Paula K. Braverman

The role of mother–daughter sexual risk communication in reducing sexual risk behaviors among urban adolescent females: a prospective study

PURPOSEnTo prospectively examine the relationship between mother-daughter communication about sex and selected sexual risk behaviors among inner-city adolescent females.nnnMETHODSnParticipants were 219 sexually experienced females, 12 to 19 years of age, recruited from an inner-city adolescent medicine clinic in Philadelphia, PA, and randomly assigned to the control group of an HIV-risk reduction intervention study. Analyses were limited to data from control group participants to avoid confounding intervention effects. Poisson regression was employed to model three self-reported sexual risk behaviors: number of male sexual partners, number of episodes of sexual intercourse, and number of episodes of unprotected intercourse. Mediation effects were evaluated using variables from the Theory of Planned Behavior. Data were analyzed using Poisson regression.nnnRESULTSnHigher levels of mother-daughter sexual risk communication were associated with fewer episodes of sexual intercourse and unprotected intercourse at 3-month follow-up. There was evidence that the relationship of communication to unprotected intercourse was mediated by condom use self-efficacy. Mother-daughter sexual risk communication was not significantly associated with adolescents reports of numbers of male sexual partner.nnnCONCLUSIONSnThis prospective study supports the notion that mothers who communicate with their daughters about sex can affect their daughters sexual behaviors in positive ways. These findings lend support for the design and implementation of family-based approaches to improve parent-adolescent sexual risk communication as one means of reducing HIV-related sexual risk behaviors among inner-city adolescent females.

Use of Ligase Chain Reaction for Laboratory Identification of Chlamydia Trachomatis and Neisseria Gonorrhoeae in Adolescent Women

STUDY OBJECTIVEnTo compare the ligase chain reaction (LCR) with culture for the detection of Neisseria gonorrhoeae (GC) and with culture and direct fluorescent antibody (DFA) for identification of Chlamydia trachomatis (CT) in cervical specimens from adolescent women.nnnDESIGNnA prospective study of test performance.nnnSETTINGnTwo urban, hospital-based adolescent clinics.nnnPARTICIPANTSnAdolescent women aged 12-22 yr undergoing pelvic examination for routine sexually transmitted disease (STD) screening or symptoms suggestive of an STD.nnnMAIN OUTCOME MEASURESnLCR results were considered to be true positives if confirmed by culture and/or DFA (CT only). Discrepant LCR results were confirmed by testing an alternative locus.nnnRESULTSnWith 538 subjects, LCR for CT had a sensitivity of 98.4% (61/62) and specificity of 96.4% (459/476) prior to resolution and a sensitivity of 98.6% (70/71) and specificity of 99.6% (459/461) after resolution. With 1225 subjects, LCR for GC had a sensitivity of 90.0% (54/60) and specificity of 99.4% (1158/1165) prior to resolution and a sensitivity of 90.6% (58/64) and specificity of 100% (1158/1158) after resolution. CT culture alone identified 80% of the true positives and DFA alone only identified 72%. GC culture alone identified 94% of the true positives.nnnCONCLUSIONSnLCR is an extremely sensitive and specific rapid test, utilizing a single swab and convenient room-temperature storage and transport of specimens. LCR testing of cervical specimens for CT in adolescent women is a better test for detecting CT infection than culture or DFA. LCR testing for cervical GC infection may provide an advantage over culture in circumstances in which optimal transport conditions and viability of the organism cannot be assured.

Sexually transmitted diseases in adolescents

Abstract STDs are a major health concern for sexually active adolescents. The ED is at the front lines in diagnosing and treating acute symptoms of STDs, as well as their complications. Prompt recognition and treatment of these infections can prevent significant mobidity. National data has shown that aggressive screening and treatment can significantly reduce the incidence of STDs. Although the ED is traditionally focused on acute complaints, a recent study has shown that the ED may be an ideal location for detecting and treating asymptomatic STDs. 25 The ability to use nucleic acid amplification techniques on urine samples has provided non-invasive alternatives for screening. The ED serves many high-risk patients who do not have other identified health care resources and may be a key clinical site for STD reduction interventions.

Sexual Activity and Other High-Risk Behaviors in Adolescents with Chronic Illness: A Review

new or multiple partners or do not use consistent barrier contraception. Studies have demonstrated decreased rates of pelvic inflammatory disease with the institution of routine screening for chlamydia. More than one-half of the 15-19-year-olds in this country have been sexually active, and for women, this age group has the highest age-specific rate of chlamydia infection with the 20-24-year-old age group coming in second. Although rates of chlamydia are higher among minorities, this infection is pervasive throughout all ethnic/racial groups. Physicians caring for sexually active adolescents should be screening for STDs, especially chlamydia. More education is needed on STDs, the importance of screening, and the ability of screening and subsequent treatment to prevent negative sequelae. As outlined in this study, specific populations of physicians to target more intensively may be male physicians, those in private practice, and those practicing in rural areas. Newer diagnostic techniques include nucleic acid amplification (ligase chain reaction, polymerase chain reaction, transcription-mediated amplification) which allow for noninvasive screening on urine. Although this article focused on females, adolescent males are also at risk for asymptomatic chlamydia infection and should also be included in the routine screening process. The noninvasive urine-based testing is particularly attractive for the male patient population. -PKB

Differences Between Adolescents and Young Adults at Presentation to an Eating Disorders Program

an eating disorders program in a division of adolescent medicine between 1980 and 1994 were reviewed retrospectively. Data from the initial evaluation were recorded for demographic and family factors; weight loss and weight changes; eating-related behaviors; diagnosis and severity; and treatment issues. The age breakdown was 9-14 years (14.5%), 15-19 (55.9%), and 20-24 (21.4%). Most of the patients were white (>95%) and from upper or middle-class backgrounds (>93%) and there were no significant differences by age for these variables. DSM III-R criteria were used to classify eating disorders with 35% meeting criteria for anorexia ner-

Barriers to Screening Sexually Active Adolescent Women for Chlamydia: A Survey of Primary Care Physicians:

Intervention should occur in EDNOS patients, notjust those meeting strict criteria for anorexia or bulimia. As the authors point out, adolescents present with more rapid weight loss over a shorter period of time and tend to have less severe illness. They also are less likely to have engaged in prior therapy and are more likely to deny their illness and not want treatment. The youngest adolescents (9-14) may be the hardest to diagnose because they are the least likely to fulfill diagnostic expectations. As stated by the authors, aggressive treatment during adolescence and as early as possible to reverse weight loss and provide psychological intervention may lead to better outcomes than those in adults who have had a longer duration of illness and more chronic issues. -PKB