Kimberly Sidora

Does child abuse predict adolescent pregnancy

Objective. To determine whether sexual and nonsexual childhood abuse are risk factors for early adolescent sexual activity and pregnancy. Design. Cross-sectional study. Setting. Prenatal clinic within an inner-city teaching hospital from June 1990 to August 1991. Population. One thousand twenty-six primiparous, African-American women enrolled in a randomized clinical trial of nurse home visitation. Main Outcome Measures. Four measures of child abuse were used: sexual abuse, incidents of physical abuse, any major physical abuse, and emotional abuse. The outcome measures were age of first consensual coitus and age of first pregnancy. Results. After adjustments for household income, parental separation, urban residence, age of menarche, and teen smoking, sexual abuse during childhood was associated with younger age at first coitus (7.2 months; 95% confidence interval [CI], 2.6 to 11.7 months) and younger age at first pregnancy (9.7 months; 95% CI, 3.0 to 16.3 months). Incidents of physical abuse showed minimal effect on age at first coitus (1.2 days per incident; 95% CI, 0.5 to 1.9 days) and no effect on age of first pregnancy. A history of major physical abuse or emotional abuse showed no effect on age of first coitus or first pregnancy. Conclusion. Child sexual abuse, but not child physical or emotional abuse, seems to be a risk factor for earlier pregnancy among African-American adolescents.

Symptom perception in childhood asthma: how accurate are children and their parents?

Accurate symptom perception on the part of the patient is a critical component of asthma management. Limited data are available about how accurate children and their parents are in evaluating asthma symptoms. This study was designed to determine the symptom perceptual accuracy of families and to identify risk factors associated with inaccurate symptom perception. One hundred children (6–19 years) and their parents evaluated symptoms using subjective (visual analog scales) as well as objective (peak expiratory flow rates) measures of symptom severity. Accuracy was evaluated by comparing the match in zones (based on NHLBI clinical practice guidelines) indicated on the subjective measure with the objective measure. Children and parents were inaccurate about one-third of the time overall. Poor and minority families initially appeared to be less accurate; however, when we adjusted for the childs illness severity, these sociodemographic features were no longer significant risk factors. Children were as accurate as parents. When we evaluated symptom accuracy at “sick times” (when the childs peak flow reading was <80% personal best) accuracy decreased markedly to only about one-third of the episodes being correctly evaluated.

Symptom monitoring in childhood asthma: a randomized clinical trial comparing peak expiratory flow rate with symptom monitoring

BACKGROUND Accurate symptom evaluation is a critical component of asthma management. Limited data are available about the accuracy of symptom evaluation by children with asthma and their parents, or the impact of various symptom-monitoring strategies on asthma morbidity outcomes. OBJECTIVE The purpose of this randomized clinical trial was to evaluate the effect of three different intensities of symptom monitoring on asthma morbidity outcomes. METHODS One hundred sixty-eight children (ages 6 to 19) of diverse racial, geographic, and socioeconomic backgrounds were randomized to 1 of 3 treatment groups (subjective symptom evaluation, symptom-time peak expiratory flow rate (PEFR) monitoring, daily PEFR monitoring) in this longitudinal, clinical trial. Outcome measures included a summary asthma severity score, forced expiratory volume in 1 second, symptom days, and health care utilization. RESULTS Children who used PEFR meters (PFMs) when symptomatic had a lower asthma severity score, fewer symptom days, and less health care utilization than children in the other two treatment groups. Minority and poor children had the greatest amount of improvement using PFMs when symptomatic. Results were much less striking in white families. Thirty percent of families in the PFM treatment groups discontinued use entirely by 1 year postexit, whereas the majority of families who continued use (94%) used them only when symptomatic to inform symptom interpretation and management decisions. CONCLUSIONS Not every child with asthma needs a PFM. Children and families facing extra challenges as a result of illness severity, sociodemographic, or health care system characteristics clearly benefited most from PFM use.

Family context as a moderator of program effects in prenatal and early childhood home visitation

Typically research addressing minority family issues focuses on broad cultural differences between majority and minority families, and ignores or minimizes the diversity among families in the minority population. In this article, we address this diversity, specifically the influence of household configuration on the quality of the caregiving environment, and the ability of a nurse home-visitation program for first-time mothers and their infants to affect changes in the environment. Mothers who live with husbands or boyfriends have the best care-giving environments, and mothers who live alone make the greatest improvements. These results are discussed in the context of the nature of the relationship the home visitor is able to establish with key members of the household.

Delayed first pregnancy among African-American adolescent smokers

PURPOSE This study aimed to compare rates of adolescent pregnancy among African-American adolescents who began smoking as adolescents with those who did not. METHODS Cross-sectional data on 1042 primiparous African-American women enrolled in a randomized clinical trial of nurse home visitation were examined. The independent variable, adolescent smoking, was defined as a report of smoking before the age of 18 years. The outcome variable was adolescent pregnancy, defined as first pregnancy before the age of 18 years. Logistic regression was used to control for potential confounders. RESULTS After adjustments for drug use, use of contraception, frequency of coitus, and sexually transmitted diseases, women who smoked during adolescence had a 50% lower risk of becoming pregnant as an adolescent [odds ratio of 0.46 (95% confidence interval [CI] 0.27-0.76)]. When time to first pregnancy was examined as a continuous variable, adolescent smoking was associated with a delay in pregnancy of 22.6 months (95% CI 16.8-29.2). CONCLUSIONS Teen smoking appears to be associated with a significantly lower rate of adolescent pregnancy among African-Americans. Although the nature of this relationship is unclear, this finding suggests the need for linkage between smoking prevention and adolescent pregnancy prevention.