Polly F. Cromwell

Clinical and Functional Correlates of Posttraumatic Stress Disorder in Urban Adolescent Girls at a Primary Care Clinic

OBJECTIVE To identify clinical and functional correlates of posttraumatic stress disorder (PTSD) in trauma-exposed urban adolescent girls. METHOD Ninety female adolescents aged 12 to 21 years (mean 17.3 years) who presented for routine medical care at an adolescent primary care clinic were assessed with self-report questionnaires and interviews for trauma exposure, posttraumatic stress symptoms, other psychopathology, and psychosocial, family, and school function. RESULTS Ninety-two percent (n = 83) endorsed at least one trauma. Witnessing community violence (85.6%) and hearing about a homicide (67.8%) were the most common traumatic events endorsed. Twelve (14.4%) and 10 (11.6%) traumatized girls met DSM-IV symptom criteria for full and partial PTSD, respectively. Compared with traumatized girls without PTSD, girls with PTSD were significantly more depressed, used more cigarettes and marijuana, and were more likely to have failed a school grade, been suspended from school, or been arrested. CONCLUSIONS Urban adolescent girls are exposed to multiple types of trauma. Whereas most develop at least one posttraumatic stress symptom, girls who meet full symptom criteria for PTSD show evidence of other psychopathology, increased cigarette and marijuana use, and poorer school performance. Further research is needed to identify and treat inner-city girls with PTSD.

Posttraumatic stress disorder and substance use in inner-city adolescent girls.

The purpose of this study is to examine rates of nicotine, marijuana, and alcohol use as well as patterns of problematic substance use and posttraumatic stress disorder (PTSD) symptoms in inner-city adolescent girls. One hundred four adolescents who obtained medical care at a hospital-based adolescent clinic were systematically surveyed for trauma exposure, posttraumatic stress symptoms, and substance use. A subset (N = 54, 52%) of girls completed a semistructured psychiatric diagnostic interview (K-SADS-PL) to ascertain timing of PTSD symptoms relative to substance use. Compared with traumatized girls without PTSD, girls with full and partial PTSD were significantly more likely to use nicotine, marijuana, and/or alcohol on a regular basis. Fifteen girls met criteria for both PTSD and a substance-use disorder. For 80% of these girls, the age of onset of PTSD was either before or concurrent with the onset of their substance-use disorder. Inner-city adolescent girls with PTSD exhibit problematic substance use and may be at high risk of developing a comorbid substance-use disorder.

Implementation of a screening program for chlamydial infection in incarcerated adolescents.

Background In collaboration with the Houston Department of Health and Human Services, the authors implemented and evaluated a urine-based chlamydia screening program in incarcerated youth in Harris County, Texas, and assessed predictor variables for infection. Goal To implement and evaluate chlamydia screening in incarcerated youth. Study Design The authors determined prevalence of chlamydial infection, treatment rates, and predictor variables in 589 youth and repeated the measures 6 months later in 975 additional youth. Results Initially, the prevalence of infection was 9.6% in males and 28.1% in females; 88% of infected youth were treated while incarcerated. White males had a significantly lower prevalence of chlamydial infection; however, consistent condom use was not associated with a lower prevalence of chlamydia. In the 6-month assessment of chlamydia prevalence in 975 youth, prevalence and treatment rates remained high and predictor variables were similar. Conclusion The authors instituted a screening program for chlamydial infection in incarcerated youth that was performing well at reassessment 6 months later.

Prevalence and incidence of pelvic inflammatory disease in incarcerated adolescents.

Background Few recent studies have determined the prevalence and incidence of pelvic inflammatory disease (PID) among adolescents. Goal The goal of this study was to determine these parameters among incarcerated youths. Study Design Both on admission and during incarceration, consecutive adolescents entering the Harris County, Texas, Juvenile Detention Center were evaluated for symptoms of PID. One of two experienced clinicians examined adolescents with possible PID. For the diagnosis of PID, we used the minimal criteria of the CDC. Results In sexually active heterosexual or bisexual adolescents (N = 313), the prevalence of PID at admission was 4.5%; during the first 31 days of incarceration, the incidence density of PID was 3.3 cases/100 person-months, and the cumulative incidence was 2.2%. The prevalence among these youths of chlamydial and/or gonorrheal infection, as determined by urine or cervical testing, was 24.9%. Conclusion The high prevalence and incidence of PID underscore the need for effective programs to eradicate chlamydial and gonorrheal infections in high-risk youths.

How to perform a pelvic exam for the sexually active adolescent.

The pelvic examination is a necessary health screening for sexually active female adolescents. This article describes how to perform a pelvic examination, including collecting specimens for sexually transmitted infections, wet mount evaluation, and the Papanicolaou test. Additional sections cover abnormal findings and special considerations.

Acute and non-acute lower extremity pain in the pediatric population: part III.

216 Volume 26 Number 3 Lower extremity pain is common in childhood, with etiologies ranging from benign muscular conditions to systemic disease. We are presenting a three-part series of evidence-based practice guidelines to aid the provider in efficiently determining the diagnosis and treatment of a childwith lower extremity pain. Part I focused on the history, physical examination, and diagnostic workup (Duey-Holtz, Collins, Hunt, Husske, & Lange, 2012; Duey-Holtz, Collins, Hunt & Cromwell, 2012). Parts II and III have been divided to include comprehensive treatment guidelines, which are summarized in the Table. In general, the most common diagnoses for musculoskeletal pain can be categorized into the following etiologies:

Effective contraceptive counseling with adolescents in a nurse-based setting

Nurses serve a critical role in working with adolescents on reproductive health issues. Nurses must be knowledgeable and comfortable with providing counseling on contraceptive choices and decision making in order to meet the important goal of helping teens prevent unintended pregnancies.