Elizabeth M. Alderman

Problem Behaviors in Inner-City Adolescents with Chronic Illness

This study examines the prevalence of problem behaviors (sexual activity, substance use, delinquency, and school failure) in a clinical hospital-based sample of 217 inner-city, 14 to 17 year olds with a variety of serious, chronic medical illnesses and compares this prevalence to that in a group of 121 similaraged, healthy friends with no known chronic illnesses living in the same community. No differences were found between groups in substance use, delinquency, percent who had ever had sexual intercourse, or mean age at first intercourse. There was a significant interaction effect of chronic illness and gender on age at first intercourse (p = .015); boys without chronic illness initiated sexual intercourse at a younger age than those with an illness. Conversely, girls with a chronic illness initiated sexual intercourse at a younger age than their girlfriends without illness. Contrary to expectations, significantly more of the healthy friends had repeated a grade in school than had those with chronic illness (p = .002). Results are discussed in terms of the interrelationships of chronic illness, gender, and environment on problem behaviors.

The impact of marijuana policies on youth

This policy statement is an update of the American Academy of Pediatrics policy statement “Legalization of Marijuana: Potential Impact on Youth,” published in 2004. Pediatricians have special expertise in the care of children and adolescents and may be called on to advise legislators about the potential impact of changes in the legal status of marijuana on adolescents. Parents also may look to pediatricians for advice as they consider whether to support state-level initiatives that propose to legalize the use of marijuana for medical and nonmedical purposes or to decriminalize the possession of small amounts of marijuana. This policy statement provides the position of the American Academy of Pediatrics on the issue of marijuana legalization. The accompanying technical report reviews what is currently known about the relationships of marijuana use with health and the developing brain and the legal status of marijuana and adolescents’ use of marijuana to better understand how change in legal status might influence the degree of marijuana use by adolescents in the future.

Effect of telephone calls from primary care practices on follow-up visits after pediatric emergency department visits: evidence from the Pediatric Emergency Department Links to Primary Care (PEDLPC) randomized controlled trial.

OBJECTIVE To test whether follow-up phone calls to counsel families about pediatric emergency department (PED) use and primary care availability made after an index PED visit would modify subsequent PED use. DESIGN Longitudinal prospective randomized intervention. SETTING An urban academic childrens hospital. PATIENTS A total of 4246 individuals aged 0 to 21 years from each of 4 participating primary care practices recording an index PED visit from April through December 2005. INTERVENTION Follow-up phone call from the primary care practice within 72 hours of the initial PED visit to counsel about the availability of after-hours advice and when to access the PED. MAIN OUTCOME MEASURES All subsequent visits to primary care practices, PED, pediatric subspecialists, or for inpatient hospitalization during a 365-day follow-up period. Logistic and ordinary least squares regressions estimated unadjusted and adjusted odds ratios of follow-up visits, controlling for covariates. RESULTS Of the 2166 intervention subjects, 816 (37.7%) recorded follow-up PED visits compared with 819 (39.4%) of the 2080 control subjects (P = .26, not significant). The adjusted odds of a follow-up visit being to the PED rather than to another venue was significantly less for intervention than for control subjects (odds ratio, 0.88; confidence interval, 0.82-0.94), indicating decreased intensity of PED use. CONCLUSION Follow-up phone calls from primary care practices after PED visits counseling patients on the use of primary care and emergency services can modulate subsequent care-seeking behavior and decrease future PED use.

Are There Risk Factors for Hepatitis B Infection in Inner-City Adolescents That Justify Prevaccination Screening?

PURPOSE This study was undertaken to determine if homelessness could serve as a marker for previous hepatitis B infection (HBI), and thus justify prevaccination screening. METHODS One hundred sexually active 13-21-year-olds (mean = 17 years), 74% female, attending an inner-city hospital-based adolescent clinic (HOSP), and 48 sexually active 13-21-year-olds (mean = 19 years), 40% female, attending a clinic based at an urban drop-in center (UDC) for street youth were consecutively enrolled, screened for HBI serum markers and administered a structured interview about sexual practices, sexual abuse, prior sexually transmitted diseases (STDs), and injection drug use. RESULTS For the HOSP group, 7% were homeless and 4% were HBI positive. In the UDC group, 96% were homeless and 23% were HBI positive. Homelessness was significantly associated with HBI (p < 0.001), and this was corroborated by logistic regression analysis (p < 0.01). Other factors significantly associated with HBI in adolescents included a history of anal sex (p < or = 0.002), anal-receptive sex (p < or = 0.01), genital Chlamydia (p < or = 0.03), prostitution (p < or = 0.03), and sexual abuse (p < or = 0.002). For both populations, gender, sexual orientation, intravenous drug use, and genital sex were not related to HBI. CONCLUSION These data indicate that homelessness and associated high-risk sexual practices may be indications for prevaccination screening for HBI in adolescents.

The Teen Driver

For many teenagers, obtaining a driver’s license is a rite of passage, conferring the ability to independently travel to school, work, or social events. However, immaturity, inexperience, and risky behavior put newly licensed teen drivers at risk. Motor vehicle crashes are the most common cause of mortality and injury for adolescents and young adults in developed countries. Teen drivers (15–19 years of age) have the highest rate of motor vehicle crashes among all age groups in the United States and contribute disproportionately to traffic fatalities. In addition to the deaths of teen drivers, more than half of 8- to 17-year-old children who die in car crashes are killed as passengers of drivers younger than 20 years of age. This policy statement, in which we update the previous 2006 iteration of this policy statement, is used to reflect new research on the risks faced by teen drivers and offer advice for pediatricians counseling teen drivers and their families.

Cervical Papanicolaou smear abnormalities and Chlamydia trachomatis in sexually active adolescent females

STUDY OBJECTIVE To examine the effect of cervical Chlamydia trachomatis infection on the prevalence of Papanicolaou (Pap) smear abnormalities in adolescent females. DESIGN Retrospective study performed by examination of previously obtained cervical C. trachomatis cultures and Pap smear results. SETTING Urban adolescent health care clinic in the Bronx, New York. PARTICIPANTS Sexually active females, aged 13 to 23 (mean age: 17.9 years), attending the clinic for evaluation of sexually transmitted diseases. INTERVENTION Patients who had undergone a gynecological examination with performance of cervical Pap smears and culture for C. trachomatis were enrolled in the study. MAIN OUTCOME MEASURE Determine the prevalence of cervical C. trachomatis infection and compare cervical smear abnormalities in those with and without infection. RESULTS Of a study population of 257 females, 24 patients (9.3%) were culture positive for C. trachomatis and 58 patients (22.6%) had significant cervical smear abnormalities, i.e., atypical squamous cells of undetermined significance (ASCUS), low grade squamous intraepithelial lesion (LGSIL), or high grade squamous intraepithelial lesion (HGSIL). The 24 patients infected with C. trachomatis showed the following cervical smear abnormalities: within normal limits-37.5%, benign cellular changes-41.7%, ASCUS-12. 5%, and LGSIL-8.3%. A total of 233 patients (90.7%) were culture negative for C. trachomatis and showed the following cervical smear abnormalities: within normal limits-37.3%, benign cellular changes-39.9%, ASCUS-13.3%, LGSIL-8.6%, and HGSIL-.9%. Statistical analysis suggested no significant differences between the two groups (P >.9 by the Kruskal-Wallace test). CONCLUSIONS The isolation of C. trachomatis from the cervix of sexually active adolescent females at a single point in time does not impact on the prevalence of significant cervical smear abnormalities.

The adolescent's right to confidential care when considering abortion

In this statement, the American Academy of Pediatrics reaffirms its position that the rights of adolescents to confidential care when considering abortion should be protected. Adolescents should be encouraged to involve their parents and other trusted adults in decisions regarding pregnancy termination, and most do so voluntarily. The majority of states require that minors have parental consent for an abortion. However, legislation mandating parental involvement does not achieve the intended benefit of promoting family communication, and it increases the risk of harm to the adolescent by delaying access to appropriate medical care. This statement presents a summary of pertinent current information related to the benefits and risks of legislation requiring mandatory parental involvement in an adolescent’s decision to obtain an abortion.

Adolescents' views on barriers to health care: a pilot study.

Objectives: To determine from adolescents using health care their: 1) perceptions of barriers to obtaining health services, 2) views on how to overcome the barriers and 3) views on how to create an adolescent-friendly primary care practice. Design: Six focus group interviews. Methods: Adolescents 11-21 years old from three health centers in the Bronx were recruited. Main Outcome Measures: 1) barriers to accessing health care such as insurance, language barriers, transportation, making an appointment; 2) identifying barriers related to issues of consent and confidentiality; 3) exploring barriers to accessing mental health and related issues; and 4) their visions of an adolescent-friendly office. Results: Thirty-one adolescents, aged 11-21 years old, participated. The majority were Hispanic and 52% were female. Fifty percent of adolescents had a routine visit within the past month. Most adolescents reported experiencing barriers to making an appointment. Additionally, they complained about long waiting times to be seen by providers on the day of their scheduled appointment. Another key barrier was related to knowledge and perceptions about consent and confidentiality. Further, in regard to mental health, many adolescents from focus groups reported that they felt that their primary providers had little interest in this topic and limited knowledge about it. Most of the adolescents reported no barriers with insurance, language or transportation. Their visions of an adolescent-friendly office would include a separate adolescent waiting area equipped with entertainment units. Conclusion: In this study of adolescents who already have primary care providers and are seemingly well-connected to the health care system, there remained significant reported barriers to accessing necessary health services.

Fatherhood in Adolescence

1. Dominic Hollman, MD 2. Elizabeth Alderman, MD 1. Childrens Hospital at Montefiore Bronx, NY Adolescent Fathers: What We Know and What We Need to Know. Miller DB. Child Adolesc Social Work J.1997;14 :55– 69[OpenUrl][1][PubMed][2] Psychosocial Correlates of Intimacy Achievement Among Adolescent Fathers-to-be. Winstanley MR, Meyers SA, Florsheim P. J Youth Adolesc.2002;31 :91– 100[OpenUrl][3][CrossRef][4] Research Review: Teenage Pregnancy and Parenthood: The Role of Fathers. Bunting L, McAuley C. Child Family Social Work.2004;9 :295– 303[OpenUrl][5][CrossRef][6] Young Dads: The Effects of a Parenting Program on Urban African-American Adolescent Fathers. Mazza C. Adolescence.2002;37 :681– 693[OpenUrl][7][PubMed][8][Web of Science][9] The challenges of teen pregnancy and motherhood long have been considered in depth, but attention to adolescent fathers has been far less conspicuous. The relative lack of attention given to adolescent fathers by health-care practitioners, social workers, government agencies, and researchers furthers the (sometimes incorrect) idea that the fathers often are absent. Although many adolescent mother-baby programs are available, few include provisions for adolescent fathers. In recent years, efforts have increased to acknowledge teen fathers in clinical practice and in the research forum, but much still needs to be addressed. Numerous studies have characterized adolescent fathers as being older than the mothers of their children. Several studies have found that fathers of the children of adolescent mothers are an average 2 to 3 years older than the mothers. However, in a large California study of adolescent mothers younger than age 15 years, the age difference was nearly 9 years. The actual number of adolescent fathers is difficult to ascertain because the age of the father is not always on the birth certificates of children born to adolescent mothers. Several factors are correlated with becoming a father during adolescence, particularly low income and poor academic achievement, which also are predictive of adolescent motherhood. Some … [1]: {openurl}?query=rft.jtitle%253DMedline%2BRows%2BWith%2BNULL%2Bissns%2BWill%2BPoint%2BTo%2BThis%26rft.stitle%253DDUMMY%26rft.aulast%253DFrengen%26rft.auinit1%253DE.%26rft.volume%253D14%26rft.issue%253D2%26rft.spage%253D55%26rft.epage%253D59%26rft.atitle%253DTransfer%2Bof%2Bsmall%2BYACs%2Bto%2BE.%2Bcoli%2Bas%2Blarge%2Bcircular%2Bplasmids.%26rft_id%253Dinfo%253Apmid%252F9349942%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=9349942&link_type=MED&atom=%2Fpedsinreview%2F29%2F10%2F364.atom [3]: {openurl}?query=rft.jtitle%253DJ%2BYouth%2BAdolesc.%26rft.volume%253D31%26rft.spage%253D91%26rft_id%253Dinfo%253Adoi%252F10.1023%252FA%253A1014093308760%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [4]: /lookup/external-ref?access_num=10.1023/A:1014093308760&link_type=DOI [5]: {openurl}?query=rft.jtitle%253DChild%2BFamily%2BSocial%2BWork.%26rft.volume%253D9%26rft.spage%253D295%26rft_id%253Dinfo%253Adoi%252F10.1111%252Fj.1365-2206.2004.00335.x%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [6]: /lookup/external-ref?access_num=10.1111/j.1365-2206.2004.00335.x&link_type=DOI [7]: {openurl}?query=rft.jtitle%253DAdolescence%26rft.stitle%253DAdolescence%26rft.aulast%253DMazza%26rft.auinit1%253DC.%26rft.volume%253D37%26rft.issue%253D148%26rft.spage%253D681%26rft.epage%253D693%26rft.atitle%253DYoung%2Bdads%253A%2Bthe%2Beffects%2Bof%2Ba%2Bparenting%2Bprogram%2Bon%2Burban%2BAfrican-American%2Badolescent%2Bfathers.%26rft_id%253Dinfo%253Apmid%252F12564822%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [8]: /lookup/external-ref?access_num=12564822&link_type=MED&atom=%2Fpedsinreview%2F29%2F10%2F364.atom [9]: /lookup/external-ref?access_num=000180575600002&link_type=ISI

Exploring the Spiritual/Religious Dimension of Patients: A Timely Opportunity for Personal and Professional Reflection for Graduating Medical Students

Teaching about spirituality in medical school training is lacking. Spirituality is a dimension of humanity that can put experiences of health and illness into a meaningful context. Medical students might benefit from understanding how spirituality is an important element in learning to care for patients. Spirituality also provides a context for medical students to explore their own motivations for doctoring. This article describes a longitudinal senior elective course at the end of their medical school training to delve into matters of religion/spirituality surrounding patient care. The authors pose their own perspectives on what both students and faculty gained from the experience.