Rebecca L. Huston

Unwanted sexual experiences in adolescents. Patterns of disclosure

More than 300 patients who presented consecutively to a sexual abuse clinic, a family planning clinic, and a family practice clinic filled out an anonymous survey regarding unwanted sexual experiences. In the family planning and family practice clinics, 40% of females and 16% of males reported having at least one unwanted sexual experience prior to their 18th birthday. Although 85% had disclosed their unwanted sexual experience, time to disclosure was prolonged (mean 2.3 years, median 5 to 6 months). Fear and embarrassment were the most common reasons for delay or lack of disclosure. The most common reasons for disclosure reflected internal rather than external or environmental influences. Increased awareness of unwanted sexual experiences and patterns of disclosure may enhance detection and treatment in children and adolescents.More than 300 patients who presented consecutively to a sexual abuse clinic, a family planning clinic, and a family practice clinic filled out an anonymous survey regarding unwanted sexual experiences. In the family planning and family practice clinics, 40% of females and 16% of males reported having at least one unwanted sexual experience prior to their 18th birthday. Although 85% had disclosed their unwanted sexual experience, time to disclosure was prolonged (mean 2.3 years, median 5 to 6 months). Fear and embarrassment were the most common reasons for delay or lack of disclosure. The most common reasons for disclosure reflected internal rather than external or environmental influences. Increased awareness of unwanted sexual experiences and pattern of disclosure may enhance detection and treatment in children and adolescents.

Characteristics of childhood sexual abuse in a predominantly Mexican-American population

Little has been written about the characteristics of childhood sexual abuse among Mexican Americans. In addition, certain aspects of the epidemiology of reported sexual abuse in the United States have changed significantly over the past 12 years. To better understand how characteristics of sexual abuse vary with ethnicity, race, gender, and age, we reviewed the records of 2,130 children under age 18 who were evaluated at our university-based facilities for possible sexual abuse from 1987 to 1989. The demographic, historical, and physical findings of the cases from our predominantly Mexican-American population were analyzed. T-test, analysis of variance, and chi-square analyses were used to test for differences related to ethnicity, race, gender, and age. Significant differences in these factors were found with respect to the relationship of the perpetrator to the child, the number of perpetrators, the interval from the abuse to the evaluation, the types of abuse, and the findings of the physical examination. This study demonstrates the important influences of ethnicity, race, gender, and age on characteristics of childhood sexual abuse. Awareness of these influences can be helpful in understanding factors that contribute to childhood sexual abuse, preparing for legal proceedings, and designing appropriate prevention programs.

Effect of a Program to Facilitate Parent-Child Communication About Sex

U.S. teens have high rates of premarital sexual activity resulting in alarming rates of teenage pregnancy and sexually transmitted disease. One possible way to combat the problem of teenage sexual activity is to promote sexuality education within the family. The purpose of this study was to increase parent-child communication about sex through an educational program for parents. The effect of the educational program was evaluated by a nonrandomized, controlled trial. Volunteer parents were recruited from three middle schools (grade six through eight) located in middle to upper-middle socioeconomic class neighborhoods. The parents participated in four 2-hour sessions which included factual information about sexuality and exercises to improve communication skills. The experimental group (N=47) were requested to fill out questionnaires immediately before and one month after the program. The control group (N=17) were requested to fill out questionnaires one month before and again immediately before the program. Parents were asked to report the number of times they talked with their adolescents about 11 sex-related topics. The difference in reported frequency of communication before and after the program was compared using a two-tailed, matched pairs t-test. Twenty-four (51%) experimental group parents and eight (47%) control group parents completed both questionnaires. There was a significant increase in communication reported by the experimental group. The mean difference of the number of topics discussed was 10.9 (SD 7.3) for participants versus -2.5 (SD 5.9) for controls (p=.00053). This study shows that parent-child communication about sex can be facilitated by an educational program for parents.

Toxicity From Topical Administration of Diphenhydramine in Children

From the Department of Pediatrics, University of Texas Health Science Center at San Antonio, Texas. Correspondence to: Rebecca Lea Huston, MD, Department of Pediatrics, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78284-7808. Diphenhydramine hydrochloride is a widely used antihistamine now available in many oral and topical nonprescription preparations. There have been numerous reports of morbidity and mortality due to diphenhydramine, especially in young children. Despite this, the potential toxicity of diphenhydramine is not well appreciated by the public or by many physicians. In this paper, we present two cases of diphenhydramine toxicity in young children with varicella. The first case involved both oral

Resident Documentation of Diagnostic Impression in Sexual Abuse Evaluations

In sexual abuse evaluations, the documentation of the examiners diagnostic impression is essential. If the diagnostic impression is not documented, the examiner will have to rely on memory rather than the medical record when called to testify. The purpose of this study was to determine whether pediatric residents adequately document their diagnostic impression in child sexual abuse evaluations. We performed a three-year retrospective chart review from patients 0-17 years of age who were evaluated at our emergency room for suspected sexual abuse. We reviewed 1,487 charts for historical information, physical findings, and diagnostic impression. Physical findings were categorized as normal, nonspecific, suggestive, or indicative of penetration. In 77% of cases (N=256) with hymenal findings indicative of penetration and 84% of cases (N=31) with vaginal findings indicative of penetration, residents recorded no impression or a nonspecific impression. Results were similar for vulvar and rectal findings indicative of penetration. Residents fail to document an adequate interpretation of their physical examinations in sexual abuse evaluations.

Problems with Vaccination Coverage in the United States

Address correspondence to: Rebecca L. Huston, M.D., M.P.H., Division of General Pediatrics, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78284-7808 Three papers in this issue of Clinical Pediatrics address -A~ important problems relating to immunization coverage for children in the United States.1-3 The low rate of immunizations, particularly among certain subgroups of children, has led to epidemics throughout the country. From 1989 through 1991, state health depart-