May Lau

Racial/ethnic disparities in health and health care among U.S. adolescents

OBJECTIVE To examine racial/ethnic disparities in medical and oral health status, access to care, and use of services in U.S. adolescents. DATA SOURCE Secondary data analysis of the 2003 National Survey of Childrens Health. The survey focus was children 0-17 years old. STUDY DESIGN Bivariate and multivariable analyses were conducted for white, African American, Latino, Asian/Pacific Islander, American Indian/Alaskan Native, and multiracial adolescents 10-17 years old (n = 48,742) to identify disparities in 40 measures of health and health care. PRINCIPAL FINDINGS Certain disparities were especially marked for specific racial/ethnic groups and multiracial youth. These disparities included suboptimal health status and lack of a personal doctor or nurse for Latinos; suboptimal oral health and not receiving all needed medications in the past year for African Americans; no physician visit or mental health care in the past year for Asian/Pacific Islanders; overweight/obesity, uninsurance, problems getting specialty care, and no routine preventive visit in the past year for American Indian/Alaska Natives; and not receiving all needed dental care in multiracial youth. CONCLUSIONS U.S. adolescents experience many racial/ethnic disparities in health and health care. These findings indicate a need for ongoing identification and monitoring of and interventions for disparities for all five major racial/ethnic groups and multiracial adolescents.

Dating and sexual attitudes in Asian-American adolescents

Dating behaviors and sexual attitudes of Asian-American youth were examined in a cross-sectional, mixed-methods study in the context of adherence to Asian values, measured by the Asian Values Scale (AVS). In all, 31 Asian-American adolescents (age 14-18 years old) from a Houston community center were interviewed regarding dating behaviors and sexual attitudes. Almost three-fourth of adolescents dated without parental knowledge. Compared with adolescents with the lowestAVS scores, those with the highestAVS scores were significantly more likely to date without parental knowledge and date longer before sex. Many adolescents proceeded directly to single, steady, relationships. Parents permitted dating, as long as grades were maintained. Asian-American adolescents should be questioned about secret dating, sexual activity, and participation in other high-risk activities.

Clusters of markers identify high and low prevalence of adolescent pregnancy in the US.

STUDY OBJECTIVE To identify markers that, when clustered, are associated with the highest and lowest pregnancy prevalence among US adolescent females. DESIGN Secondary database analysis of the National Survey of Family Growth. PARTICIPANTS Adolescent females 15-19 years old. SETTING United States. METHODS Bivariate analyses were performed of the 2002 and 2006-08 cycles to identify markers associated with pregnancy in females 15-19 years old. Recursive partitioning analysis (RPA) was done to identify markers which, when combined, identify adolescent females with the highest and lowest pregnancy prevalence. RESULTS Pregnancy prevalence in 2,528 adolescent females was 14%. In RPA, females who ever HIV tested had a 48% pregnancy prevalence vs 4% in those never tested. The highest pregnancy prevalence (78%) was associated with the combination of ever HIV tested, never lived away from parents before 18 years old, age >17 years old, and age of sexual debut ≤14 years old. Adolescent females with a combination of ever HIV tested, never lived away from parents before 18 years old, age >17 years old, age of sexual debut at 15-16 years old, and the adolescents father not having a high-school diploma had a pregnancy prevalence of 75%. CONCLUSIONS Two clusters of markers yield adolescent females with a very high adolescent pregnancy prevalence, at 75%-78%. Pregnancy prevention efforts might be especially effective when targeting combinations of HIV-testing history, never living away from home before 18 years old, adolescent age, age of sexual debut, and paternal educational attainment.

Developing a multidisciplinary Young Women's Blood Disorders Program: a single‐centre approach with guidance for other centres

Bleeding from the reproductive tract in women is a natural event, generally occurring with menstruation and childbirth. Women with an underlying bleeding disorder may experience heavy menstrual bleeding (HMB) and thereby, unacceptable blood loss. Up to 20% of US women with abnormal uterine bleeding and a normal gynaecological exam may have an underlying bleeding disorder corresponding to almost 2–3 million American women. These females face many obstacles in achieving optimum medical care for their problems. A haematologist may not evaluate these women as they are treated symptomatically. Recognition of an underlying bleeding disorder is not straightforward and many come to attention after serious bleeding events. Although mortality from HMB is uncommon, the true burden of HMB is its impact on health‐related quality of life. To address these issues, women with HMB require a comprehensive approach to their care.

Pleased to be pregnant? Positive pregnancy attitudes among sexually active adolescent females in the United States

STUDY OBJECTIVE To identify factors associated with a positive pregnancy attitude among sexually active US teen females. DESIGN Secondary database analysis of the National Survey of Family Growth. PARTICIPANTS Adolescent females 15-19 years old. SETTING Nationally representative sample. METHODS Bivariate and multivariable analyses were performed of the 2002 and 2006-08 cycles to examine whether sociodemographic factors, contraceptive history, sexual education and behavior history, medical services history, and family and sexual attitudes were associated with a positive pregnancy attitude among sexually active teen females. RESULTS Among the 975 sexually active US adolescent females surveyed, 15% reported a positive pregnancy attitude. Compared with adolescent females with a negative pregnancy attitude, those females with a positive pregnancy attitude were significantly (P < .05) more likely to have public insurance (43% vs 20%), to be poor (33% vs 10%), to have reached menarche at an earlier age (12 years old vs 13 years old), ever have HIV tested (35% vs 23%), but less likely to have ever been forced to have sex (1% vs 10%). In multivariable analyses, Latino race/ethnicity was associated with triple the odds, and African-American double the odds, of a positive pregnancy attitude. Older age of menarche and higher family income were associated with reduced odds of a positive pregnancy attitude. CONCLUSIONS One in 7 sexually active US adolescent females had a positive pregnancy attitude. Minority race/ethnicity was associated with greater odds of a positive pregnancy attitude, whereas older age of menarche and a higher family income were associated with lower odds of a positive pregnancy attitude. Assessing pregnancy attitudes for these groups of adolescent females might prove useful to decrease adolescent pregnancy rates.

A novel behavioral intervention in adolescents with type 1 diabetes mellitus improves glycemic control: preliminary results from a pilot randomized control trial.

Purpose The purpose of this study was to develop and pilot-test an innovative behavioral intervention in adolescents with type 1 diabetes mellitus (T1DM) incorporating structured care of a pet to improve glycemic control. Methods Twenty-eight adolescents with A1C > 8.5% (69 mmol/mol) were randomly assigned to either the intervention group (care of a Betta splendens pet fish) or the control group (usual care). Adolescents in the intervention group were given instructions to associate daily and weekly fish care duties with diabetes self-management tasks, including blood glucose testing and parent-adolescent communication. Results After 3 months, the participants in the intervention group exhibited a statistically significant decrease in A1C level (−0.5%) compared with their peers in the control group, who had an increase in A1C level (0.8%) (P = .04). The younger adolescents (10-13 years of age) demonstrated a greater response to the intervention, which was statistically significant (−1.5% vs 0.6%, P = .04), compared with the older adolescents (14-17 years of age). Conclusions Structured care of a pet fish can improve glycemic control in adolescents with T1DM, likely by providing cues to perform diabetes self-management behaviors.

If You Do Not Ask, They Will Not Tell: Evaluating Pregnancy Risk in Young Women in Pediatric Hospitals

Adolescents experience some of the highest rates of unintended pregnancy among women of all reproductive age groups. And despite the fact that adolescents often receive care in pediatric hospital settings, evaluation of pregnancy risk is inconsistent. Pregnancy risk assessments can identify opportunities to deliver reproductive health services, allow earlier pregnancy diagnoses, and reduce morbidity and mortality for medically complex adolescent patients and their pregnancies. In this commentary we discuss some of the challenges and potential solutions to performing pregnancy risk assessments in pediatric hospital settings.

Communication Between Asian American Adolescents and Health Care Providers About Sexual Activity, Sexually Transmitted Infections, and Pregnancy Prevention

Asian American adolescents have been reported to have the lowest amount of communication with health care providers regarding sexual health topics (sexual activity, contraception, sexually transmitted infections, and pregnancy prevention). This study identified Asian American adolescents’ attitudes/beliefs regarding how health care providers can be most helpful in communicating about sexual health topics. Twenty participants revealed the following information: (a) confidentiality concerns resulted in lying to health care providers about sexual histories or refusing hormonal contraception, (b) a general lack of knowledge regarding sexual health topics, and (c) a hesitancy to discuss sexual histories with Asian American health care providers. Asian American adolescents expressed a need for privacy from parents regarding their sexual behaviors, and want health care providers to initiate conversations and provide information about sexual health topics.

Factors Associated With Being Pleased With a Female Partner Pregnancy Among Sexually Active U.S. Adolescent Males

Adolescent pregnancy remains a major U.S. public health problem. Little is known about pregnancy attitudes in U.S. adolescent males. The study objective was to identify factors from different domains that are associated with sexually active U.S. adolescent males who would be pleased with a female partner pregnancy (hereafter known as pleased with a pregnancy). The National Survey of Family Growth is a nationally representative survey of those 15 to 44 years old. Bivariate and multivariable analyses were performed of the 2002 and 2006-2010 cycles to examine factors associated with being pleased with a pregnancy among sexually active U.S. males. Among the 1,445 sexually active U.S. adolescent males surveyed, 25% would be pleased with a pregnancy. In bivariate analyses, ever being suspended from school, having sporadic health insurance, age, and ever HIV tested were significantly associated with being pleased with a pregnancy. In final multivariable analyses, sporadic insurance was associated with almost triple the odds, and being older and ever HIV tested with double the odds of being pleased with a pregnancy. Higher educational attainment for both adolescent males and adolescent males’ fathers was associated with reduced odds of a being pleased with a pregnancy. One quarter of sexually active U.S. adolescent males would be pleased with a pregnancy. Adolescent males who have been sporadically insured, are older, and ever HIV tested have higher odds of being pleased with a pregnancy. Targeting these adolescent males for more focused pregnancy-prevention counseling may prove useful in reducing adolescent pregnancy rates.