Cognitive and behavioral predictors of sexually transmitted disease risk behavior among sexually active adolescents

A Smartphone-Based Pilot HIV Prevention Intervention (Sakhi) among Transgender Women who Engage in Sex Work in India: Efficacy of a Pre- and Post-Test Quasi-Experimental Trial

Transgender women (TGW) in India, especially those who engage in sex work, are at high risk for HIV. Guided by the information-motivation-behavioral skills model and qualitative formative research findings, Sakhi (girlfriend), a 3-week smartphone-based pilot intervention consisting of short videos (one/week) and text messages (two/week), was implemented using a one-group pre- and post-test design to test its efficacy in promoting condom use and HIV testing among TGW (N = 50) who engage in sex work in Chennai. Changes in outcomes were assessed by conducting multivariable analyses using generalized estimating equations. Participants' mean age was 26 years, and the mean monthly income was INR 21700 (USD 292). About one-third completed college, and 96% were HIV-negative. Significant changes in the desired direction were observed in the primary outcomes: condom use - decrease in the engagement of condomless anal sex with male partners (12% to 2%, p < 0.05) and HIV testing - increase in intentions to undergo HIV testing every 6 months (34% to 86%, p < 0.001); and in some of the secondary outcomes: decrease in alcohol use before sex, increase in intentions to use condoms consistently and increase in the well-being score. This study demonstrated the feasibility, acceptability, and preliminary efficacy of the Sakhi intervention and warrants a larger randomized trial among diverse sub-groups in diverse settings.

Addressing Military Sexual Violence by Proposing a Social Media Influencer Model

Military sexual violence (MSV) is a prevalent issue that uniquely affects mission readiness. Although research on MSV and social media is growing, examinations of possible interventions like those employing social media in this population are scant. Given the growing interest in targeting MSV, the present systematic review was conducted. The PRISMA framework was used to conduct a systematic review of MSV and social media (N = 71). Queries were limited to articles published between 2010 and 2020. SAGE Journals, PubMed, and JSTOR were utilized. Terms and potential combinations were entered into the databases in varying Boolean combinations. Additional recorders were identified for inclusion via the reference sections of relevant records. After removing duplicates from the query results, we selected records of suspected relevance by title and screened abstracts. Finally, articles with relevant abstracts were reviewed thoroughly to determine whether they met inclusion criteria for the review. The employments of military leaders in a social media intervention puts into practice the military's central values and development of its leadership core. This intervention promotes group solidarity while maximizing conversations around meaningful messages. Findings in this review suggest military leaders could feasibly employ a cost-effective global intervention using social media, as a tool to help actively address MSV.

Adolescent Women's Sexual Self-Efficacy: Associations with Personal and Perceived Partner Beliefs that Condoms Interfere with Pleasure

Sexual self-efficacy, an individual's confidence in the domain of sexual health behaviors, was studied among an ethnically diverse sample of 128 sexually active adolescent women between the ages of 14 and 18 years. A hypothesized interaction between women's belief that condoms interfere with sexual pleasure and her perception of a partner's belief that condoms interfere with sexual pleasure was not supported. Both adolescent women's belief that condoms interfere with pleasure and their perception that their partner believed condoms interfere with pleasure were separately associated with lower self-efficacy to refuse sex without condoms and use condoms. Both a partner's and one's own sexual pleasure may be important determinants of adolescent women's confidence to engage in health protective sexual behaviors. Adolescents' self-efficacy to experience pleasure when using condoms should be enhanced.

The impact of a syndemic theory-based intervention on HIV transmission risk behaviour among men who have sex with men in India: Pretest-posttest non-equivalent comparison group trial

This study aimed to examine the effect of a syndemic theory-based intervention to reduce condomless anal intercourse among men who have sex with men (MSM) in India. In 2016/17, a pre- and post-test comparison group design was used to implement a syndemic theory-based intervention among 459 MSM (229, intervention; 230, standard-of-care comparison) recruited through non-governmental organizations in Chandigarh, India. The intervention group received two-session peer-delivered motivational interviewing-based HIV risk reduction counselling and skills training to improve sexual communication/negotiation and condom use self-efficacy, and screening/management of psychosocial health problems. The intervention's effect on consistent condom use was estimated using difference-in-differences (DiD) approach. Mediation analysis assessed the extent to which intervention effects on the outcome were mediated by changes in psychosocial health problems and condom use self-efficacy. A process evaluation assessed implementation fidelity and intervention acceptability. Baseline consistent condom use was 43% in the intervention group and 46% in the standard-of-care group. Baseline survey findings demonstrated that a psychosocial syndemic of problematic alcohol use, internalised homonegativity and violence victimisation synergistically increased condomless anal intercourse. Using DiD, we estimated that the intervention increased consistent condom use with male partners by 16.4% (95% CI: 7.1, 25.7) and with female partners by 28.2% (95% CI: 11.9, 44.4), and decreased problematic alcohol use by 24.3% (95%CI: -33.4, -15.3), depression by 20.0% (95% CI: -27.6, -12.3) and internalised homonegativity by 34.7% (95% CI: -43.6%, -25.8%). The mediation analysis findings suggested that the intervention might have improved consistent condom use by decreasing internalised homonegativity and by increasing condom use self-efficacy. The process evaluation showed high levels of acceptability/satisfaction among participants and high levels of implementation fidelity. A syndemic theory-based intervention tailored for MSM in India is feasible, acceptable, and can reduce HIV transmission risk behaviour as well as problematic alcohol use, depression and internalised homonegativity.

Dealing with pre-exposure prophylaxis-associated condom migration: changing the paradigm for men who have sex with men

The behavioural aspects of pre-exposure prophylaxis (PrEP) are challenging, particularly the issue of condom migration. Three vital questions are: (1) at the population-level, will condom migration lead to increases in non-viral sexually transmissible infections?; (2) how can clinic-based counselling best promote the dual use of condoms and PrEP?; and (3) in future PrEP trials, what are the 'best practices' that should be used to avoid type 1 and type 2 errors that arise without accounting for condom use behaviours? This communication piece addresses each question and suggests the risk of a 'PrEP only' focus to widening health disparities.

Condom use attitude and self-efficacy, and STIs risk perception among Iranian female sex workers: A psychometric study

In this cross-sectional study, we aimed to investigate psychometric properties of the Persian versions of condom use self-efficacy (CUSES), attitude toward condom use (ATCUS), and sexually transmitted infection risk perception (STIsRP) scales among Iranian female sex workers (FSWs). We translated original versions of the scales into Persian, and through census, recruited and interviewed 140 FSWs. Appropriate validity, reliability, functionality and simplicity were demonstrated for the scales. We found the measurement model with a good fit to the data (χ² [104] = 89.537, p < .01, CFI = 0.978, NFI = 0.931, TLI = 0.981, RMSEA = 0.055 [0.023-0.081]). Our findings supported the applicability of the Persian CUSES, ATCUS, and STIsRP in the Iranian and other Persian-speaking FSW populations.

Pathways From Peer Victimization to Sexually Transmitted Infections Among African American Adolescents

African American youths, especially those in low resource communities, are vulnerable to peer victimization, which can increase risk of sexually transmitted infections. However, few studies explored the relationship between these two health concerns and the pathways that may link them. The present study aimed to address this gap. We used descriptive statistics, correlation coefficients, and structural equation modeling to analyze data collected from 277 adolescents ages 13 to 24 years in Chicago. Primary results indicated that peer victimization was not directly related to acquisition of sexually transmitted infections. However, peer victimization was negatively associated with condom use, and condom use was negatively associated with sexually transmitted infections. Furthermore, affiliation with sexually active peers was positively associated with substance use. These findings have implications for bullying and sexual risk prevention and intervention of low-income youths. Attention to treatment approaches and interventions that are holistic and culturally feasible is recommended for practitioners working with urban youth.

The Effects of School-Based Discrimination on Adolescents of Color Sexual Health Outcomes: A Social Determinants Approach

Social inequalities are at the heart of disparities in sexual health outcomes among African American and Latino/a adolescents living in the United States. Schools are typically the largest and primary context in youth development. School characteristics such as peer and teacher discrimination and school performance were examined to determine whether such characteristics predict sexual behavior in adolescents of color. This study utilized a representative sample of high school age students to assess sexual risk behavior. Findings indicate that there was a clear disparity in sexually transmitted infection diagnoses. School characteristics such as teacher discrimination and Grade Point Average were significant predictors to sexual risky behaviors among adolescents of color. The study adds to the literature in examining contextual factors that are associated with adolescent sexual risk behavior, and findings provide implications for future prevention work.

Sexually Transmitted Diseases and Managed Care: An Inquiry and Review of Issues Affecting Service Delivery

To understand the potential role of managed care organizations (MCOs) in prevention and control of sexually transmitted diseases (STDs), we conducted a systematic review of articles on STDs and managed care and sought qualitative information from MCOs on STD-related activities. The review focused on prevention, risk assessment, patient education, counseling, screening, and costs of care, but revealed relatively few published articles. Barriers to STD service delivery included competing priorities, lack of time or supporting organizational structures, and differing mandates of health departments and MCOs. Facilitators included collaboration between health departments and MCOs, regulatory and performance incentives, buy-in from key stakeholders, availability of infrastructure to support data collection, and inclusion of chlamydia screening in the Health Employer Data and Information Set to monitor plan performance. Because of the shift of STD service delivery from the public to private sector, incentives need to maximize interest and cooperation of patients, clinicians, and MCOs in STD prevention.

Anabolic-androgenic steroids and condom use: potential mechanisms in adolescent males

Previous research has revealed a significant bivariate relationship between anabolic-androgenic steroid (AAS) use and reduced condom use among adolescent boys. However, to date, no known studies have explored the psychological mechanisms that may explain this relationship. Thus, the current study sought to examine two possible mediators in the association between AAS and condom use: depressive symptoms and substance use. Data were extracted from a nationally representative sample of U.S. adolescents. Participants were 3,780 U.S. high school boys who responded to self-report items assessing a number of health behaviors, including symptoms of depression, substance use, AAS use, and use of condoms during their most recent act of intercourse. Both depression and substance use were significant mediators in the relationship between AAS and condom use. However, when these effects were contrasted, the indirect effect of substance use was significantly stronger in magnitude than the effect of depression. Although AAS use was associated with sexual risk behaviors among adolescent boys, significant variance in this relationship was accounted for by elevated levels of depression and substance use, with substance use demonstrating a particularly salient pathway.

Condom migration resulting from circumcision, microbicides and vaccines: brief review and methodological considerations

OBJECTIVE

To provide an updated review of condom migration as a means of highlighting methodological issues for future studies of this behavioural issue.

METHODS

Electronic searches of PubMed, MEDLINE and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were carried out in October 2010 and updated in January 2011 for English-language articles published from 1994 onward.

RESULTS

Evidence addressing condom migration from microbicides and vaccines is vastly underdeveloped, simply because these products are still experimental. In contrast, the more advanced evidence regarding male circumcision is hopeful because it suggests that migration may not be an overwhelming issue. Nonetheless, the entire body of empirical evidence on this question could be substantially expanded and improved.

CONCLUSION

Until stronger evidence suggests that condom migration is unlikely, it is important to be mindful of the potential for condom migration to occur in response to biomedical interventions (circumcision, microbicides and vaccines).

A Clinic-Based Youth Development Program to Reduce Sexual Risk Behaviors Among Adolescent Girls

Multifaceted, sustained efforts are needed to reduce early pregnancy and sexually transmitted diseases among high-risk adolescents. An important area for research is testing youth development interventions offered through clinic settings, where access to high-risk adolescents is plentiful and few efforts have rigorously evaluated a dual approach of building protective factors while addressing risk. This article presents findings from a pilot study of Prime Time, a clinic-based youth development intervention to reduce sexual risk behaviors among girls at risk for early pregnancy. Girls aged 13 to 17 years meeting specified risk criteria were assigned to Prime Time treatment groups. The Prime Time intervention included a combination of case management services and peer leadership groups. Participants completed self-report surveys at baseline, 12 and 18 months following enrollment. At 12 months, the intervention group reported significantly fewer sexual partners than the control group. At 18 months, the intervention group reported significantly more consistent condom use with trends toward more consistent hormonal and dual method use. Dose-response analyses suggested that relatively high levels of exposure to a youth development intervention were needed to change contraceptive use behaviors among adolescents at risk for early pregnancy. Given promising findings, further testing of the Prime Time intervention is warranted.

Alcohol and STI risk: evidence from a New Zealand longitudinal birth cohort

BACKGROUND

The present study examined the associations between involvement with alcohol and risks of sexually transmitted infection (STI) during adolescence and early adulthood.

METHODS

A 30-year prospective longitudinal study of the health, development, and adjustment of a birth cohort of 1265 New Zealand-born individuals. Measures included repeated assessments of frequency of alcohol use and number of symptoms of alcohol disorder from ages 15 to 30 and rates of STI from ages 14 to 30. Conditional fixed effects regression models augmented by observed time-dynamic covariate factors were used to control for non-observed confounding in the associations between alcohol and STI risk.

RESULTS

There were clear and consistent trends for increasing involvement with alcohol to be linked with increased risk of STI diagnoses. Adjustment of the associations for sources of non-observed confounding and time-dynamic covariate factors reduced the magnitude of these associations, but they remained statistically significant (p < .05).

CONCLUSIONS

The results of the current study support the notion of the existence of a causal pathway in which increasing levels of alcohol use and symptoms of alcohol abuse/dependence led to increased risks of STI exposure. There was little evidence to suggest that the links between alcohol involvement and STI risk could be fully explained by an underlying predisposing factor that increased the risks of both alcohol involvement and STI.

The effects of psychological inoculation on cognitive barriers against condom use in women with HIV: A controlled pilot study

Past studies have shown that in attempts to prevent HIV, health education yields little change in condom use. The reason may be that education fails to target barriers for changing behaviour. The present controlled pilot study tested whether psychological inoculation (PI) reduces such barriers for using male condoms. Twenty-two Nigerian women with HIV were randomly assigned to receive PI or health education (control). In the PI condition, women learned to refute sentences reflecting barriers against condom use, while controls learned how to use condoms and the consequences of their non-use. Barriers for condom use, self-efficacy to negotiate condom use with partners and actual condom use were self-reported before and one week after interventions. Results revealed that only in the PI group were there statistically significant increases in condom use negotiating self-efficacy and reductions in barriers concerning motivation, sexual satisfaction and partners. Controls reported no statistically significant changes. However, actual reported condom use was unchanged in both groups. Thus, it is feasible to conduct PI interventions in an African sample of HIV patients. Furthermore, PI can reduce cognitive barriers for condom use, while health education yields little changes in such outcomes over time. If replicated in larger samples with longer follow-ups, these findings could eventually have implications for HIV prevention in several world regions.

Multi-system influences on adolescent risky sexual behavior

We examined multi-system influences on risky sexual behavior measured by cumulative sexual risk index and number of nonromantic sexual partners among 4,465 single, sexually experienced adolescents. Hierarchical Poisson regression analyses were conducted with Wave I-II data from the National Longitudinal Study of Adolescent Health. Individual and family factors predicted both outcome measures. Neighborhood set predicted cumulative sexual risk index only, and peer factors predicted the number of nonromantic sexual partners only. School set did not predict either outcome. There were significant associations among risky sexual behavior, drug use, and delinquent behaviors. The results highlight the need for multifaceted prevention programs that address relevant factors related to family, peer and neighborhood influence as well as individual factors among sexually active adolescents.

Individual, interpersonal, and relationship factors predicting hormonal and condom use consistency among adolescent girls

INTRODUCTION

Few existing studies have considered influences of adolescents' sexual partners on contraceptive consistency. This study examines the influence of personal characteristics, partner characteristics, and relationship factors on consistency of contraceptive use among an ethnically diverse sample of adolescent girls at high risk for pregnancy and sexually transmitted diseases.

METHOD

Data are from 110 sexually active 13- to 17-year-old girls participating in a clinic-based intervention study aimed at reducing sexual risk behaviors. Personal characteristics were assessed at baseline (T1), and partner and relationship characteristics were assessed at 12 months (T2).

RESULTS

Multivariate analyses revealed that T2 hormonal contraceptive consistency was predicted by T1 hormonal consistency, girls' desire to use birth control, having the same sexual partner at T1 and T2, perceived partner support for birth control, and communication with partner about sexual risk. T2 condom use consistency was negatively predicted by emergency contraceptive use history and perceived partner support for birth control.

DISCUSSION

Findings underscore the importance of nurses addressing both personal and relationship factors in their efforts to promote consistent contraceptive use among sexually active adolescent girls.

Competence as a predictor of sexual and reproductive health outcomes for youth: a systematic review

To examine the association between "competence" and adolescent sexual and reproductive health (ASRH) outcomes. Competence refers to the development of skills to perform tasks successfully in four areas including social and behavioral, cognitive, emotional, and moral competence. We conducted a systematic review of research published from 1985 through 2007. Inclusion criteria included use of multivariate analyses, a sample size of >or=100, publication in a peer-reviewed journal, and measurement of an ASRH outcome. We coded findings as protective, risk, or no association and as longitudinal or cross-sectional. We considered the presence of two longitudinal studies with consistent findings for at least one outcome to be sufficient evidence for a risk or protective association. We identified 77 studies that examined cognitive competence, 27 studies that examined social and behavioral competence, 12 studies that examined emotional competence, and no studies that met inclusion criteria for moral competence. The evidence indicated that cognitive competence and social and behavioral competence can be protective factors for ASRH, with findings from at least two longitudinal studies demonstrating a protective association with an ASRH outcome. Findings across cognitive, social and behavioral subconstructs and ASRH outcomes were more mixed. There was insufficient evidence to draw conclusions about emotional and moral competence and ASRH. Helping adolescents to achieve cognitive, social, and behavioral competence may reduce the likelihood of sexual activity and teen pregnancy, and increase contraceptive use. Additional research is needed to examine other outcomes and the generalizability of findings.

Confidence as a predictor of sexual and reproductive health outcomes for youth

PURPOSE

To assess the association between four positive youth development (PYD) constructs of confidence and adolescent sexual and reproductive health (ASRH) outcomes.

METHODS

We searched nine online databases to locate behavioral research that examined the association between four constructs of confidence (belief in the future, self-determination, clear and positive identity, and self-efficacy) and ASRH outcomes (e.g., ever had sex, condom use, contraception use, number of partners, pregnancy/birth, and sexually transmitted infection). Findings were coded as "protective," "risk," or "no association." The presence of at least two longitudinal studies reporting consistent significant associations for at least one ASRH outcome indicated evidence for a protective or risk association.

RESULTS

We found evidence to support two of the four PYD constructs of confidence (belief in the future and self-determination) as protective factors for ASRH outcomes. Evidence was insufficient to draw conclusions about clear and positive identity as a protective factor, and was mixed for self-efficacy. Measures of confidence varied considerably across the studies reviewed, reflecting varying definitions; often, the measures used had limited information on reliability. Few longitudinal investigations were identified, and available studies were inconsistent in how they examined the association between the PYD constructs and ASRH outcomes. Evidence for most constructs was insufficient to identify their influence on specific sub-groups of youth.

CONCLUSIONS

Despite the need for additional research, this review suggests that belief in the future and self-determination are promising protective factors. Further research is needed to better understand the potential for self-efficacy and clear and positive identity as protective factors.

Protective and risk factors for sexually transmitted infections in middle school students

PURPOSE

Significant numbers of adolescents are initiating sexual activity at age 13 and younger. Little is known about this younger population of adolescents. This includes risk or protective factors for sexual activity and sexually transmitted infection (STI) acquisition. To safeguard all adolescents from the consequences of risky sexual behaviors, and to insure age appropriate and effective interventions, further study is critical to address risky behaviors specific to early adolescents.

METHODS

This study was a retrospective chart review of 155 sexually active adolescent girls enrolled in 3 inner city school-based health centers. Students were divided into those who never had a documented STI and those who had 1 or more STIs. Data were collected from a sexual history questionnaire and the Guidelines for Adolescent Preventive Services questionnaire. These data were grouped into risk or protective Guidelines for Adolescent Preventive Services domains. Domains were made up of 5 items of protective factors, 3 items of peer risks, 2 items of family risks, and 7 items of individual risks. STI outcomes were compared to these characteristics.

RESULTS

One hundred fifty-five sexually active black adolescents were studied. A univariate and multivariate analysis of risk and protective factors for testing positive for an STI demonstrated that high levels of protective factors reduced the risk of STIs.

CONCLUSION

Increased levels of protective factors were associated with a decrease in STI risk. This suggests that STI prevention programs should focus on increasing protective factors among young adolescents in addition to reducing risk factors.

Adapting an HIV prevention intervention for high-risk, incarcerated adolescents

This study examined the effectiveness of an adapted 4-session HIV prevention program. Participants included 490 adolescents who participated in either the 8- or the adapted 4-session HIVEd program. Analyses to identify mean changes in HIV-related knowledge, attitudes, self-efficacy, and behavioral intentions between participants in either the 4- (n = 274) or 8-session (n = 216) programs were completed. Findings indicate participants in both programs had positive changes at post interview across all study outcomes. No significant differences in changes between participants in the 4- and 8-session programs were found except that male adolescents in the 4-session program had significantly higher mean changes in condom knowledge (p < .01). The adaptation of the 8-session HIVEd program was undertaken to better reach and accommodate the needs of a high risk incarcerated adolescent population. Findings demonstrate that HIV prevention interventions for high risk populations may be successfully adapted and condensed when based on rigorously evaluated and theoretically driven programs.

Psychological and behavioural factors associated with sexual risk behaviour among Slovak students

Background

Knowledge about the prevalence of sexual risk behaviour (SRB) in adolescence is needed to prevent unwanted health consequences. Studies on SRB among adolescents in Central Europe are rare and mostly rely on a single indicator for SRB. This study aims to assess the association of behavioural and psychological factors with three types of SRB in adolescents in Central Europe.

Methods

We obtained data on behavioural factors (having been drunk during previous month, smoking during previous week, early sexual initiation), psychological factors (self-esteem, well-being, extroversion, neuroticism, religiousness), and SRB (intercourse under risky conditions, multiple sexual partners, and inconsistent condom use) in 832 Slovak university students (response 94.3%).

Results

Among those with sexual experience (62%), inconsistent condom use was the most prevalent risk behaviour (81% in females, 72% in males). With the exception of having been drunk in males, no factor was associated with inconsistent condom use. Regarding the other types of SRB, early sexual initiation was most strongly associated. In addition, other, mostly behavioural, factors were associated, in particular having been drunk.

Conclusion

Results suggest that behavioural factors are more closely related to SRB than psychological factors. Associations differ by type of SRB and gender but offer few clues to target risk groups for inconsistent condom use. Results show a high need for health-promotion programmes in early adolescence that target SRB in conjunction with other health risk behaviours such as alcohol abuse.

Impulsivity and its Relationship to Risky Sexual Behaviors and Drug Abuse

We examined a mediational model of the inter-relationship of drug use, sexual risk and impulsivity in a sample of young adults (N = 89), of which almost half displayed highly disruptive behaviors as children. We chose a mediational model given the emerging evidence that impulsivity is an underlying risk factor for many youth health risk problems, including sexual risk behaviors. The findings supported a partial mediational model in that the three target variables were significantly related to each other, yet the association of drug use and sexual risk was significantly reduced (although not to zero) when controlled by impulsivity. The findings support the view that the association of drug use and sexual risk behaviors is partially mediated by impulsivity, as well as the broader theory that youth with deficits in self-regulatory behavioral systems confer a greater likelihood of engaging in risky behaviors. Study implications and limitations are discussed.

Associations between health screening questions and sexual risk behaviors in adolescent female clinic patients: identifying a brief question format to yield critical information

This study examines the ability of brief screening questions to identify adolescent girls at high risk for sexually transmitted infections and teen pregnancy. Participants included 103 sexually active 13-year-old to 17-year-old girls recruited from adolescent clinics who (1) were identified as at risk for negative sexual health outcomes through responses to an 8-item Health Screening Survey, and (2) returned to clinic within 2 weeks to complete a self-report survey about sexual risk behaviors and contraceptive use. Analyses examined relationships between girls' total screening scores, individual screening survey items, and 5 self-reported sexual risk behaviors. Higher screening scores correlated with lower levels of refusing unprotected sex and less consistent condom use (P < .05 and P < .01, respectively). High-risk responses to 2 screening items were associated with all 5 sexual risk behaviors. Findings suggest useful questions in routine clinical screening of sexually active adolescent girls to identify those at high levels of sexual risk.

Psychosocial predictors of HIV-associated sexual behaviors and the efficacy of prevention interventions in adolescents at-risk for HIV infection: what works and what doesn't work?

The HIV epidemic among adolescents in the United States is inherently tied to individual, psychosocial, and cultural phenomena. Expanding intervention development and implementation to incorporate a broader spectrum of determinants of adolescents' sexual risk for sexually transmitted infections (STIs)/HIV acquisition may provide an opportunity to prevent disease transmission more effectively. To address the STI/HIV prevention needs of adolescents, we highlight research assessing adolescents' sexual risk behavior and place the findings in the context of the diverse array of psychosocial factors influencing adolescents. This synthesis provides an opportunity to examine why adolescents engage in risky sexual behavior and to review the effectiveness of theory-based prevention programs. Subsequently, we offer recommendations for improving future programs aimed at reducing the incidence of STI/HIV infection among adolescents.

Personal, relational, and peer-level risk factors for laboratory confirmed STD prevalence among low-income African American adolescent females

OBJECTIVES

To identify risk factors for laboratory confirmed sexually transmitted disease (STD) prevalence among low-income African American adolescent females living in a high-risk urban area of the Southern United States.

METHODS

Participants were 715 African American adolescent females recruited from urban clinics. Data collection occurred from 2002 to 2004 and included an audio-computer assisted self-interview lasting about 60 minutes and a self-collected vaginal swab for NAAT to detect Trichomonas vaginalis, Chlamydia trachomatis, and Neisseria gonorrhoeae. Ten personal-level risk factors were assessed as well as 8 risk factors involving either peer or relational factors.

RESULTS

Adolescents (28.8%) tested positive for at least 1 STD. Six personal-level and 4 social-level measures achieved a bivariate screening level of significance. In the multivariate model, only 3 measures achieved significance: gang involvement, social support from peers, and fear of condom use negotiation. Compared to those who had never belonged to a gang, those who had were about 4.2 times more likely (95% CI = 2.16-9.44) to test positive. Adolescents' who had higher levels of fear pertaining to condom use negotiation were more likely to test positive as were adolescents who perceived higher levels of social support from their peers.

CONCLUSIONS

This finding suggests and supports the utility of designing interventions for high-risk African American adolescent females that incorporate objectives to modify the significant social influences related to STD acquisition.

Susceptibility of middle adolescent females to sexually transmitted infections: impact of hormone contraception and sexual behaviors on vaginal immunity

PROBLEM

The resistance and/or susceptibility to infections can be influenced by patterns of immunomodulators. Based on this and the high rate of sexually transmitted infections (STIs) in adolescents, we examined the longitudinal relationship between sexual behaviors, hormonal contraceptive use, and bacterial vaginosis (BV) with vaginal-associated immunomodulators in adolescent females.

METHOD OF STUDY

Over 27 months, subjects completed detailed questionnaires, and consented to vaginal swabs for STI testing, and vaginal lavages for identification of immunomodulators including T-helper, proinflammatory, and chemokines. Concentrations of immunomodulators were correlated with each parameter together with prevalence of STIs.

RESULTS

Each parameter had a limited influence on vaginal immunomodulators with no evidence of any pattern(s) associated with infection. Conversely, the local presence of proinflammatory cytokines and neutrophils in those with an STI indicated some immune responsiveness.

CONCLUSION

Sexual behaviors, contraceptive usage, and BV do not appear as factors in susceptibility of adolescents to STIs through the influence of local immunomodulators.

Oral contraceptive use may not preclude condom use: a study of non-pregnant African-American adolescent females

OBJECTIVE

To determine the association between oral contraceptive and condom use, and laboratory-confirmed sexually transmitted infection (STI) among African-American adolescent females at a high risk of STI acquisition.

METHODS

A cross-sectional study of 715 African-American adolescent females (15-21 years old) was conducted. Data collection included (a) an audio-computer-assisted self-interview and a self-collected vaginal swab for nucleic acid amplification testing of Trichomonas vaginalis, Chlamydia trachomatis and Neisseria gonorrhoeae.

RESULTS

The age-adjusted odds ratio (AOR) indicated a modest protective effect of oral contraceptive use against unprotected vaginal sex (UVS) using a 60-day recall period (AOR = 0.66; 95% CI 0.43 to 0.99). The age-adjusted difference in mean frequency of UVS in the past 60 days was non-significant (p = 0.23) as was condom use at last sex (p = 0.34). The age-AOR relative to STI prevalence also showed a protective effect (AOR = 0.60; 95% CI 0.36 to 0.98) for those using oral contraceptives.

CONCLUSION

The findings suggest that the use of oral contraceptives may not preclude safer sex practices for the prevention of STIs among high-risk African-American adolescent females.

Prevention and control of sexually transmitted infections among adolescents: the importance of a socio-ecological perspective--a commentary

The sexually transmitted infection (STI) epidemic among adolescents in the USA is inextricably tied to individual, psychosocial and cultural phenomena. Reconceptualizing the epidemic within an expanded socio-ecological framework may provide an opportunity to better confront its challenges. In this article, we use a socio-ecological framework to identify determinants of adolescents' sexual risk and protective behaviours as well as antecedents of their STI acquisition. The goal is to provide a synthesis of several discrete categories of research. Subsequently, we propose an integrated strategy that addresses the STI epidemic among adolescents by promoting a socio-ecological perspective in both basic research and intervention design. This approach may expand the knowledge base and facilitate the development of a broader array of intervention strategies, such as community-level interventions, policy initiatives, institutionally based programmes, and macro-level societal changes. Although there are inherent challenges associated with such an approach, the end result may have reciprocal and reinforcing effects designed to enhance the adoption and maintenance of STI-preventive practices among adolescents, and further reduce the rate of STIs.

Depressive symptoms as a longitudinal predictor of sexual risk behaviors among US middle and high school students

OBJECTIVE

The purpose of this study was to examine whether depressive symptoms are predictive of subsequent sexual risk behavior in a national probability sample of US middle and high school students.

METHODS

Sexually active, unmarried, middle and high school students (n = 4152) participated in home interviews in waves I and II of the National Longitudinal Study of Adolescent Health, at an approximately 1-year interval. Associations between baseline depressive symptoms and sexual risk behaviors over the course of the following year were examined separately for boys and girls, adjusting for demographic variables, religiosity, same-sex attraction/behavior, sexual intercourse before age 10, and baseline sexual risk behavior.

RESULTS

In adjusted models, boys and girls with high depressive symptom levels at baseline were significantly more likely than those with low symptom levels to report > or = 1 of the examined sexual risk behaviors over the course of the 1-year follow-up period. For boys, high depressive symptom levels were specifically predictive of condom nonuse at last sex, birth control nonuse at last sex, and substance use at last sex; these results were similar to those of parallel analyses with a continuous depression measure. For girls, moderate depressive symptoms were associated with substance use at last sex, and no significant associations were found between high depressive symptom levels and individual sexual risk behaviors. Parallel analyses with the continuous depression measure found significant associations for condom nonuse at last sex, birth control nonuse at last sex, > or = 3 sexual partners, and any sexual risk behavior.

CONCLUSION

In this study, depressive symptoms predicted sexual risk behavior in a national sample of male and female middle and high school students over a 1-year period.

Condom use measurement in 56 studies of sexual risk behavior: review and recommendations

Despite numerous studies that measure self-reported condom use, there is currently no agreed upon "gold standard" in terms of the best way to assess condom use. The purpose of the current study was to review measures of self-reported condom use within correlational studies of sexual risk behavior, and to evaluate such measures on the basis of suggestions from the methodological literature. An additional purpose was to examine specifically whether measures published in the correlational literature have improved over time. A systematic review of studies was undertaken and specific review criteria were used to guide the inclusion of studies. A final set of 56 studies that contained 72 measures of self-reported condom use were included in the review. These measures were coded and evaluated on 12 dimensions, including measure type, number of response categories, recall period, sex partner specificity, and sex act specificity. Results indicated a great amount of diversity in terms of how condom use has been measured in the literature. Although results indicated that measures published between 1996 and 2003 were of higher quality on a number of dimensions as compared to 1989-1995, a number of these gains were minimal and in some cases measures have decreased in quality. The overall conclusion is that the sexual risk behavior literature should implement more of the recommendations made by methodological scholars in this area. Specific recommendations are summarized and presented in a way that may be helpful in guiding the development of future measures of self-reported condom use.

Why communication is crucial: meta-analysis of the relationship between safer sexual communication and condom use

The purpose of this study was to quantitatively synthesize the growing literature on the relationship between safer sexual communication (SSC) among sexual partners and condom use, and to systematically examine a number of conceptual and methodological moderators of this relationship. Data from 53 articles published in 27 journals met criteria for the study. Fifty-five independent effect sizes coded from samples totaling N=18,529 were meta-analyzed. Results indicate that the mean sample-size weighted effect size of the SSC-condom use relation was r=.22, and a number of conceptual variables were found to moderate this relationship. Specifically, communication about condom use (r=.25) and sexual history (r=.23) had significantly (p<.05) larger effect sizes than communication about safer sex (r=.18). In addition, SSC measures operationalized differently had significantly (p<.05) different effect sizes. From largest to smallest, these were behavioral format (r=.29), intentional format (r=.18), and self-efficacy format (r=.13). Measures that tried to assess persuasion attempts as compared with informational exchanges were not found to have significantly different effect sizes (p>.05). Further, methodological moderators tended to be unrelated to effect size. Implications for the future study of safer sexual communication as well as the importance of emphasizing communication skills in HIV preventive interventions are discussed.

Condom use at first intercourse with a new partner in female adolescents and young adults: the role of cognitive planning and motives for having sex

This study examined the extent to which cognitive planning and motives for sex can explain condom use at first intercourse with young females' most recent partner. A total of 133 female adolescents completed a questionnaire on cognitive planning (i.e., mentally preparing oneself for discussing condom use and for managing condoms), motives for having sex (i.e., having sex to express love, to experience pleasure, to enhance mood, and to please others), and condom use at this particular occasion. Logistic regression analyses showed that condom use was positively related to cognitive planning with respect to discussing condom use and negatively related to the motive for having sex to enhance mood. Cognitive planning for the management of condoms did not have a significant overall effect on condom use, but it did appear to be very effective for those adolescents who had a low score on the motive for having sex to express love. It thus appears useful to strengthen the skills of adolescents to discuss the use of condoms. Furthermore, stressing the negative affective consequences of unsafe sex may be particularly effective for those who are inclined to have sex to enhance mood, while encouraging adolescents to make plans for the management of condoms is likely to positively affect the use of condoms among those who are not primarily motivated to express love by having sex.

Using intervention mapping to adapt an effective HIV, sexually transmitted disease, and pregnancy prevention program for high-risk minority youth

Although many programs have been developed to reduce adolescent pregnancy and sexually transmitted diseases (STDs) (including HIV), with some showing promise in reducing sexual risk-taking behavior, little guidance has been given as to how to adapt existing interventions to new communities. When adapting a program, effective elements deemed necessary to change behaviors need to be preserved, while cultural competence and relevance for the new population must be considered in creating new elements. To address these needs, the authors describe the application of a systematic process, intervention mapping (IM), to adapt a theory-based, multicomponent HIV, STD, and pregnancy prevention program titled Safer Choices to a new target population, at-risk youth attending alternative schools and at risk of dropping out. IM is a detailed process that provides planners with a systematic method for decision making in each phase of developing or adapting an intervention to influence changes in behavior and environmental conditions.

Adolescent girls with negative pregnancy tests

STUDY OBJECTIVES AND DESIGN: This descriptive study assessed background characteristics and attitudes about pregnancy held by adolescent girls presenting for pregnancy tests and receiving negative results. An additional aim was to determine types of health care services that would be of perceived benefit to them to reduce their risk of subsequent pregnancy.

SETTING

Two health care sites in an urban community included a hospital-based adolescent clinic and a hospital-based women's health care clinic.

PARTICIPANTS

Sixty-five adolescent, low-income, single women with negative pregnancy test results in a consecutive sample were included in the study. Participants had a mean age of 16.9 (+/-1.3) years and described themselves as 64.1% African American, 26.6% Latina and 9.4% white, with 81.5% enrolled or recently graduated from high school.

MAIN OUTCOME MEASURES

The following variables were included: demographic characteristics, reproductive health history, personal and perceived partner attitude about the negative pregnancy test result, perceived parental influences, and teens' suggestions for health care services to prevent unintended pregnancy.

RESULTS

Health history data revealed high risk status for unintended pregnancy and sexually transmitted infections (STI); 28.5% of participants were ambivalent or disappointed with their negative result, 71.4% were pleased and the majority felt that their partners would be more disappointed with the negative result than they were. Health care services that teens felt would be most helpful were one-on-one contraceptive education and discussion sessions with their own health care provider.

CONCLUSIONS

Sexually active teen women with negative pregnancy test results are at high risk of subsequent pregnancy and STIs, and present important opportunities for preventive reproductive health care during visits with health care providers.

Condom use, frequency of sex, and number of partners: multidimensional characterization of adolescent sexual risk-taking

Sexual health research often relies on single risk indicators. However multi-variable composites may better capture the underlying construct of risk-taking. Latent Profile Analysis identified subgroups based on condom use consistency, partner numbers, and sex frequency among 605 adolescents. Three profiles were identified for each of grades 8 to 10 (Condom Users, Few Partners, and Risk-Takers) and 4 in grades 11 and 12 (Condom Users, One Partner Two Partners, and Risk-Takers). Inconsistent condom use groups reported more non-condom (and often less effective) birth control use and STD and pregnancy histories. Females had greater representation in the Few Partners, One Partners, and Two Partners groups, which also contained increasing proportions of participants in each subsequent year. Males had greater representation in the Risk-Takers group. A profile approach to measurement has methodological advantages, can add to substantive knowledge, and can inform content, timing, and targets of sexual health interventions.

Applying a cognitive-behavioral model of HIV risk to youths in psychiatric care

This study examined the utility of cognitive and behavioral constructs (AIDS information, motivation, and behavioral skills) in explaining sexual risk taking among 172 12-20-year-old ethnically diverse urban youths in outpatient psychiatric care. Structural equation modeling revealed only moderate support for the model, explaining low to moderate levels of variance in global sexual risk taking. The amount of explained variance improved when age was included as a predictor in the model. Findings shed light on the contribution of AIDS information, motivation, and behavioral skills to risky sexual behavior among teens receiving outpatient psychiatric care. Results suggest that cognitive and behavioral factors alone may not explain sexual risk taking among teens whose cognitive and emotional deficits (e.g., impaired judgment, poor reality testing, affect dysregulation) interfere with HIV preventive behavior. The most powerful explanatory model will likely include a combination of cognitive, behavioral, developmental, social (e.g., family), and personal (e.g., psychopathology) risk mechanisms.

Reliability of self-reported contraceptive use and sexual behaviors among adolescent girls

This study examines two issues relevant to adolescents' self-reported sexual and contraceptive use behaviors: reliability of partner-referent reports versus 3 and 6 month reports, and test-retest reliability of reports completed over a 2 week period. Data are from 196 13 to 18 year old girls recruited into this study while they south reproductive care from health clinics in a metropolitan area. All participants reported having had sexual intercourse during the past 6 months. Twice over a 2 week interval, participants completed the same paper and pencil surveys. The survey presented questions about sexual behavior and contraceptive use using 3 sequential frames of reference: within the past 6 months, within the past 3 months, and by specific sexual partners in the past 6 months. Findings demonstrate that adolescent girls can reliably report sexual behavior and contraceptive use over a 6 month interval. Study findings have implications for future research utilizing adolescents' self-reported sexual and contraceptive use behaviors.

A rose by any other name? Objective knowledge, perceived knowledge, and adolescent male condom use

OBJECTIVE

To investigate the role of objective and perceived knowledge about condoms in adolescent males' condom use at first intercourse.

METHODS

A longitudinal analysis was conducted of data from a nationally representative sample of 404 virgin male adolescents who were aged 15 to 17 years at wave 1 and reported becoming sexually experienced at the second wave of data collection. Objective knowledge was measured as a 5-item knowledge test about condoms. Perceived knowledge was measured as a 5-item scale regarding participants' confidence about their answers on the objective knowledge test. Condom use was assessed by self-report.

RESULTS

Objective and perceived knowledge were moderately correlated with each other. Male adolescents with low objective but high perceived knowledge were identified as being at particular risk for not using a condom in that they were nearly 3 times less likely to report using a condom at first intercourse (odds ratio: 0.35) than those with other levels of objective and perceived knowledge.

CONCLUSIONS

Previous evidence suggests that knowledge about sex does not accurately predict sexual behavior. This lack of predictive accuracy may be because studies have focused only on objective knowledge. Our results suggest that both objective and perceived knowledge serve as antecedents to male condom use at first intercourse. However, those with higher perceived knowledge, particularly in the context of low objective knowledge, may be at greater risk for not using condoms. Addressing not only objective but also perceived knowledge may increase the effectiveness of interventions that are designed to increase rates of condom use among male adolescents.

Risk and protective factors for sexual risk taking among adolescents involved in Prime Time

This article describes a preliminary qualitative evaluation of risk and protective factors associated with consistent contraceptive use and healthy sexual decision-making among ten of the first participants in the Prime Time intervention study. Prime Time is an 18-month intervention including one-on-one case management and peer educator training targeting sexually active 13-17-year-old girls who are recruited from health care clinics. Using an approach grounded in findings from previous research, social cognitive theory, and the social development model, Prime Time aims to improve participants' contraceptive use consistency, reduce number of sexual partners, and reduce unwanted sexual activity. Findings from this preliminary evaluation alert health care providers to the complex and dynamic nature of adolescent girls' sexual behaviors and to a broad range of risk and protective factors within individuals and their environments that may influence adolescent girls' sexual behaviors and contraceptive use. Findings suggest that an ongoing, supportive relationship with a case manager who is able to pace and tailor an intervention to the individual young person can have positive effects on adolescent girls' sexual behaviors and contraceptive use.

Is Condom Use Habit Forming?

OBJECTIVE

The objective of this study was to assess whether using a condom at adolescent sexual debut is associated with an increased likelihood of subsequent condom use.

STUDY DESIGN

A nationally representative sample was used, including 4024 sexually active adolescents (12-18 years) from the National Longitudinal Study of Adolescent Health. Logistic regression was used to model the association of condom use at sexual debut on condom use at most recent sex (mean interval, 23 months).

RESULTS

Condom use at adolescent sexual debut was associated with a twofold increased likelihood of condom use during most recent sex (odds ratio, 2.28; 95% confidence interval, 1.91-2.73).

CONCLUSIONS

Among adolescents, early condom use is associated with an increased likelihood of subsequent condom use.

Adolescent women underestimate their susceptibility to sexually transmitted infections

OBJECTIVES

Adolescent females are at significant risk for sexually transmitted infections (STI) and may not accurately incorporate indicators of risk into their perceptions of susceptibility. The objectives of the current analyses were to: (1) examine the relation between perceived susceptibility and indicators of risk; and (2) investigate the relation between perceived susceptibility and actual STI diagnosis.

METHODS

Participants were 209 sexually active adolescent females. Indicators of STI risk included STI history, recent symptoms, and sexual risk behaviour (that is, recent unprotected sex and numbers of sexual partners). Chlamydia and gonorrhoea infection were assessed at baseline, 6, and 12 months post-baseline using urine based ligase chain reaction testing.

RESULTS

Most participants perceived little or no chance that they would be diagnosed with an STI in the following year. There was no relation between almost all STI indicators and perceptions of susceptibility. Among those receiving a positive chlamydia or gonorrhoea test (n=49) at baseline or in the year following, almost all (81.3%) had perceived themselves to be at little or no risk.

CONCLUSION

The adolescent females in this sample did not accurately perceive their susceptibility to STI. They must be enabled to more effectively assess and modify their risk.

To know that we know what we know: perceived knowledge and adolescent sexual risk behavior

STUDY OBJECTIVE

To examine the relationship between perceived knowledge about sex and adolescent sexual behaviors.

DESIGN

Secondary analysis of the 2001 Minnesota Student Survey. Bivariate and multivariate relationships between perceived knowledge about sex and sexual behaviors were examined.

SETTING

Minnesota.

PARTICIPANTS

83,481 9(th) and 12(th) grade public school students.

MAIN OUTCOME MEASURES

Students' report of sexual experience and sexual behaviors.

RESULTS

Students with low perceived knowledge were less likely to be sexually experienced (OR=0.22, CI=0.17-0.29, females, OR=0.70, CI=0.59-0.82, males, P=0.00). Among sexually active students, those with low perceived knowledge also had significantly higher odds of engaging in risky sexual behaviors. Sexually experienced females with low perceived knowledge were more likely to report not talking with their partners about STIs (OR=1.83, CI=1.1-3.16, P=0.02), a history of pregnancy (OR=2.87, CI=1.59-5.18, P=0.00), and had higher numbers of male (P=0.03) and female (P=0.00) sexual partners. Sexually experienced males with low perceived knowledge were more likely to report not talking with their partners about pregnancy (OR=1.43, CI=1.11-1.84, P=0.01), pregnancy involvement (OR=2.22, CI=1.65-2.95, P=0.00), inconsistent use of birth control (OR=1.30, CI= 1.01-1.68, P=0.04), inconsistent use of condoms (OR=1.79, CI=1.38-2.32, P=0.00), not using a condom at last intercourse (OR=1.58, CI=1.22-2.04, P=0.00), and had a higher numbers of male (P=0.00) and female (P=0.00) sexual partners.

CONCLUSIONS

Perceived knowledge may be a salient antecedent of adolescent sexual risk behavior. Health care providers and programs should incorporate the construct of perceived knowledge into their assessments of and interventions targeted at adolescents.

Social and psychological influences on HIV preventive behaviors of youth in Haiti

PURPOSE

To examine HIV/AIDS prevention-related sexual behaviors and identify potential predictors of those behaviors among youth living in Haiti.

METHODS

Data were gathered from a cross-sectional survey conducted with 845 youth, aged 15-19 years, attending 12 primary and/or secondary schools. A subsample of the 491 students who were sexually active comprised the study sample. Data were collected using a theory-based, self-administered questionnaire. Data were analyzed by multiple logistic regression using SPSS for Windows.

RESULTS

Only 18% of sexually active adolescents reported always or sometimes using condoms and 27% reported having used a condom the last time they had sex. Over 40% (43%) had had three or more lifetime sex partners. Findings from the multivariate logistic regression analyses indicate that consistent condom use, condom use at last sexual intercourse, and fewer lifetime sexual partners were significantly associated with high levels of self-efficacy to communicate about HIV/AIDS or use a condom. Significant negative associations were found among consistent condom use, condom use at last sex, and high barriers to condom use. Fewer lifetime sexual partners was significantly associated with high peer preventive norms and low traditional gender norms.

CONCLUSION

These findings emphasize the importance of providing HIV prevention programs for young people in the study communities which enhance effective sexual communication and negotiation skills, target prevention-oriented social norms, and address how to overcome barriers to condom use.

Tracing the roots of early sexual debut among adolescents in psychiatric care

OBJECTIVE

To identify the most important social and personal characteristics related to early sexual debut among troubled teenagers.

METHOD

One hundred ninety-eight youths aged 12-19 years were recruited from outpatient mental health clinics and completed self-reports and interviews about their age of sexual debut; family, peer, and partner relationships (e.g., parental hostile control, negative peer influence, need for intimacy); and personal characteristics (e.g., achievement motivation, externalizing problems). Broad-band (externalizing, internalizing) and narrow-band (depression/anxiety, delinquency) psychopathology was assessed with the Youth Self-Report and Child Behavior Checklist.

RESULTS

Optimal Data Analysis was used to generate a classification tree model to identify variables associated with whether or not youths initiated oral, vaginal, and/or anal sexual activity before or after age 14. Three social context variables (parental hostile control, negative and positive peer influence) and one personal characteristic (externalizing problems) correctly classified 87.4% of teenagers as initiating sexual activity at < or =14 or >14 years of age.

CONCLUSIONS

Parental behavior and peer influence were the most important variables associated with the timing of sexual debut. Results support a social-personal framework for understanding sexual risk-taking among adolescents in psychiatric care, and the data offer relatively strong evidence that specific factors could be used to identify troubled teens at risk for early sexual debut.

Psychiatric functioning and substance use: factors associated with HIV risk among incarcerated adolescents

This study examined several types of psychiatric functioning (neuropsychiatric, emotional, and cognitive functioning) and substance use in relation to HIV risk behavior among 894 incarcerated girls and boys. Youth remanded to juvenile correctional facilities in a southern US state completed a structured interview regarding abuse history, emotional and behavioral difficulties, and demographics. Adolescents who experienced sullen affect were significantly more likely to engage in behaviors that put them at risk for HIV infection. Moreover, higher levels of alcohol use predicted HIV risk behavior. HIV prevention efforts need to address emotional distress as well as substance use among delinquent adolescents to reduce HIV risk behavior. Implications for treatment and future research are discussed.

Increased IgG 3:4 ratios in adolescent antisocial females: evidence of Th1/Th2 imbalance?

Female antisocial behavior in adolescence and late childhood has been associated with low basal cortisol levels. Because low cortisol has also been correlated with T helper cell Type 1 (Th1) predominance and suppression of T helper cell Type 2 (Th2), we investigated whether adolescent antisocial girls demonstrated this immunologic profile. Using plasma levels of IgG3 and IgG4 as markers for Th1 and Th2 activity, we studied IgG 3:4 ratios in 16-year-old girls with conduct disorder (CD) (n=42) or no psychiatric disorder (normal controls (NC)) (n=35). The mean IgG 3:4 ratio was higher in the CD group; this relationship remained significant after controlling for the effects of other variables. These data indicate that immunologic abnormalities are present in adolescent antisocial girls. Future studies should measure cytokine levels and investigate the clinical implications of these findings.

A model of teen-friendly care for young women with negative pregnancy test results

Sexually active adolescents, and especially those who receive negative pregnancy test results, are a self-identified group at particularly high risk for STIs and unintended pregnancies. Although reproductive health care alone will not totally prevent the occurrence of teen pregnancy and STIs, providing care that is accessible and designed to be teen-friendly will help diminish this area of health risk for hundreds of thousands of U.S. adolescents. Clinical interventions that are theoretically sound and based on research allow for the development of innovative, individualized, and evolving models of adolescent health care to address the needs of a challenging group of patients within a changing and competitive health care environment.