Rina Lazebnik

How children perceive the medical evaluation for suspected sexual abuse

This study investigated how 99 children who were examined for suspected sexual abuse (SSA) perceived their own medical evaluation experiences. Each child was interviewed about the degree of pain and fear associated with the experience, the kindness of the doctor, general fear of doctor visits, and degree of fear associated with a hypothetical second examination. The majority of children did not perceive their SSA examination to be strongly negative. However children did report greater fear associated with the SSA evaluation compared to an ordinary doctor visit. Using multiple regression, general fear of doctor visits and fear and pain associated with the SSA examination contributed to the prediction of intensity of fear about a hypothetical second SSA evaluation. Perceived kindness of the doctor, patient sex and age, and physician sex and age did not contribute to the regression equation. The relatively low reported rate of intense distress associated with medical evaluation of SSA suggests that fear and pain can be minimized and effectively managed for many children. The results of the regression analysis suggest that previous negative medical experiences may play an important role in determining how a child interprets the experience of an SSA medical evaluation.

Sexual Behavior, Drug Use, and Aids Knowledge among Midwestern Runaways:

The authors evaluated sexual behaviors, drug use, and AIDS knowledge among Cleveland runaways (N = 108). Results indicated variable rates of risky sexual behaviors, minimal illicit drug use, and high levels of knowledge about true behavioral risks for HIV infection. These runaways demonstrated less frequent health-compromising sexual behavior and drug use compared to runaways described in other studies. Assumptions should not be made that all runaway youths engage in an unusually high rate of risky behaviors.

Relationship of AIDS-related attitudes to sexual behavior changes in adolescents

The impact of the acquired immunodeficiency syndrome (AIDS) epidemic on a group of adolescents was investigated by surveying 197 sexually active, predominantly African-American, urban high school students. Reported sexual behavior changes were evaluated in relation to AIDS-related knowledge and attitudes. Over 50% of the students decreased their frequency of sexual activity, increased their condom use, and/or decreased their number of partners. These students had significantly higher scores on a measure of worry about vulnerability to human immunodeficiency virus (HIV) infection than those whose behavior had not changed. AIDS knowledge, AIDS beliefs, and AIDS-related anxiety interacted with gender to affect sexual behavior change. Male students reporting decreased frequency of sexual activity, for example, had more accurate beliefs about AIDS than males reporting no decrease. Among female students, however, those reporting decreased frequency had less accurate beliefs than those reporting no decrease. These results highlight the importance of considering gender and specific sexual behaviors when designing AIDS education interventions.

Urban Emergency Department Utilization by Adolescents

This study describes urban emergency department (ED) utilization and follow-up referral patterns among adolescents. ED visits for 14-19-year-old patients at an urban university hospital with adjacent adult and pediatric emergency departments during specified months in 1993 were retrospectively reviewed. A subgroup (n=150) was randomly selected for detailed chart review. One thousand six hundred and thirty-six adolescents were seen in the ED during the study period. Public assistance (n=763; 47%) and commercial insurance (n=480; 29%) were the most common forms of insurance, followed by self-pay (n=357; 22%). The majority of triage codes for ED visits were nonurgent (n=140; 93%). Twenty-five patients (17%) were not referred for follow-up upon ED discharge. Adolescents on public assistance or without insurance may frequently utilize an urban ED for nonurgent medical problems. A group of patients did not identify a primary care provider at triage and were not referred for follow-up. Defining medical problems for which adolescents utilize the ED may help health professionals to tailor community resources to better serve adolescent health care needs.

Changes in adolescents' knowledge and attitudes about AIDS over the course of the AIDS epidemic

We compared AIDS-related attitudes of junior and senior high school students from 1988 to 1991 and across grade level to examine how effectively schools are addressing AIDS. Attitudes measured included knowledge and social anxiety about AIDS, as well as perceptions of vulnerability to HIV infection. Junior high school students (grades 7-9) were sampled three times, from 1989 to 1991. High school students (grades 10-12) were sampled four times, from 1988 to 1991. The 1991 junior high school sample had lower AIDS knowledge scores than the 1989 sample. Conversely, the 1991 high school sample had more accurate knowledge than earlier groups. With respect to grade level, 9th graders had more accurate knowledge than 7th and 8th graders, but knowledge did not increase from 10th through 12th grade. Anxiety about interacting with a person with AIDS and perceptions of vulnerability to HIV infection were unrelated to either sampling time or grade level. It is concluded that it will be important to redouble efforts to educate adolescents about AIDS and that particular attention needs to be paid to young adolescents.

Atypical squamous cells of undetermined significance in the pediatric population: Implications for management and comparison with the adult population

OBJECTIVE To determine the significance of an atypical squamous cells of undetermined significance (ASCUS) diagnosis in patients 18 years or younger. STUDY DESIGN From June 1994 to June 1995, 630 cervicovaginal smears were performed on patients 18 years or younger (mean age 16.4, range 14-18) at University Hospitals of Cleveland. Of these patients, 69 (10.9%) were diagnosed with ASCUS or ASCUS with a qualifying statement. Follow-up cervicovaginal smears, biopsies and charts were reviewed for a 12-18-month period following the initial diagnosis of ASCUS. RESULTS The study population was sexually active: 63% were gravid, 21% were multigravid, 68% had a history of sexually transmitted diseases (STDs), and 32% had multiple STDs. Follow-up cervicovaginal smears or biopsies were obtained on 46 patients (32 cervicovaginal smears and 14 biopsies/endocervical curettage cases). Mild to moderate dysplasia was identified in 21.6% of patients (10.8% on cervicovaginal smears and 10.8% on biopsies), and a repeat diagnosis of ASCUS was given in 37%. In patients with a repeat diagnosis of ASCUS, a follow-up cervicovaginal smear or biopsy revealed dysplasia in an additional 13%. The overall rate of dysplasia was 34.7%. CONCLUSION Regardless of age, the diagnosis of ASCUS in a sexually active patient population has significant implications. Furthermore, we recommend that these patients be managed the same way as high-risk adult patients.

The relationship of Magic Johnson's announcement of HIV infection to the AIDS attitudes of junior high school students

One month after Magic Johnson announced that he had tested positive for human immunodeficiency virus (HIV), 103 junior high school students were surveyed about the impact of his announcement on their desire to learn about acquired immunodeficiency syndrome (AIDS), their worries about vulnerability to HIV infection, and their anxiety about interacting with a person with AIDS (PWA). Students also were administered established AIDS‐related scales of knowledge, vulnerability worries, and social anxiety. Their scores on these scales were compared to the scores of different students from the same school sampled at three previous times. As expected, 58% of the students reported a desire to know more about AIDS, and 40% reported increased worries about vulnerability to HIV infection because of Magic Johnsons announcement. Contrary to expectations, 21% reacted with a report of increased anxiety about interacting with a PWA, whereas 12% reported less anxiety. Also contrary to expectations, when compared with the p...

Adolescents with ASCUS: Are They a High Risk Group?

Population demographics, risk behaviors, and compliance rates for the management of an ASCUS (atypical squamous cells of undetermined significance) diagnosis are not well studied in the adolescent population. From June 1994 to December 1996, 1175 Papanicalou (pap) smears were performed in an urban adolescent clinic on patients age 12 to 18. Of these, 124 (10.5%) were diagnosed with ASCUS or ASCUS with a qualifying statement. A retrospective chart review (n=83) and telephone interview was performed on patients with ASCUS. Ninety-nine percent of enrollees were African American. Comparisons were made between those patients with normal pap smears and those with ASCUS. No statistically significant difference existed pertaining to age at pap smear, age at menarche, age at first coitus, and education level. A positive association was found in the ASCUS group for the presence of sexually transmitted diseases (P<0.001), number of sexual partners (P<0.0007), and pregnancy (P<0.001). Of the 80% of patients who had an ASCUS diagnosis and were referred for colposcopy (n=62), only 61% attended their appointment (n=38). Thirty-nine percent of these patients were aware of an abnormal diagnosis after colposcopy. For those that attended colposcopy, 56% were accompanied by a parent. For those who were not compliant with attendance, none cited parental consent for the procedure as a barrier to obtaining treatment. Adolescent females in an urban setting with multiple sexual partners, history of sexually transmitted diseases, and prior pregnancy are at a greater risk for ASCUS on cervicovaginal smear when compared to their age-matched controls. In addition, the adolescent compliance rate for colposcopy is low. We, therefore, recommend that these adolescent females be observed diligently.

Text Message Reminders Increase Appointment Adherence in a Pediatric Clinic: A Randomized Controlled Trial

Background. High no-show rates can burden clinic productivity and affect patient care. Although multiple studies have shown that text messages improve appointment adherence, very little research has focused on low-income and predominantly African American populations in resident clinic settings. Objectives. To determine whether incorporating a text message reminder reduces the no-show rate at an urban, pediatric resident clinic. Methods. A randomized controlled trial was conducted at a tertiary level ambulatory pediatric practice between August 2014 and February 2015. Following a demographic survey, 170 patients were enrolled. Patients were randomized into control or intervention groups. All patients received the standard voice message appointment reminder, but the intervention group additionally received a text message reminder. The primary outcome was no-show rate. Results. 95.3% of the participants were African American, and the overall no-show rate was 30.8%. No-show rate was significantly lower in the intervention group (23.5%) than the control group (38.1%) representing a difference of 14.6% (p = 0.04). No demographic factors were found to alter the association between no-show rate and text message intervention. Conclusions. Text message reminders effectively improve show rates at a resident pediatric practice with high no-show rates, representing a promising approach to improving appointment adherence.

Awareness of a rape crisis center and knowledge about sexual violence among high school adolescents

STUDY OBJECTIVE This study examined awareness among adolescents of a local rape crisis center as well as their knowledge about sexual violence. DESIGN The Cleveland Rape Crisis Center (CRCC) conducts sexual violence prevention programs for high school students. A written, anonymous survey was distributed to students prior to the start of the program. Students were asked if they had heard of the CRCC; knowledge about sexual violence was assessed with a series of 7 statements (rape myths) that participants identified as true or false. Surveys were reviewed retrospectively. Analyses were carried out for individual questions and frequencies compared using chi-square analysis. RESULTS A total of 1633 surveys were collected; 1118 (68.5%) participants were female and 514 (31.5%) were male; ages ranged from 12 to 19 years. Respondents described themselves as being of European descent (45.9%), African descent (26.2%), or mixed race (17.7%). Just over half (863, 52.9%) of survey respondents had heard of the CRCC. Over half (950, 58.2%) of participants answered 5 or more questions correctly (range of correct answers 0 to 7). In general, more participants who were aware of the CRCC were able to identify statements about rape correctly (P < .01 for statements 1, 4, 5, 6, and 7, P < .001 for ≥ 5 correct). Age, gender, and race were all significantly associated with knowledge about rape. Females were consistently more likely to get an answer correct, as were participants of European descent. CONCLUSION Awareness of the CRCC was associated with increased knowledge about sexual violence.