Robert H DuRant

Compliance with therapeutic regimens

Focusing on the issue of adolescent compliance with medical regimens, the discussion defines compliance; reports on the incidence of noncompliance; discussed direct and indirect methods of measuring compliance; considers noncompliance as a diagnostic issue; reviews theoretical approaches to compliance research -- individualistic models, the health-belief model, and the provider-patient relationship; and examines adolescent compliance with oral contraceptives (OCs) and improving adolescent compliance with therapeutic regimens. Compliance has been defined as the extent to which an individuals behavior -- in terms of taking medications, following diets, or executing lifestyle changes -- coincides with medical or health advice. It has been reported that there is more noncompliance associated with longterm prescriptions than with those of shorter durations. The most common approach to the study of nonconforming health behavior has been to identify individual factors that are associated with various forms of noncompliance. Study finding suggest that despite the characteristics of the patient, the behavior of the health care provider can largely determine whether the adult patient will comply or not with medical advice. Further study will determine if adolescents behave similarly. Confirming previous reports, the findings suggest that the nature of the interaction between the health care provider and the patient, combined with the adolescents sexual behavior and social psychological status, may influence how compliant she will be with her regimen. More ongoing research that will allow physicians to identify adolescents at risk of noncompliance so that appropriate intervention strategies may be employed is needed in this area. Strategies to increase the likelihood that adolescent patients will follow prescribed treatment regimens include: reminding the patient about the importance of compliance at each and every visit; improving the physician-patient relationship; and rewarding and reinforcing compliance.

Observations on Physical Activity in Physical Locations: Ager Gender, Ethnicity, and Month Effects

The level of physical activity of 3- and 4-year-old children was assessed in alternative physical locations by month and time of day and by age, gender, and ethnicity. Physical activity was assessed by observation with the Childrens Activity Rating Scale (CARS) for up to 12 hours from 7:00 am to 7:00 pm. A sample of 191 three- and four-year-old children was observed for up to four times in the course of a year. The sample was tri-ethnic. Boys were significantly more active than girls. Activity was consistently higher outside than inside. There were significant differences in the amount of time children in this age group spent inside versus outside by time of year; the activity levels of boys and girls differed by time of year, particularly when outside. A model including gender, month, and location terms accounted for 75% of the variance in physical activity. These data further documented gender differences in physical activity among very young children using measures not subject to self-report biases but did not explain or clarify the gender differences. The substantial differences by physical location and time of year deserve future attention, but more refined methods will be needed to balance data by location and important seasonal times. An inference from these results is that activity levels among young children may be increased by encouraging them to spend more time outdoors.

Use of multiple drugs among adolescents who use anabolic steroids

BACKGROUND Because adolescent users of anabolic steroids are concerned with increasing muscle size and strength, they may be unique among substance users and unlikely to use other drugs. Alternatively, if the factors that cause the use of anabolic steroids are similar to those associated with the use of other substances, adolescents who use anabolic steroids would be expected to report use of other drugs as well. METHODS We administered a questionnaire based on the 1989 Secondary School Health Risk Survey and the 1990 Youth Risk Behavior Survey of the Centers for Disease Control and Prevention to 1881 students enrolled in compulsory health-science classes (mean [+/- SD] age, 14.9 +/- 1.0 years) in the Richmond County, Georgia, school system. RESULTS A higher percentage of boys (6.5 percent) than girls (1.9 percent, P < or = 0.001) reported using anabolic steroids without a doctors prescription. Among ninth-grade students only, 5.4 percent of boys and 1.5 percent of girls reported using anabolic steroids (P < or = 0.001). Among users of anabolic steroids, 25 percent reported sharing needles to inject drugs. The frequency of anabolic-steroid use was significantly (P < 0.001) associated with the frequency of use in the previous 30 days of cocaine (r = 0.44), injectable drugs, alcohol (r = 0.23), marijuana (r = 0.42), cigarettes (r = 0.25), and smokeless tobacco (r = 0.40). On the basis of multiple regression analysis, the use of marijuana, shared needles, smokeless tobacco, and cocaine accounted for 33 percent of the variation in anabolic-steroid use among the ninth-grade students. CONCLUSIONS In our study, adolescent users of anabolic steroids were likely to use other drugs as well, and many were sharing needles.

The association of sexual risk behaviors and problem drug behaviors in high school students

PURPOSE To examine the associations among early age of onset of sexual intercourse and drug use, lifetime and current problem drug behaviors, and sexual risk behaviors. METHODS The 1993 Massachusetts Youth Risk Behavior Survey was administered to a sample of 3,054 students from randomly selected high schools and classrooms; 36% (1,078) consistently reported having had sexual intercourse. Three indicators of sexual risk behaviors were assessed: (1) number of lifetime sexual partners, (2) number of recent partners, and (3) condom nonuse at last intercourse. Three sets of independent variables were analyzed: (1) age of onset of sexual intercourse and drug use, (2) lifetime drug use, and (3) recent drug use. RESULTS Years of sexual intercourse, early age of onset of marijuana and cocaine use, lifetime frequency of marijuana, crack/freebase cocaine and alcohol use, and black race accounted for moderate amounts of the variation in the number of lifetime sexual partners. Years of sexual intercourse, early age of onset of marijuana use and cocaine use, lifetime frequency of crack/freebase and marijuana use, and recent use of cocaine, alcohol, and cigarettes accounted for smaller but significant amounts of the variation in the number of recent partners. Students more likely to report recent condom nonuse were older, females, had more years of sexual intercourse, had tried cocaine at a younger age, had used marijuana and cocaine more times (lifetime), and had more frequent recent use of marijuana. CONCLUSION Increased frequency and severity of drug use behaviors and more years of sexual intercourse are associated with an increased number of sexual partners and recent condom nonuse. These findings may guide history-taking and referral practices of health care providers. Programs designed to prevent sexually transmitted diseases and pregnancy should address drug use as well as sexual behavior.

Victimization, use of violence, and drug use at school among male adolescents who engage in same-sex sexual behavior

OBJECTIVE To examine the relationship between the number of male sexual partners of adolescent males and the frequency of victimization at school, missed school because of fear, used drugs at school, and engagement of fighting and weapon carrying both in and out of school. STUDY DESIGN Sexually active male adolescents (N = 3886) in 8th through 12th grades were administered the 1995 Vermont Youth Risk Behavior Survey. RESULTS A total of 8.7% of male adolescents reported one or more male sexual partners. Alcohol, marijuana, and smokeless tobacco use at school, not attending school because of fear, having been threatened or injured with a weapon at school, and weapon carrying at school accounted for 15.8% of the variation in the number of male sexual partners (p < 0.0001). Suicide attempts, school absence because of fear, cigarette smoking, alcohol use, and smokeless tobacco use at school, frequency of fighting requiring medical treatment, carrying a weapon,aand carrying a weapon at school accounted for 17.2% out of 100% of the variation in the number of male sexual partners (p < or 0.00001). CONCLUSION The number of male sexual partners reported by sexually active male adolescents correlated with a higher frequency of victimization, use of violence and drug use at school. Frequency of suicide attempts and fighting outside of school were also correlated with the number of same-sex sexual partners.

Tobacco and alcohol use behaviors portrayed in music videos: a content analysis.

OBJECTIVES Music videos from five genres of music were analyzed for portrayals of tobacco and alcohol use and for portrayals of such behaviors in conjunction with sexuality. METHODS Music videos (n = 518) were recorded during randomly selected days and times from four television networks. Four female and four male observers aged 17 to 24 years were trained to use a standardized content analysis instrument. All videos were observed by rotating two-person, male-female teams who were required to reach agreement on each behavior that was scored. Music genre and network differences in behaviors were analyzed with chi-squared tests. RESULTS A higher percentage (25.7%) of MTV videos than other network videos portrayed tobacco use. The percentage of videos showing alcohol use was similar on all four networks. In videos that portrayed tobacco and alcohol use, the lead performer was most often the one smoking or drinking and the use of alcohol was associated with a high degree of sexuality on all the videos. CONCLUSIONS These data indicate that even modest levels of viewing may result in substantial exposure to glamorized depictions of alcohol and tobacco use and alcohol use coupled with sexuality.

Exposure to violence and victimization and depression, hopelessness, and purpose in life among adolescents living in and around public housing.

This study examines the relationships between exposure to violence and depression, hopelessness, and purpose in life among black adolescents living in or around public housing developments. Black adolescents (N= 225, males = 44%) ages 11 to 19 years in a southern city were administered an anonymous questionnaire. Depression was correlated with the exposure to violence (r= .28), family conflict (r= .29), and corporal punishment (r= .32) scales, perceived probability of being alive at age 25 years (r = -.14), socioeconomic status of head of household (r = .14), anticipated socioeconomic status as an adult (r = .21), and number of sexual partners (r = .22). Based on multiple regression analysis, corporal punishment, family conflict, educational level of head of household, and perceived probability of being alive at age 25 years explained 18% (p ≤ .0001) of the variation in depression. Family conflict, corporal punishment, and unemployed head of household explained 11% of the variation in the hopelessness scale. Unemployed head of household, the corporal punishment scale, and number of sexual partners explained 9.7% of the variation in purpose in life. Even when accounting for other social factors, exposure to violence in the home was associated with psychological distress in this sample of adolescents.

The Social Ecology of Adolescent Alcohol Misuse.

A conceptual framework based on social ecology, social learning, and social control theories guided identification of social contexts, contextual attributes, and joint effects that contribute to development of adolescent alcohol misuse. Modeling of alcohol use, suggested by social learning theory, and indicators of the social bond, suggested by social control theory, were examined in the family, peer, school, and neighborhood contexts. Interactions between alcohol modeling and social bond indicators were tested within and between contexts. Data were from a longitudinal study of 6,544 students, 1,663 of their parents, and the U.S. Census. All contexts were uniquely implicated in development of alcohol misuse from ages 11 through 17 years, and most alcohol modeling effects were contingent on attributes of social bonds.

The association between weapon carrying and the use of violence among adolescents living in and around public housing

PURPOSE To test the hypothesis that adolescents who carry lethal weapons are more likely to engage in violent behavior than adolescents who do not carry weapons. DESIGN Cross-sectional Survey. SUBJECTS Black adolescents (N = 225) from a lower socioeconomic (SES) background living in or around nine Housing and Urban Development housing projects. MEASUREMENTS An anonymous questionnaire containing scales from the CDC Youth Risk Behavior Survey and Self-Reported Delinquency Questionnaire was administered. Data were analyzed with Spearman rho correlation coefficients (r), followed by partial correlation coefficients controlling for age and gender. RESULTS Thirty-five percent of males and 16% of females reported carrying a weapon during the previous 30 days. Frequency of weapon-carrying was correlated (r = .33, p < or = 0.0001). with the frequency of physical fights in the last month, but the relationship was stronger among males than females. Weapon-carrying was also associated (r = .20, p < or = 0.003) with frequency of receiving a serious injury during a fight and the frequency of attacking someone with a weapon with the idea of seriously hurting or killing them (r = .48, p < or = 0.0001). Although males were more likely to carry a hidden weapon than females, the frequency of weapon-carrying was more highly correlated with the frequency of carrying a hidden weapon by females (r = .63, p < or = 0.0001) than males (r = .49, p < or = 0.0001). Females who carried weapons were more likely than males to be involved in gang fights. Among males (r = .27, p < or = 0.008), frequency of weapon-carrying was correlated with frequency of attacking someone with whom they lived. This was not so among females (r = .02). CONCLUSION These data support the hypothesis that the lower SES black adolescents in this sample who carried weapons were more likely to engage in violent behaviors than those who did not carry weapons.

Attitudinal and behavioral correlates of condom use in urban adolescent males

To determine correlates of condom use in adolescent males, we administered a sexual behavior questionnaire to 105 urban males attending a general adolescent clinic. The mean age was 16.5 +/- 1.6 years, and all reported heterosexual activity during the prior 3 months. Condom use was significantly (p less than 0.05) associated with perceived hassle of use (Spearmans rho = -0.40), perception of girlfriends attitude toward condoms (rho = -0.36), self-confidence in correct use (rho = 0.26), younger age (rho = 0.25), reported degree of exposure to sexually transmitted disease (STD) education (rho = 0.23), perceived condom safety (rho = 0.23), and perceived risk of STD if not wearing a condom (rho = 0.21). Using stepwise multiple regression, four variables explained a significant amount of variation in condom use: perceived hassle of use, perceived girlfriends attitude toward condom use, age, and self-confidence in correct use (adjusted R2 = 0.28, p less than 0.001). Intention to use free condoms was significantly (p less than 0.05) associated with past use (rho = 0.63), girlfriends attitude toward use (rho = -0.46), self-confidence in correct use (rho = 0.36), perceived hassle (rho = -0.31), and degree of exposure to STD education (rho = 0.25). Three variables in a regression model explained a significant amount of variation in intent to use free condoms: self-reported past use, girlfriends attitude, and self-confidence in correct use (adjusted R2 = 0.51, p less than 0.001).