Donald P. Orr

Behavioral intervention to increase condom use among high-risk female adolescents.

OBJECTIVE To determine whether condom use among high-risk female adolescents could be increased by a behavioral intervention, with the use of infection with Chlamydia trachomatis as a biomarker of condom practices. DESIGN Prospective, randomized, controlled intervention. SETTING Urban family planning and sexually transmitted disease clinics. PARTICIPANTS Two hundred nine female adolescents, aged 15 through 19 years, who were treated for C. trachomatis genitourinary infection, were randomly assigned to standard (control) or experimental (behavioral intervention) groups. One hundred twelve subjects returned for follow-up 5 to 7 months after enrollment and comprise the study subjects. MEASUREMENTS Subjects completed a multiinstrument questionnaire measuring sexual behavior, condom practices, attitudes and beliefs, cognitive complexity, sociodemographics, and motivation at enrollment and follow-up. Endourethral and endocervical sites were sampled for C. trachomatis. RESULTS Among the 112 subjects who returned for repeated examination, those who had received the experimental intervention reported increased use of condoms by their sexual partners for protection against sexually transmitted diseases (odds ratio = 2.4; p = 0.02) and for vaginal intercourse (odds ratio = 3.1; p = 0.005) at the 6-month follow-up. Multivariable logistic regression analysis controlling for condom use at enrollment demonstrated that the experimental intervention (odds ratio = 2.8; p = 0.03) and the higher cognitive complexity (odds ratio = 4.6; p = 0.02) independently contributed to greater condom use at follow-up. Despite greater use of condoms among the group who had received the intervention, use remained inconsistent and rates of reinfection with C. trachomatis were not significantly different (26% vs 17%; p = 0.3). CONCLUSION Although a brief behavioral intervention among high-risk female adolescents can increase condom use by their sexual partners, incident infection does not appear to be reduced, because condom use remained inconsistent.

Psychosocial implications of chronic illness in adolescence

One hundred forty-four young adults and adolescents representative of an upstate New York community were studied on two occasions to identify relationships between chronic illness and psychosocial well-being. In the 8 years since the original survey, the health status of 62 of the 106 with a chronic medical condition improved, remained unchanged in 27, and worsened in 17. Subjects whose chronic medical problem persisted and was associated with at least mild impairment in daily living demonstrated significantly more psychosocial problems, centering around future plans, perceptions of family life, and having a drivers license. Those who had recovered from their illness or did not have any associated impairment appeared no different from the controls. Multidimensional scaling confirmed that chronic illness and poor psychosocial functioning are related, as are physical wellness and better psychosocial function. These results confirm the contention that chronic illness persisting into adolescence has a small but measurable effect on psychosocial adjustment.

STRUCTURE OF PROBLEM BEHAVIORS IN YOUNG ADOLESCENTS

The syndrome of problem behaviors (problem drinking, illicit drug use, delinquent-type behavior and precocious sexual intercourse) has been demonstrated among older adolescents and college students. To determine if this complex of behaviors is present in early adolescence, 709 junior high students were surveyed. 50 % were male; the mean age was 13.5 yrs. 77 % were white. All Hollingshead socioeconomic groups (SES) were represented. The prevalence of health damaging behaviors increased with age (p<.001), e.g. 23 % of 12 yr olds and 71 % of 15 yr olds reported intercourse. Principal axis factor analysis with varimax rotation confirmed the presence of 2 behavioral clusters: (1) problem behaviors (PROB) and (2) psychological symptoms (PSYCH). Both factors were independent of race and SES. PSYCH were more common among girls (p<.001) and PROB were more common among boys (p<.001). Self-esteem and PSYCH (r=-.412;p<.001) but not PROB were significantly correlated. This data confirm that the syndrome of problem behaviors is a stable construct among young adolescents and suggest that lowered self-esteem is not etiologically involved in the origin of health damaging behaviors.

ABUSE AND HEALTH BEHAVIORS IN A STUDENT POPULATION

Behavioral sequellae of child abuse are frequently noted, however, there are few studies of nonclinical children examining the strength of such associations. As part of a health needs assessment, we surveyed 712 junior high students (7th-9th grade, mean age 13.5 years) for self-reports of abusive experiences and health behaviors. The sample was 50% male, 77% white and represented all socioeconomic levels. 18.3% students reported physical (PA) and/or sexual abuse (SA); 14.7% reported PA, 8.1% reported SA and 4.1% reported both. Reports did not differ by age or race, but more females (12.6%) than males (3.9%) reported SA (p=0.0, X2). Both PA and SA were associated with running away, considering hurting oneself, suicide attempts, and the use of drugs, pot, alcohol, cigarettes, and laxatives (all p<.01). Strength of associations (odds ratios) range from 1.8 for the risk of alcohol use to 4.7 for the risk of running away. No clinically significant relationships were found between SA/PA and anger, sadness or self-esteem. This data confirms some previous reports and indicates the need for studies of nonclinical populations.

IS THERE A CULTURE OF CORPORAL PUNISHMENT AMONG ADOLESCENTS

Increased acceptance of violent or abusive disciplinary measures has been argued to support the increased prevelance of reports of child abuse among ethnic minorities. To identify whether previous experience with physical punishment or discipline is related to the acceptance of such measures, high school students of Anglo and Hispanic backgrounds were studied. Preliminary indepth interviews identified disciplinary items. Sentence substitution was used to compare teenage misbehaviors with possible adult responses to those behaviors and independently replicated in two multi-ethnic high schools. 178 students (56% Anglo) participated: 11% felt severely punished, 26% had been punished physically, 14% had been struck in the past six months. No statistically significant differences in the prevelance of reports were noted between Anglo and Hispanic. Adolescents viewed physical punishment as unacceptable. There was a tendency for physically punished students to report physical punishment as more appropriate. Response patterns were analyzed for individual deviations from the majority using the Quadratic Assignment Program. Anglos and Hispanics did not have different beliefs about the appropriateness of discipline (p<.05). Responses of those not originally reporting physical punishment were different from those who had (p<.05). The physically punished youth did not agree with each other (p<.05). These findings contradict the notion that there is a coherent subculture of corporal punishment. The relationship to abuse is unclear.