Youth Aged 10–17 Years by Sex: Data From the National Violent Death Reporting System, 16 States, 2005–2008

July 2013


173 Reads

We examined the circumstances that precipitated suicide among 1,046 youth aged 10-17 years in 16 U.S. states from 2005 to 2008. The majority of deaths were among male subjects (75.2%), non-Hispanic whites (69.3%), those aged 16-17 years (58.1%), those who died by hanging/strangulation/suffocation (50.2%) and those who died in a house or an apartment (82.5%). Relationship problems, recent crises, mental health problems, and intimate partner and school problems were the most common precipitating factors and many differed by sex. School problems were reported for 25% of decedents, of which 30.3% were a drop in grades and 12.4% were bullying related. Prevention strategies directed toward relationship-building, problem-solving, and increasing access to treatment may be beneficial for this population.

Emergency contraception among teenagers in Switzerland: A cross-sectional survey on the sexuality of 16- to 20-year-olds

August 2002


117 Reads

To describe and analyze emergency contraception (EC) awareness and use among sexually active Swiss teenagers. Anonymous computerized questionnaires were distributed to a national representative sample of 4283 in-school adolescents (aged 16 to 20 years) in high schools and professional centers. Young people who were sexually active (51.5% of the sample: 1058 girls and 1073 boys) responded to questions on EC awareness and use and on sexual perception, attitude, and behaviors. Univariate analyses and multiple regression analyses were used to describe EC awareness and use and their correlates. Most of the sexually active girls (89.3%) and boys (75.2%) knew of the existence of EC. Of girls, 20% reported having used EC, and the majority of them used it only once (64.1%) or twice (18.5%). EC awareness was positively associated with the father's level of education (girls: odd ratio 5.18) and the scholastic curriculum of the respondent. Gender differences in the correlates of EC awareness demonstrate that girls who had a confidant or a group of friends or boys of Swiss nationality and those who have had the opportunity to discuss the issue of contraception declare greater awareness of EC. EC use was higher among girls who lived in urban areas (odds ratio 1.91) and occasionally had unprotected intercourse. We did not find any significant difference in the profile of multiple vs. one-time users. EC awareness and use should be improved through better information and accessibility, especially among teenagers who place themselves in at-risk situations.

Immunogenicity and Safety of Human Papillomavirus-16/18 AS04-Adjuvanted Cervical Cancer Vaccine Coadministered With Combined Diphtheria-Tetanus-Acellular Pertussis-inactivated Poliovirus Vaccine to Girls and Young Women

February 2010


88 Reads

Many countries recommend human papillomavirus (HPV) vaccination in female adolescents at an age when other vaccines are routinely administered. This open, randomized, multicenter study (108464/NCT00426361) evaluated coadministration of HPV-16/18 AS04-adjuvanted vaccine with diphtheria-tetanus-acellular pertussis-inactivated poliovirus vaccine (dTpa-IPV). Healthy females aged 10-18 years were randomized to receive HPV vaccine at months 0, 1, and 6 (n = 248), HPV vaccine coadministered with dTpa-IPV at month 0 and HPV vaccine at months 1 and 6 (n = 255), or dTpa-IPV at month 0 followed by HPV vaccine at months 1, 2, and 7 (n = 248). Immunogenicity was evaluated at months 0, 1, and 7 or 8 (depending on group). Vaccine reactogenicity and safety were also assessed. Coadministered dTpa-IPV and HPV vaccine was noninferior to dTpa-IPV alone in terms of seroprotection against diphtheria (99.2% and 100%), tetanus (100% and 100%) and poliovirus types 1, 2, and 3 (> or = 99.6%), and geometric mean antibody concentrations (ELISA Units/mL) for pertussis toxoid (84 vs. 75), filamentous hemagglutinin (612 and 615) and pertactin (426 and 360) at month 1. Coadministered dTpa-IPV and HPV vaccine was noninferior to HPV vaccine alone in terms of seroconversion rates for HPV-16 (99.5% and 100%) and HPV-18 (99.5% and 100%) and geometric mean antibody titers (ELISA Units/mL) for HPV-16 (15,608 and 18,965) and HPV-18 (6,597 and 6,902) at month 7. Coadministration was generally well tolerated. The reactogenicity of dTpa-IPV and the first dose of HPV vaccine was similar. Results from this study support coadministration of the HPV-16/18 AS04-adjuvanted vaccine with dTpa-IPV vaccine in females aged 10-18 years.

Fortenberry JD. Adolescent substance use and sexually transmitted diseases risk: a review. J Adolesc Health 16: 304-308

May 1995


13 Reads

The behavioral antecedents and correlates of sexually transmitted diseases (STD) among adolescents are issues of clear relevance to the prevention of STD. Substance use particularly of alcohol and other mood-altering drugs--is often identified as an important causal link with risky sexual behavior. This assumption of causal relationships between abuse of substances and high-risk sexual behavior is derived from cultural lore and patterns of increasing involvement in both types of behavior during adolescence. Heavy alcohol use is associated with increased STD rates for some adolescent groups and "sex under the influence" as a risk for adolescent STD appears to be an assumption held by both researchers and policy makers. Many STD prevention programs now target substance use as a preventable antecedent of risky sexual behavior. Some studies however raise questions about a causal role for substance use in STD-risk and point toward more complex relationships of these behaviors. (excerpt)

The Determinants of Sexual Intercourse before Age 16

September 2000


265 Reads

To identify risk and protective factors for initiation of sexual intercourse before age 16 years at the level of the individual, family, and school. A longitudinal study based on a cohort of 1020 people born in Dunedin, New Zealand in 1972/73 and followed up to age 21 years. Demographic characteristics of the sample were similar to the New Zealand population of that age, except that a smaller proportion (3%) were Maori or Pacific Island Polynesian. Information on individual, family and school factors was collected by interview with parents at ages 3, 5, 7 and 9 years and then by postal questionnaire two-yearly up to 15 years. Subjects were assessed two-yearly from age 3 years and interviewed about their behaviours and ambitions at ages 11, 13, and 15 years. Questions about age at first intercourse were asked by computer at age 21 years. Multivariate logistic regression was used to model associations with age of first intercourse less than 16 years. Data on age at first intercourse were available for 926/1020 (91%) of surviving members of the cohort assembled at age 3 years. Overall 27.5% of males and 31.7% of females reported sexual intercourse before age 16 years. In multivariate analyses the independent predictors for early sexual initiation for males were: not having outside home interests at age 13 years, no religious activity at age 11 years, not being attached to school at age 15 years, a low reading score, and a diagnosis of conduct disorder in early adolescence. For females, independent predictors were: socioeconomic status in the middle range, mother having her first child before age 20 years, IQ in the middle range, not being attached to school, being in trouble at school, planning to leave school early, cigarette smoking and higher self-esteem score. Individual and school factors appear to be more important than family composition or socioeconomic status in the decision to have sexual intercourse before age 16 years. The lowering of age at first intercourse may be partly a cohort effect related to high rates of teenage childbearing in the mothers' generation, and to changes in social acceptability of early sexual behaviour.

The SAPHO syndrome in a 16-Year-old boy: Coincidence of acne conglobata and osteoarthritis

April 1993


21 Reads

A 16-year-old boy developed arthritis and osteitis (anterior thoracic wall, ankle of left foot, spinal column) within 5 weeks of an exacerbation of acne. Both the local skin condition and the locomotory system improved after treatment, but sternocostoclavicular hyperostosis persisted. The syndrome of acne, pustulosis, hyperostosis, and osteitis (SAPHO syndrome) identified in 1987, represents an entity usually classified as one of the seronegative spondylarthrites close to ankylosing spondylarthritis and psoriatic arthritis.

Table 2 Association of contraceptive method at first intercourse with pregnancy reported at age 16 follow-up, RIPPLE and SHARE data sets 
Contraceptive Method at First Sexual Intercourse and Subsequent Pregnancy Risk: Findings from a Secondary Analysis of 16-Year-Old Girls from the RIPPLE and SHARE Studies

February 2009


187 Reads

Existing failure rate studies indicate that typical use of oral contraception (OC) results in fewer unplanned pregnancies than condom use, even among teenagers. However, comparative data on pregnancy risk associated with different contraceptive methods are lacking for younger teenagers starting their first sexual relationship. This study examined associations between contraceptive method at first intercourse and subsequent pregnancy in 16-year-old girls. Six thousand three hundred forty-eight female pupils from 51 secondary schools completed a questionnaire at mean age 16 years; 2,501 girls reported sexual intercourse. Logistic regression (N = 1952) was used to model the association of contraceptive method at first intercourse with pregnancy. At first intercourse (median age 15 years) 54% reported using condoms only, 11% dual OC and condoms, 4% OC only, 4% emergency contraception, and 21% no effective method. Method used was associated with a similar method at a most recent intercourse. One in 10 girls reported a pregnancy. When compared to use of condoms only, greater pregnancy risk was found with no effective method (odds ratio [OR] 2.97, 95% confidence interval [CI] 2.12-4.15) or OC only (OR 2.44, 95% CI 1.29-4.60). Pregnancy risk for dual use and emergency contraception did not differ from that for condoms only. Both significant effects were partially attenuated by adjusting for user characteristics and sexual activity. Young teenagers may use OC less efficiently than condoms for pregnancy prevention. The characteristics of those using OC-only confirm vulnerability to unintended pregnancy, and suggest that alternative contraceptive strategies should be considered for these young women.

Immunization of Early Adolescent Females with Human Papillomavirus Type 16 and 18 L1 Virus-Like Particle Vaccine Containing AS04 Adjuvant

July 2007


78 Reads

In female individuals 15-25-years of age, the AS04-containing human papillomavirus (HPV)-16/18 vaccine is highly immunogenic and provides up to 100% protection against HPV-16/18 persistent infection and associated cervical lesions up to 4.5 years. Optimal cervical cancer prevention will require prophylactic vaccination against oncogenic HPV 16 and 18 before the onset of sexual activity in early adolescent girls. To establish the feasibility of vaccination in girls 10-14 years of age, we compared the immunogenicity and safety in early adolescent female individuals to those 15-25 years in whom vaccine efficacy has been demonstrated. We enrolled 773 female participants aged 10-14 years and 15-25 years to receive the HPV-16/18 L1 VLP AS04 vaccine, which was administered at months 0, 1, and 6. Serum samples were collected at months 0 and 7; antibodies to HPV 16 and 18 VLPs were measured by enzyme-linked immunosorbent assay. Vaccine safety was assessed at 7 or 30 days after each dose; serious adverse events were recorded during the entire study period. Both age groups achieved 100% seroconversion for HPV 16 and 18. Participants in the group aged 10-14 years were not only noninferior to those 15-25 years in terms of HPV 16 and 18 seroconversion rates but also had approximately twice as high geometric mean titers. The vaccine was generally safe and well tolerated. These findings suggest that HPV vaccination during early adolescence is generally safe, well tolerated, and highly immunogenic. The observed higher antibody titers in the group 10-14 years of age are likely to result in longer antibody persistence. Overall, these data support the implementation of prophylactic HPV vaccination in this age group.

Table 1 Study measures and survey items with responses, Global Youth Tobacco Survey (GYTS)
Table 2 Prevalence estimates of secondhand smoke (SHS) exposure among never-smoking adolescents worldwide
Secondhand Smoke Exposure Among Never-Smoking Youth in 168 Countries

December 2014


388 Reads

To estimate the prevalence of secondhand smoke (SHS) exposure among never-smoking adolescents and identify key factors associated with such exposure. Data were obtained from nationally representative Global Youth Tobacco Surveys conducted in 168 countries during 1999-2008. SHS exposure was ascertained in relation to the location-exposure inside home, outside home, and both inside and outside home, respectively. Independent variables included parental and/or peer smoking, knowledge about smoke harm, attitudes toward smoking ban, age, sex, and World Health Organization region. Simple and multiple logistic regression analyses were conducted. Of 356,414 never-smoking adolescents included in the study, 30.4%, 44.2%, and 23.2% were exposed to SHS inside home, outside home, and both, respectively. Parental smoking, peer smoking, knowledge about smoke harm, and positive attitudes toward smoke ban were significantly associated with increased odds of SHS exposure. Approximately 14% of adolescents had both smoking parents and peers. Compared with never-smoking adolescents who did not have both smoking parents and peers, those who had both smoking parents and peers had 19 (adjusted odds ratio [aOR], 19.0; 95% confidence interval [CI], 16.86-21.41), eight (aOR, 7.71; 95% CI, 7.05-8.43), and 23 times (aOR, 23.16; 95% CI, 20.74-25.87) higher odds of exposure to SHS inside, outside, and both inside and outcome home, respectively. Approximately one third and two fifths of never-smoking adolescents were exposed to SHS inside or outside home, and smoking parents and/or peers are the key factors. Study findings highlight the need to develop and implement comprehensive smoke-free policies consistent with the World Health Organization Framework Convention on Tobacco Control. Copyright © 2014 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Violence prevention in middle schools: A pilot evaluation. Journal of Adolescent Health, 17, 360-371

January 1996


274 Reads

To evaluate the effect of a violence prevention curriculum and of trained peer leaders on self-reported aggressive behaviors, knowledge about violence and conflict-resolution skills, self-efficacy, and attitudes among 223 6th graders. The effect of two intervention groups (violence prevention curriculum taught by the teacher with or without the assistance of trained peer leaders) and one control group were compared. Ten 6th grade classes (four control and six intervention classes) of four middle schools participated in the study. Students were evaluated before and shortly after the implementation of the curriculum, as well as 3 months later. The intervention reduced self-reported aggressive behaviors among boys, but this reduction was significant only in two of the six intervention classes. Both interventions had an overall significant effect on increasing knowledge about violence and skills to reduce violence. After the intervention, students also developed a more negative attitude toward responding violently when provoked. Attitude change was stronger among students from the teacher plus peer leader group. No intervention effect was observed on self-efficacy nor on attitudes toward skills to reduce violence. Changes were not maintained over time. Results emphasize the need for continuous and comprehensive interventions, follow-up evaluations, and careful selection of peer leaders. Aggressive behaviors, not knowledge alone, should be used as the main dependent variable.

Low Back Pain and Comorbidity Clusters at 17 Years of Age: A Cross-sectional Examination of Health-Related Quality of Life and Specific Low Back Pain Impacts

May 2012


34 Reads

Comorbidities in adults negatively affect the course of low back pain (LBP). Little is known of the presence and/or impact of LBP comorbidities in adolescents. Subjects from the Raine Study cohort at age 17 years (n = 1,391) provided self-report of diagnosed medical conditions/health complaints, health-related quality of life (36-Item Short Form Health Survey [SF-36]), lifetime experience of LBP, and specific LBP impacts (taking medication, missing school/work, interference with normal/physical activities). Latent class analysis was used to estimate clusters of comorbidities based on diagnosed disorders. Profiles of SF-36 and impact were examined between clusters. Four distinct comorbidity clusters were identified: cluster 1: Low probability of diagnosed LBP or any other medical condition (79.7%); cluster 2: High probability of diagnosed LBP and neck/shoulder pain, but a low probability of other diagnosed health conditions (9.6%); cluster 3: Moderate probability of diagnosed LBP and high probability of diagnosed anxiety and depression (6.9%); cluster 4: Moderate probability of diagnosed LBP and high probability of diagnosed behavioral and attention disorders (3.8%). The clusters had different SF-36 and LBP impact profiles, with clusters 3 and 4 having poorer SF-36 scores, and clusters 2 to 4 having greater risk for specific LBP impacts, than cluster 1. Identified comorbidity clusters support adolescent and adult studies reporting associations between LBP, other pain areas, psychological disorders, and disability. Tracking these clusters into adulthood may provide insight into health care utilization in later life, whereas identification of these individuals early in the life span may help optimize intervention opportunities.

Table 1 Demographics of juvenile gang members compared with nongang members
Figure 2. The age-graded prevalence of gang joining and leaving in the United States, ages 6 to 17 years. CI ¼ confidence interval, MAR ¼ missing at random estimate. 
Table 2 National estimate of youth gang membership frequency and prevalence in 2010 a
Gang Membership Between Ages 5 and 17 Years in the United States

February 2015


5,622 Reads

This study determined the frequency, prevalence, and turnover in gang membership between ages 5 and 17 years in the United States. Data were from the National Longitudinal Survey of Youth 1997, which is representative of youth born between 1980 and 1984. Age-specific patterns of gang joining, participation, and leaving are estimated based on youths (N = 7,335) self-reported gang membership at the baseline and eight subsequent interviews, which were combined with population age estimates from the 2010 U.S. Census to produce national estimates of gang membership. Sampling variance-adjusted bounds were estimated based on assumptions about missing cases and survey design effects. Demographic and socioeconomic variables are used to compare differences between gang and nongang youth. Youth gang members were disproportionately male, black, Hispanic, from single-parent households, and families living below the poverty level. We estimated that there were 1,059,000 youth gang members in the United States in 2010 (bounds ranging from 675,000 to 1,535,000). The prevalence of youth gang membership was 2.0% (1.2%-2.8%), peaking at age 14 years at 5.0% (3.9%-6.0%). Annually, 401,000 (204,000-639,000) juveniles join gangs and 378,000 (199,000-599,000) exit gangs, with a turnover rate of 36%. We discovered that significantly more people are involved with gangs than previous estimates would suggest. Clinicians and policy makers must recognize that youth gang members may not conform to popular perceptions of gang demographics. The patterns of youth gang membership observed in this study support prevention programs aimed at children before the teen years. This strategy is more likely to succeed than gang intervention or suppression strategies aimed at teens. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Substance use in female adolescents with eating disorders. Journal of Adolescent Health, 31, 176-82

September 2002


84 Reads

To determine the prevalence of substance use in adolescents with eating disorders, compare the results with a data set of Ontario high school students, and explore why adolescents with eating disorders do, or do not, use various substances. From January 1999 to March 2000, 101 female adolescents who met the DSM-IV criteria for an eating disorder were followed up in a tertiary care pediatric treatment center. They were asked to participate in a cross-sectional study using a self-administered questionnaire assessing substance use and investigating reasons for use and nonuse; 95 agreed to participate and 77 completed the questionnaire (mean age, 15.2 years). The patients were divided into two groups: 63 with restrictive symptoms only, 17 with purging symptoms. The rates of drug use between subjects and their comparison groups were compared by z-scores, with the level of significance set at.05. During the preceding year, restrictors used significantly less tobacco, alcohol, and cannabis than grade- and sex-matched comparison populations, and purgers used these substances at rates similar to those of comparison subjects. Other drugs seen frequently in the purgers included hallucinogens, tranquilizers, stimulants, LSD, PCP, cocaine, and "ecstasy." Both groups used caffeine and laxatives, but few used diet pills. Restrictors said they did not use substances because they were bad for their health, tasted unpleasant, were contrary to their beliefs, and were too expensive. Purgers generally used substances to relax, relieve anger, avoid eating, and "get away" from problems. Female adolescents with eating disorders who have restrictive symptoms use substances less frequently than the general adolescent population but do not abstain from their use. Those with purging symptoms use substances with a similar frequency to that found in the general adolescent population. Because the sample size for the purging group was small, firm conclusions cannot be drawn from our analysis. Health care providers who treat adolescents with eating disorders are in a good position to identify those who use substances and may be at risk for substance abuse.

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