Vaughn I. Rickert

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.

Text message reminders to promote human papillomavirus vaccination

OBJECTIVE To implement and evaluate text message reminders for the second (HPV2) and third (HPV3) vaccine doses. DESIGN Site-based intervention. SETTING Nine pediatric sites (5 academic and 4 private) located in New York City. PARTICIPANTS Parents of adolescents 9-20 years who received HPV1 or HPV2 during the intervention period, January-June 2009. INTERVENTION Parents who enrolled received up to three weekly text message reminders that their daughter was due for her next vaccine dose. OUTCOME MEASURE On-time receipt of the next vaccine dose, within one month of its due date. RESULTS During the intervention period, of 765 eligible HPV vaccine events, 434 enrollment instructions were distributed to parents (56.7% of doses). Parents of 124 adolescent girls (28.6% of those handed instructions) activated text message reminders. Comparing children of parents who enrolled versus those who did not, on-time receipt of next HPV vaccine dose occurred among 51.6% (95% CI 42.8-60.4%) versus 35.0% (95% CI 29.6-40.2%) of adolescents (p=.001). Similarly, among a historical cohort of adolescents, receiving HPV1 or HPV2 in the six months prior to the intervention period, on-time receipt of next vaccine dose was noted for 38.1% (95% CI 35.2-41.0%) (p=.003). Increases in receipt of next vaccine dose among intervention subjects were sustained at 4 months following the vaccine due date. Using a logistic regression model, after controlling for insurance and site of care, intervention subjects were significantly more likely than either control population to receive their next HPV vaccine dose on-time. CONCLUSION Among those choosing to enroll, text message reminders were an effective intervention to increase on-time receipt of HPV2 or HPV3.

A prospective, controlled study of the effects of hormonal contraception on bone mineral density ☆

OBJECTIVE To compare the effect of depot medroxypro‐gesterone acetate (DMPA) and two types of oral contraceptives (OC) on bone mineral density (BMD) among women 18–33 years of age with those not using hormonal contraception. METHODS Data from 155 women were analyzed. Depot medroxyprogesterone acetate was administered to 33 women; 63 women who chose oral contraception were randomly assigned to receive either a norethindrone‐containing pill (n = 28) or a desogestrel‐containing pill (n = 35). Fifty‐nine women who did not use hormonal contraception served as controls. Lumbar spine BMD was determined using dual‐energy x‐ray absorptiometry at baseline and after 12 months of contraceptive use. We analyzed method‐related percent change in BMD while controlling for body mass index, calcium intake, exercise, and smoking. We had approximately 90% power to detect a 2.5% difference between any two groups. RESULTS Users of DMPA experienced a mean BMD loss of 2.74% over 12 months compared with controls who sustained a 0.37% loss (P = .01). Users of OCs generally demonstrated a gain (2.33% for norethindrone‐containing pills, 0.33% for desogestrel‐containing pills), which was different from controls among users of norethindrone‐containing pills (P = .01), but not among users of desogestrel‐containing pills (P = .99). Observed changes in BMD among DMPA users differed from women who used either type of pill (P < .002). CONCLUSION Depot medroxyprogesterone acetate has an adverse effect on BMD, in comparison with OCs or non‐hormonal methods, when used for 12 months. Results must be interpreted cautiously until it is determined whether these effects endure or are reversible.

Effects of hormonal contraception on bone mineral density after 24 months of use

OBJECTIVE: To measure the effect of 24 months of depot medroxyprogesterone acetate use on bone mineral density compared with oral contraception (pills) and nonhormonal contraception. METHODS: Women aged 18–33 years self-selected oral contraception, depot medroxyprogesterone acetate, or nonhormonal contraception (controls). Those selecting pills were randomized to formulations containing either 35 &mgr;g ethinyl estradiol and norethindrone or 30 &mgr;g ethinyl estradiol and desogestrel. Controls were frequency matched on age and race/ethnicity to hormonal contraception users. Dual-energy X-ray absorptiometry of the lumbar spine (L1–L4) was performed at baseline, 12 months, and 24 months. Percent change in bone mineral density was analyzed by using analysis of covariance, adjusting for age, race/ethnicity, weight-bearing exercise, calcium intake, smoking status, and body mass index. RESULTS: Of the 191 women making up the final sample, 86 used pills, 47 used depot medroxyprogesterone acetate, and 58 used nonhormonal contraception. Women using depot medroxyprogesterone acetate for 24 months experienced, on average, a 5.7% loss in bone mineral density, with a 3.2% loss occurring between months 12 and 24. On average, users of desogestrel pills experienced a 2.6% loss in bone mineral density after 24 months. Bonferroni-adjusted pairwise comparisons demonstrated that bone mineral density changes from baseline to 24 months among depot medroxyprogesterone acetate users differed significantly from changes experienced by either of the pill groups or the control group. Changes in bone mineral density among users of either pill did not significantly differ from each other or from controls. CONCLUSION: Loss of bone mineral density associated with depot medroxyprogesterone acetate use appears to be linear during the first 2 years of use. Shifts in bone mineral density among pill users were not significant when compared with controls. LEVEL OF EVIDENCE: II-1

Text4Health: a qualitative evaluation of parental readiness for text message immunization reminders.

We conducted focus groups and individual interviews in a diverse population of parents to qualitatively explore preferences and readiness for text message immunization reminders. We used content analysis to review and independently code transcripts. Text message reminders were well-accepted by parents; many thought they would be more effective than standard phone or mail reminders. Parents preferred text message reminders to be brief and personalized. Most parents were able to retrieve sample text messages but many had difficulty with interactive texting.

Date Rape Among Adolescents and Young Adults

BACKGROUND Adolescents and young adults are four times more likely to be victims of sexual assault than women in all other age groups. In the vast majority of these cases, the perpetrator is an acquaintance of the victim. Date rape is a subset of acquaintance rape where nonconsensual sex occurs between two people who are in a romantic relationship. METHODS We conducted a MEDLINE and Current Concepts search for articles relating to date rape and then systematically reviewed all relevant articles. RESULTS Lifetime prevalence of date or acquaintance rape ranges from 13% to 27% among college-age women and 20% to a high of 68% among adolescents. Demographic characteristics that increase vulnerability to date rape include younger age at first date, early sexual activity, earlier age of menarche, a past history of sexual abuse or prior sexual victimization, and being more accepting of rape myths and violence toward women. Other risk factors include date-specific behaviors such as who initiated, who paid expenses, who drove, date location and activity, as well as the use of alcohol or illicit drugs such as flunitrazepam (Rohypnol). Alcohol use that occurs within the context of the date can lead to: the misinterpretation of friendly cues as sexual invitations, diminished coping responses, and the females inability to ward off a potential attack. CONCLUSIONS Longitudinal research designs are needed to further our understanding of sexual violence among adolescents and young adults and the most effective ways to eliminate it. Understanding and comparing research findings would be easier if consensus regarding the definitions of date rape, sexual aggression, and sexual assault was obtained. Finally, primary and secondary date and acquaintance rape prevention programs must be developed and systematically evaluated.

Pregnant adolescents: experiences and behaviors associated with physical assault by an intimate partner.

Objective: To better understand the experiences and behaviors of battered pregnant adolescents and the characteristics of their intimate partners. Methods: As part of a longitudinal multiracial/ethnic study of drug use among pregnant and parenting adolescents, 724 adolescents ≤18 years of age completed face-to-face interviews on the postpartum unit between April 1994 and February 1996. Adolescent mothers reported on demographic characteristics, social support and peer contact, level of substance use before and during pregnancy, nonconforming behaviors, and both lifetime and concurrent exposure to violence. Information about the father of her baby included his level of substance use, gang and police involvement, and intimate partner violence. Chi-square and Students t tests were used to identify victim, partner, and relationship characteristics associated with being assaulted by the father of her baby during the preceding year. Results: Eighty-six (11.9%) adolescents reported being physically assaulted by the fathers of their babies. Assaulted adolescents were significantly more likely than nonassaulted adolescents to have been exposed to other forms of violence over the same 12-month period, including verbal abuse, assault by family members, being in a fight where someone was badly hurt, reporting fear of being hurt by other teens, witnessing violence perpetrated on others, and carrying a weapon for protection. A history of nonconforming behavior and frequent or recent substance use was more common among both battered adolescents and their perpetrator partners. The age and race/ethnicity of the pregnant adolescent and the length of her relationship with the father of her baby were not associated with assault status. Conclusions: Pregnant adolescents who are assaulted by intimate partners appear to live in violence-prone environments and to have partners who engage in substance use and other nonconforming behaviors. Comprehensive assessments are critical for all adolescent females at risk of assault, and direct questions about specific behaviors or situations must be used.

Is lack of sexual assertiveness among adolescent and young adult women a cause for concern

CONTEXT Understanding young womens sexual assertiveness is critical to developing effective interventions to promote sexual health and reduce sexual risk-taking and violence. Young womens perception of their sexual rights may vary according to demographic characteristics, sexual health behaviors and victimization history. METHODS Data were collected from 904 sexually active 14-26-year-old clients of two family planning clinics in Texas, reflecting their perceptions of their right to communicate expectations about or control aspects of their sexual encounters. Logistic regression analysis was used to assess which characteristics were independently associated with believing that one never has each specified sexual right. RESULTS Almost 2096 of women believed that they never have the right to make their own decisions about contraception, regardless of their partners wishes; to tell their partner that they do not want to have intercourse without birth control, that they want to make love differently or that their partner is being too rough; and to stop foreplay at any time, including at the point of intercourse. Poor grades in school, sexual inexperience, inconsistent contraceptive use and minority ethnicity were independently associated with lacking sexual assertiveness. CONCLUSIONS Many sexually active young women perceive that they do not have the right to communicate about or control aspects of their sexual behavior. Interventions to prevent sexually transmitted diseases, unwanted pregnancy and coercive sexual behaviors should include strategies to evaluate and address these perceptions.

Human Growth Hormone: A New Substance Of Abuse Among Adolescents?

It has been estimated that as many as 250,000 adolescents are using anabolic steroids (AS). Recently, anecdotal reports suggest that athletes may also be using human growth hormone (HGH). The purpose of the present study was to determine the following: 1) if adolescents in two suburban midwestern high schools (83% white, 14% Asian, and 3% black) were using HGH; 2) knowledge of its effects; 3) reasons for use; and 4) concurrent AS use. After we obtained informed written consent, 224 male and 208 female 10th-grade students were surveyed using a 15-item questionnaire. Of male students surveyed, 5% (n = 11) reported past or present use of HGH, and one female student reported use. Our data suggest that among male adolescents surveyed, a majority had heard of this substance, and 31 % of males reported knowing someone who was using HGH. Chi-square analysis found a significant association between AS and HGH use where seven AS users reported past or present use of HGH. Most HGH users were unaware of its side effects and reported first use between 14 and 15 years of age. No differences in sports activity, ethnicity, or age were found between users and nonusers of HGH.

Effects of a peer-counseled AIDS education program on knowledge, attitudes, and satisfaction of adolescents

Education programs for adolescents regarding acquired immunodeficiency syndrome (AIDS) have been advocated by many professionals to help minimize the risk of infection in this population. This study compares a peer-led vs. an adult-led AIDS education program on the knowledge, attitudes, and satisfaction of the adolescents with their education. Eighty-two male and female adolescents, ranging in age from 12 to 18 years, were randomly assigned to a peer (n = 27), adult (n = 28), and control (n = 27) group. Intervention consisted of receiving didactic information and viewing a videotape about AIDS transmission and prevention. All subjects completed the AIDS Knowledge Questionnaire-Revised, AIDS Attitude Survey, and a measure of consumer satisfaction. Statistical analyses revealed a significant effect for knowledge and attitudes toward practicing personal preventive behaviors and the seriousness of AIDS; both peer- and adult-led groups were superior to controls (p less than 0.05). With the exception of satisfaction with providers, no other significant effects were found across the intervention groups. Satisfaction with providers showed an effect for sex (p less than 0.05). Female adolescents reported more satisfaction with presenters than male adolescents did. Although both adult and peer counselors were equally effective in promoting knowledge gains and appropriate attitude changes, more questions were asked of the peer counselors. These data suggest that when education is presented by peer counselors, adolescents may be more likely to see AIDS as a personal danger and that peer counselors should be considered when designing comprehensive AIDS education programs.