Daniel P. Krowchuk

Victimization, use of violence, and drug use at school among male adolescents who engage in same-sex sexual behavior

OBJECTIVEnTo examine the relationship between the number of male sexual partners of adolescent males and the frequency of victimization at school, missed school because of fear, used drugs at school, and engagement of fighting and weapon carrying both in and out of school.nnnSTUDY DESIGNnSexually active male adolescents (N = 3886) in 8th through 12th grades were administered the 1995 Vermont Youth Risk Behavior Survey.nnnRESULTSnA total of 8.7% of male adolescents reported one or more male sexual partners. Alcohol, marijuana, and smokeless tobacco use at school, not attending school because of fear, having been threatened or injured with a weapon at school, and weapon carrying at school accounted for 15.8% of the variation in the number of male sexual partners (p < 0.0001). Suicide attempts, school absence because of fear, cigarette smoking, alcohol use, and smokeless tobacco use at school, frequency of fighting requiring medical treatment, carrying a weapon,aand carrying a weapon at school accounted for 17.2% out of 100% of the variation in the number of male sexual partners (p < or 0.00001).nnnCONCLUSIONnThe number of male sexual partners reported by sexually active male adolescents correlated with a higher frequency of victimization, use of violence and drug use at school. Frequency of suicide attempts and fighting outside of school were also correlated with the number of same-sex sexual partners.

Evaluation of a peaceful conflict resolution and violence prevention curriculum for sixth-grade students

PURPOSEnTo evaluate a Social Cognitive Theory-based violence prevention curriculum among sixth-grade students.nnnMETHODSnThe evaluation was conducted using a quasi-experimental pretest-posttest control group design. Students were pretested 2 weeks before the intervention started and were posttested 2 weeks after it ended. The study was conducted in four middle schools serving children and adolescents living in or around public housing in a southeastern city. The participants included all sixth-grade students who were predominantly African-American (88.7%), 41% lived in public housing, and 80% lived in homes with an employed head of household. The intervention schools had 292 students, and the control schools 412 students. The Peaceful Conflict Resolution and Violence Prevention Curriculum is a 13-module skills-building curriculum based on Social Cognitive Theory. It taught identification of situations that could result in violence; avoidance, confrontation, problem-solving, and communication skills; conflict resolution skills; the conflict cycle; the dynamics of a fight; and how to express anger without fighting.nnnMAIN MEASURESnThe primary outcome variable was a five-item scale assessing the frequency of fighting and weapon carrying behaviors (alpha =.72) and a scale measuring intentions to use violence in 11 hypothetical situations (alpha = .81). Levels of exposure to violence and victimization (alpha = .82) and depression (alpha = .86) were also assessed. The data were analyzed with general linear modeling with repeated measures.nnnRESULTSnAt pretest, the intervention and control groups did not differ in gender, age, depression, exposure to violence, or any other demographic variable. A group x time interaction effect (p = .029) was found in the use of violence scale. From pretest to posttest there was a decrease in the use of violence by students in the intervention group and an increase in the use of violence in the control group. Most of the changes were accounted for by changes in the frequencies of carrying concealed guns and fighting resulting in injuries requiring medical treatment. A group x time interaction effect (p = .002) was also found for the intention to use violence scale. Students in the intervention group did not change their mean scores from pretest to posttest, whereas students in the control group increased in their mean intention to use violence scale scores. Neither interaction effect was influenced by gender, exposure to violence, or level of depression.nnnCONCLUSIONnThe Peaceful Conflict Resolution and Violence Prevention curriculum appears to have positive short-term effects on self-reported use of violence and intentions to use violence by these middle-school students.

How children perceive the medical evaluation for suspected sexual abuse

This study investigated how 99 children who were examined for suspected sexual abuse (SSA) perceived their own medical evaluation experiences. Each child was interviewed about the degree of pain and fear associated with the experience, the kindness of the doctor, general fear of doctor visits, and degree of fear associated with a hypothetical second examination. The majority of children did not perceive their SSA examination to be strongly negative. However children did report greater fear associated with the SSA evaluation compared to an ordinary doctor visit. Using multiple regression, general fear of doctor visits and fear and pain associated with the SSA examination contributed to the prediction of intensity of fear about a hypothetical second SSA evaluation. Perceived kindness of the doctor, patient sex and age, and physician sex and age did not contribute to the regression equation. The relatively low reported rate of intense distress associated with medical evaluation of SSA suggests that fear and pain can be minimized and effectively managed for many children. The results of the regression analysis suggest that previous negative medical experiences may play an important role in determining how a child interprets the experience of an SSA medical evaluation.

Relationship of AIDS-related attitudes to sexual behavior changes in adolescents

The impact of the acquired immunodeficiency syndrome (AIDS) epidemic on a group of adolescents was investigated by surveying 197 sexually active, predominantly African-American, urban high school students. Reported sexual behavior changes were evaluated in relation to AIDS-related knowledge and attitudes. Over 50% of the students decreased their frequency of sexual activity, increased their condom use, and/or decreased their number of partners. These students had significantly higher scores on a measure of worry about vulnerability to human immunodeficiency virus (HIV) infection than those whose behavior had not changed. AIDS knowledge, AIDS beliefs, and AIDS-related anxiety interacted with gender to affect sexual behavior change. Male students reporting decreased frequency of sexual activity, for example, had more accurate beliefs about AIDS than males reporting no decrease. Among female students, however, those reporting decreased frequency had less accurate beliefs than those reporting no decrease. These results highlight the importance of considering gender and specific sexual behaviors when designing AIDS education interventions.

Middle school students' sources of acquiring cigarettes and requests for proof of age

OBJECTIVESnTo identify where and how middle school students acquire cigarettes and to describe factors associated with being asked for identification during their purchase.nnnMETHODSnA modified version of the Centers for Disease Control and Preventions Youth Risk Behavior Survey was administered to 2227 sixth- through eighth-grade students attending 53 randomly selected middle schools in North Carolina in 1995. Data were analyzed with Chi-square tests, Cramer V, Kruskal-Wallis nalysis of variance, and multiple logistic regression using the likelihood ratio approach.nnnRESULTSnOf the students who had smoked during the previous 30 days, 497 (22.8%) were the focus of the analyses. Fifty-eight percent of current smokers were male and 69% were white. The most frequent source of cigarettes was borrowing (32.1%). Only 16.9% of the students had purchased cigarettes from a store, and 3.9% had purchased cigarettes from a vending machine. Females were more likely (p < .006) than males to borrow or to have someone else buy cigarettes for them. Males were more likely (p < .006) than females to buy cigarettes from a store or vending machine or to steal them. Students who purchased cigarettes from a store or vending machine were more likely (p < .032) than other smokers to be 21 year older than expected for their school grade. Among the 197 students who had purchased cigarettes during the previous 30 days, only 14.2% had been asked for proof of age. Students who acquired cigarettes from a store were more likely than students who acquired them by other means not to have been asked for proof of age; while having been asked for proof of age was associated with acquiring cigarettes by other means (V = .44, p < .0001). Having been asked for proof of age was associated with earlier age of onset of smoking (V = .34, p < .0001), greater number of smoking days, and number of cigarettes smoked per day (V = .35, p < .0001). When analyzed with multiple logistic regression, only earlier age of onset of smoking remained a significant correlate of not having been asked for proof of age.nnnCONCLUSIONnIn North Carolina, it was easy for young adolescents to purchase cigarettes illegally, especially for more experienced smokers. However, being asked for proof of age forced these youth to acquire cigarettes using other methods, and this was associated with less smoking. Prevention efforts should include enforcing existing laws requiring youth to provide proof of age when attempting to buy cigarettes.

Medication adherence among acne patients: a review

Backgroundu2002 Acne is a chronic disease often requiring the use of medications for extended periods of time. In general, adherence decreases over time in patients with chronic diseases, and adherence to topical medications is poor compared to adherence to oral medications, placing individuals using topical medications at increased risk for nonadherence and treatment failure. Poor adherence may also be a common cause of treatment failure in teens with acne.

Successful treatment of a therapy‐resistant pyogenic granuloma with topical imiquimod 5% cream

A 58‐year‐old man was referred to our department for evaluation and treatment of a therapy‐resistant pyogenic granuloma on his right third digit. This biopsy‐confirmed lesion was unsuccessfully treated with shave excision and base electrocautery on two separate occasions before the patient presented to our clinic. After completing a 14‐week course of twice‐weekly imiquimod 5% topical application, this patients pyogenic granuloma completely resolved. A satisfactory cosmetic outcome was also achieved, with virtually no scarring.

Physicians' perceptions of an eczema action plan for atopic dermatitis.

Abstract Background: Poor adherence to topical medications in atopic dermatitis may lead to exposure to more costly and potentially toxic systemic agents. Written action plans (WAPs) improve adherence and treatment outcomes in asthma patients and may be useful for children with atopic dermatitis. Objective: To assess physicians perceptions of a WAP for atopic dermatitis and their openness to using it. Methods: An Eczema Action Plan (EAP) was modeled from those used in pediatric asthma. A brief survey to assess the perceived practicality and usefulness of the EAP was sent to 48 pediatricians in our local area and to 17 pediatric dermatologists nationally. Survey items included layout, graphics, readability, accuracy, and utility. Qualitative analyses were performed due to small sample sizes. Results: Seventeen pediatricians from five community practices and eight pediatric dermatologists responded (response rates of 35% and 41%, respectively). Layout was rated as excellent by 59% of pediatricians and 43% of pediatric dermatologists, the graphics were rated good (60% and 70%), the readability as good to excellent (100% and 86%), the accuracy as excellent or good (83% and 86%), and usefulness as good to excellent (100% of both groups). Most (71%) of the pediatric dermatologists reported already having their own patient education materials for atopic dermatitis, but none of the pediatricians did. All pediatricians and 60% of pediatric dermatologists reported they were likely to use the EAP in their clinical practices. Limitations included the sample size being small, but it still provided for qualitative assessment of generalists and sub-specialists. We did not assess how the EAP would be perceived by patients or their families. The practice settings of the community and academic physicians are not identical, which may make for weakened comparisons. Conclusions: Pediatricians are open to using an EAP for atopic dermatitis. If an EAP were effective at improving adherence and outcomes in atopic dermatitis, widespread implementation should be feasible.

Healthcare Utilization for Acute and Chronic Diseases of Young, School-age Children in the Rural and Non-rural Setting

To determine the most frequently diagnosed conditions among rural and non-rural children age 5 to 9 and assess for environmental influences, data from the National Ambulatory Medical Care Survey (1996-2001) were used to examine frequencies of diagnoses in children age 5 to 9. Separately, we examined rural and non-rural outpatient physician visits in weighted multivariate logistic regression models. Overall, the most frequent diagnosis was routine health check, followed by several acute conditions. When analyzed separately, non-rural children were significantly more likely to visit a physician for routine health check (P = 0.002), asthma (P = 0.005), and acute upper respiratory infection (P = 0.037). Rural counterparts were significantly more likely to be seen for attention deficit disorder (P = 0.000), otitis media (P = 0.017), chronic rhinitis (P = 0.017) and influenza (P = 0.037). Children age 5 to 9 are healthy overall. When illness occurs, it is usually acute. Rural and non-rural, young, school-aged children exhibit many similarities in healthcare utilization, but differences occur. Most surprising is the difference in the diagnosis frequency of attention deficit disorder.

Lymphomatoid papulosis : Successful weekly pulse superpotent topical corticosteroid therapy in three pediatric patients

Abstract: Lymphomatoid papulosis is a T‐cell proliferation that occurs primarily in adults but has been well described in children. Lesions may regress spontaneously but often leave residual scarring and, as a result, intervention frequently is considered. Therapeutic modalities commonly employed for adults with lymphomatoid papulosis may be poorly tolerated by pediatric patients. We present a series of three children with lymphomatoid papulosis treated with superpotent topical corticosteroids (halobetasol or clobetasol propionate). When applied twice daily for 2 to 3 weeks followed by weekly pulsed application, this treatment resulted in complete resolution of nearly all cutaneous lesions. Three ulcerated lesions, occurring in two patients, required adjuvant therapy with intrale‐sional triamcinolone. To date one patient remains free of cutaneous disease and two children experience occasional new lesions that respond to renewed treatment with topical clobetasol propionate. None of the children have evidence of systemic disease. We conclude that pulsed application of a superpotent topical corticosteroid is efficacious and safe in the management of cutaneous lesions of lymphomatoid papulosis and avoids the risks often associated with more aggressive interventions. Since these agents do not alter the risk of subsequent malignancy, careful ongoing surveillance of children with lymphomatoid papulosis is imperative.