Mothers' attitudes toward adolescent confidential services: development and validation of scales for use in English- and Spanish-speaking populations.

Purpose: To explore parental beliefs and attitudes about confidential services for their teenagers; and to develop an instrument to assess these beliefs and attitudes that could be used among English and Spanish speakers. The long-term goal is to use this research to better understand and evaluate interventions to improve parental knowledge and attitudes toward their adolescent's access and utilization of comprehensive confidential health services.

Methods: The instrument was developed using an extensive literature review and theoretical framework followed by qualitative data from focus groups and in-depth interviews.

Parental acceptability of contraceptive methods offered to their teen during a confidential health care visit.

Purpose: To examine parental acceptability of contraceptive methods offered confidentially to their adolescent daughter.

Methods: A random sample of 261 parents/guardians with a daughter aged 12-17 years completed a telephone survey examining the relationship between parental acceptability of seven contraceptive methods and adolescents' likelihood to have sex, parenting beliefs, parents' sexual health as teens, sexually transmitted infection knowledge, and demographic factors.

Results: Acceptability was highest for oral contraceptive pills (59%) and lowest for intrauterine device (18%).

Screening for adolescent alcohol and drug use in pediatric health-care settings: predictors and implications for practice and policy.

Objective: This paper used data from a study of pediatric primary care provider (PCP) screening practices to examine barriers to and facilitators of adolescent alcohol and other drug (AOD) screening in pediatric primary care.

Methods: A web-based survey (N = 437) was used to examine the influence of PCP factors (attitudes and knowledge, training, self-efficacy, comfort with alcohol and drug issues); patient characteristics (age, gender, ethnicity, comorbidities and risk factors); and organizational factors (screening barriers, staffing resources, confidentiality issues) on AOD screening practices. Self-reported and electronic medical record (EMR)-recorded screening rates were also assessed.

Male adolescent sexual and reproductive health care.

Male adolescents' sexual and reproductive health needs often go unmet in the primary care setting. This report discusses specific issues related to male adolescents' sexual and reproductive health care in the context of primary care, including pubertal and sexual development, sexual behavior, consequences of sexual behavior, and methods of preventing sexually transmitted infections (including HIV) and pregnancy. Pediatricians are encouraged to address male adolescent sexual and reproductive health on a regular basis, including taking a sexual history, performing an appropriate examination, providing patient-centered and age-appropriate anticipatory guidance, and delivering appropriate vaccinations.

Does delivering preventive services in primary care reduce adolescent risky behavior?

Purpose: To determine whether the delivery of preventive services changes adolescent behavior. This exploratory study examined the trajectory of risk behavior among adolescents receiving care in three pediatric clinics, in which a preventive services intervention was delivered during well visits.

Methods: The intervention consisted of screening and brief counseling from a provider, followed by a health educator visit.

Rate of and risks for regression of cervical intraepithelial neoplasia 2 in adolescents and young women.

Objective: To describe the natural history of cervical intraepithelial neoplasia (CIN) 2 in a prospective study of adolescents and young women, and to examine the behavioral and biologic factors associated with regression and progression.

Methods: Adolescents and women aged 13 to 24 years who were referred for abnormal cytology and were found to have CIN 2 on histology were evaluated at 4-month intervals. Risks for regression were defined as three consecutive negative cytology and histology visits, and progression to CIN 3 was estimated using Cox proportional hazards regression models.

Condom negotiation strategies and actual condom use among Latino youth.

Purpose: To examine which condom negotiation strategies are effective in obtaining or avoiding condom use among Latino youth.

Method: Interviews were conducted with 694 Latino youth, 61% female, aged 16-22. Participants reported on their condom negotiation strategies, perceptions of whether their sexual partner wanted to use condoms, and actual condom use.

Adolescent medicine training in pediatric residency programs.

Objectives: The aim of this study was to provide an assessment of pediatric residency training in adolescent medicine.

Methods: We conducted 2 national surveys: 1 of pediatric residency program directors and the other of faculty who are responsible for the adolescent medicine block rotation for pediatric residents to elicit descriptive and qualitative information concerning the nature of residents' ambulatory care training experience in adolescent medicine and the workforce issues that affect the experience.

Results: Required adolescent medicine topics that are well covered pertain to normal development, interviewing, and sexual issues.

Screening for asymptomatic Chlamydia infections among sexually active adolescent girls during pediatric urgent care.

Objective: To develop and evaluate an intervention to increase Chlamydia trachomatis (CT) screening among sexually active adolescent girls during pediatric urgent care.

Design: Ten pediatric clinics were randomly assigned to an intervention (5 clinics) or control group (5 clinics). The proportion of sexually active girls screened for CT was estimated over 18 months (April 2005-September 2006).

Are adolescents being screened for emotional distress in primary care?

Purpose: To assess primary care providers' rates of screening for emotional distress among adolescent patients.

Methods: Secondary data analysis utilizing data from: (1) well visits in pediatric clinics within a managed care plan in California, and (2) the 2003 California Health Interview Survey (CHIS), a state population sample. The Pediatric clinic sample included 1089 adolescent patients, ages 13 to 17, who completed a survey about provider screening immediately upon exiting a well visit.

Risks for cervical intraepithelial neoplasia 3 among adolescents and young women with abnormal cytology.

Objective: To estimate the risks of cervical intraepithelial neoplasia (CIN) 3 among girls and women aged 13 to 24 years who were referred for abnormal cytology while receiving care in a large health maintenance organization.

Methods: At the time of referral, patients had a colposcopic examination and biopsy if needed. Histology was sent to a centralized laboratory.

Adolescent immunizations and other clinical preventive services: a needle and a hook?

Advances in technology have led to development of new vaccines for adolescents, but these vaccines will be added to a crowded schedule of recommended adolescent clinical preventive services. We reviewed adolescent clinical preventive health care guidelines and patterns of adolescent clinical preventive service delivery and assessed how new adolescent vaccines might affect health care visits and the delivery of other clinical preventive services. Our analysis suggests that new adolescent immunization recommendations are likely to improve adolescent health, both as a "needle" and a "hook.

Acquisition of sexually transmitted infections in adolescents attending an urban, general HMO teen clinic.

To determine association between acquisition of sexually transmitted infections (STIs) over a nine-month period among sexually experienced adolescents attending an urban, general HMO teen clinic and African American race, use of marijuana more than once or twice a week, and having had relationships with a sexual partner who is more than four years older.

Screening sexually active adolescents for Chlamydia trachomatis: what about the boys?

Objectives: We sought to determine the effectiveness of a systems-based intervention designed to increase Chlamydia trachomatis (CT) screening among adolescent boys.

Methods: An intervention aimed at increasing CT screening among adolescent girls was extended to adolescent boys (14-18 years). Ten pediatric clinics in a health maintenance organization with an ethnically diverse population were randomized.

Attention-deficit/hyperactivity disorder among adolescents: a review of the diagnosis, treatment, and clinical implications.

Attention-deficit/hyperactivity disorder (ADHD) is the most common mental disorder in childhood, and primary care clinicians provide a major component of the care for children with ADHD. However, because of limited available evidence, the American Academy of Pediatrics guidelines did not include adolescents and young adults. Contrary to previous beliefs, it has become clear that, in most cases, ADHD does not resolve once children enter puberty.

Provider self-efficacy and the screening of adolescents for risky health behaviors.

Purpose: To examine the extent to which providers' perceived self-efficacy to deliver adolescent preventive services relates to their screening practices.

Methods: Screening rates were determined by both provider self-reported screening practices and the independent report of the adolescent patient. First, 66 pediatric providers (pediatricians and nurse-practitioners), working in three pediatric clinics within a managed care organization, completed surveys assessing: (a) self-efficacy for screening adolescent patients in the areas of tobacco use, alcohol use, sexual behavior, seat belt use, and helmet use; and (b) self-reported screening of adolescents during well-visits over the past month.

To screen or not to screen: prevalence of C. trachomatis among sexually active asymptomatic male adolescents attending health maintenance pediatric visits.

This study estimated the prevalence of Chlamydia trachomatis (CT) among sexually active, asymptomatic, multiethnic adolescent males attending preventive health maintenance visits at pediatric clinics within a large health maintenance organization. First-void urines of sexually active 14-18-year-old males were screened for CT. The CT infection rate was 4% (27/711), 95% CI = 2.

Effect of a clinical practice improvement intervention on Chlamydial screening among adolescent girls.

Context: Chlamydia trachomatis infection is a serious public health concern that disproportionately affects adolescent girls. Although annual C trachomatis screening of sexually active adolescent girls is recommended by health professional organizations and is a Health Employer Data and Information Set (HEDIS) performance measure, this goal is not being met.

Objective: To test the effectiveness of a system-level, clinical practice improvement intervention designed to increase C trachomatis screening by using urine-based tests for sexually active adolescent girls identified during their routine checkups at a pediatric clinic.

Interparental conflict and risk behaviors among Mexican American adolescents: a cognitive-emotional model.

This study used a cognitive-emotional model to examine the relations between multiple dimensions of interparental conflict and health risk behaviors among young adolescents. Participants were 151 Mexican American adolescents and their parents. At initial individual interviews, parents reported on conflict with their spouses, and adolescents reported on their parents' conflict, their appraisals of the conflict, their emotional distress, and their acculturation level.

What sexually transmitted disease screening method does the adolescent prefer? Adolescents' attitudes toward first-void urine, self-collected vaginal swab, and pelvic examination.

Objective: To assess sexually active adolescents' attitudes toward 3 screening collection techniques for detection of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis using first-void urine (FVU), self-collected vaginal swab specimens, and pelvic examination with clinician-collected endocervical swab specimens.

Design: Participants completed a preexamination health survey, provided FVU and self-collected vaginal swab samples, and had a pelvic examination with endocervical swab specimen collection. In a confidential postexamination interview, patients ranked the 3 screening techniques according to preference and responded to qualitative positive and negative descriptors to evaluate each technique.