Early identification of HIV by increasing testing is a national priority; however, little is known about HIV testing behaviors in high school age adolescents. We examined the association of ...individual, partner, and relationship factors with HIV testing using a computer-assisted survey administered from 2003 to 2006 in a community sample of 980 sexually active 14- to 17-year-olds (56% female, 55% Latino, 25% African American) living in a jurisdiction with a high AIDS burden. Twenty percent reported their first sexual encounter as having occurred when they were <13 years of age, 33% had had four or more lifetime sexual partners, 21% reported high partner HIV-risk behavior, and 428 (44%) had been tested for HIV. In our final regression model, independent associations with HIV testing included being female (OR=1.68 1.23-2.30), older (OR=1.41 1.21-1.65), and having had four or more lifetime sexual partners (OR=2.24 1.64-3.05). The strongest independent predictor of HIV testing was having high HIV-related partner communication (OR=3.70 2.77-4.94). Being in a serious committed relationship (OR=1.39 1.02-1.87) was also independently associated with HIV testing, whereas reporting high worry about HIV/AIDS (OR=0.53 0.40-0.71) was independently negatively associated with HIV testing. High HIV/AIDS knowledge, high partner HIV risk behavior, and young age at first sexual encounter were not associated with testing. These findings suggest that, for high school aged adolescents, optimal strategies to promote HIV testing should look beyond increasing HIV/AIDS knowledge and identifying individual risk behaviors to also considering the role of partners and relationships and their influence on testing behavior.
Abstract Purpose The importance of diagnosing trichomoniasis is highlighted by its strong association with HIV acquisition and viral shedding. The low sensitivity of wet preparation and often ...asymptomatic nature of trichomoniasis results in failure to recognize and treat this sexually transmitted infection. The purpose of this study was to evaluate the feasibility of screening high-risk adolescent females using a new highly sensitive and specific NAAT assay. Methods We enrolled a consecutive, clinical sample of 144 sexually active females, aged 13 through 21. Subjects completed a questionnaire on sexual history and current vaginal symptoms, and provided two self- or physician-collected vaginal swabs and urine. A wet preparation test was performed with one swab and the APTIMA Trichomonas vaginalis (ATV) assay (Gen-Probe, Inc.) was performed with the other and with urine. Results Mean age was 18 ± 1.6 years; 55% Hispanic and 35% black. A three-fold higher prevalence of trichomoniasis (6.3%) was detected by ATV than by wet preparation (2.1%) with 100% concordance between vaginal swab and urine. Prevalence of chlamydia by APTIMA was 11%; no gonorrhea was detected. Subjects with trichomoniasis were more likely than those without to be black ( P < 0.01), and to report past gonorrhea ( P < 0.01) and past PID ( P < 0.001). No vaginal symptom distinguished those with trichomoniasis. Conclusion Three times as many cases of trichomoniasis were identified with ATV compared to wet preparation and identical results were obtained with vaginal swabs and urine. No symptoms were associated with trichomoniasis. These findings highlight the imperative and feasibility of screening and treating at-risk populations.
Introduction. Both asthma and obesity often occur in the same individual. Each increases the risk of cardiovascular disease (CVD) with systemic inflammation likely playing a vital role. We examined ...the independent and synergistic associations of asthma and obesity with systemic inflammation using high-sensitivity C-reactive protein (hs-CRP) levels in adolescents. Methods. This study involves the cross-sectional design carried out in the adolescent and respiratory medicine practices in a children's hospital. Out of 124 adolescents (mean age 16.1 ± 2.3 years), who were either of obese (N = 75) or of normal weight (N = 49). 51 had asthma (18 normal weight and 33 obese). Results. hs-CRP levels were higher in obese versus normal weight groups (geometric mean ± SD: 2.38 ± 2.91 vs. 0.72 ± 3.54; p < .001), and in the asthmatic versus non-asthmatic groups (geometric mean ± SD: 1.21 ± 3.71 vs.1.96 ± 3.28; p = .039). We found a trend of increasing hs-CRP levels across the four groups (p < .001), with the obese asthmatic group having the highest level. In multivariate regression, we found a strong association between obesity and log-CRP (β ± SE: 1.43 ± 0.23; p < .001) and a moderate association between asthma and log-CRP (β ± SE: 0.48 ± 0.21; p < .028), with additive synergy between obesity and asthma. Conclusions. Both asthma and obesity are independently and synergistically associated with systemic inflammation. These findings underline the need of a multifaceted approach to address CVD risk in adolescence.
Abstract Little is known about prescription medication abuse by rural youth. We surveyed 849 rural high school students and found that 34% reported lifetime nonmedical use of prescription medication ...higher than the 12% reported nationally. Boys and marijuana users had higher odds of nonmedical use of prescription medication than did girls or marijuana nonusers (odds ratio 1.9 and 3.8, respectively).
Abstract Purpose During adolescence, bone formation prevails over resorption, resulting in accumulation of 40% of peak bone mass throughout this time period. Although multiple studies have explored ...bone mass accrual during the early stages of puberty, less is known about factors that may influence bone accrual during later years of adolescence. In the present cross-sectional study we examined relationships among bone mineral density (BMD) and demographic factors, behavioral variables, and bone metabolism markers in postmenarchal adolescent girls. Methods The population was comprised of 389 healthy postmenarchal adolescent girls aged 11–18 years, who were recruited into a prospective study of the effect of depot medroxyprogesterone acetate (DMPA) on bone health in adolescents. At the baseline visit, investigators collected demographic, reproductive health, and lifestyle data, and performed a complete physical examination. Body mass index (BMI) was calculated. Before study initiation, BMD at the lumbar spine, total hip, and femoral neck was measured by dual-energy X-ray absorptiometry (DXA), and markers of bone metabolism (serum bone-specific alkaline phosphatase BAP, serum osteocalcin, and urinary N-telopeptide uNTX) were measured. The baseline data from this study were analyzed to evaluate possible correlates of BMD in postmenarchal adolescent girls. Potential associations between BMD values and other parameters were assessed by analysis of variance and Pearson’s correlation coefficient. Results Participants enrolled in the study had a mean (± SD) chronological age of 14.9 ±1.7 years (range 11–18), mean gynecologic age of 39.9 ±23.0 months (range 1–120) postmenarche, and mean BMI of 23.5 ±4.6 kg/m2 (range 16.0–42.2). Racial/ethnic distribution was 46% African American, 35% Caucasian, and 19% other races; 9% had previously been pregnant. Positive correlations were observed between lumbar spine BMD and chronological age (r = .301, p < .0001), gynecologic age (r = .349, p < .0001), and BMI (r = .371, p < .0001). Total hip and femoral neck BMD values were significantly higher ( p < .05 and p < .05, respectively) in African American participants compared with non-African American participants. Previous history of pregnancy was significantly associated with a lower BMD at the lumbar spine ( p < .0001) and the total hip ( p < .01) when compared with the BMD of adolescents who had never been pregnant. Cigarette smoking and alcohol use were not associated with significant differences in BMD. Negative correlations were observed between gynecologic age and the levels of BAP (r = −.564, p < .0001), osteocalcin (r = −.349, p < .0001), and uNTX (r = −.281, p < .0001), and between lumbar spine BMD and BAP (r = −.363, p < .0001), osteocalcin (r = −.129, p < .05), and uNTX (r = −.202, p < .001) levels. Conclusions Our data demonstrate that chronological age, gynecologic age, race/ethnicity, BMI, and previous history of pregnancy are markedly associated with BMD in postmenarchal adolescent girls. Bone accretion in the postmenarchal years continues in the face of a slowdown in bone turnover during this time period.
Abstract Purpose To determine whether key associated features of hyperandrogenic anovulation (HA) in predominately Caribbean Hispanic (CH) adolescent girls can be combined to improve the early ...diagnosis of HA. Methods Unselected observational sample of females aged 12 to 21 years (mean 17.5 ± 2.4 years), (64% CH, 28% African American). One hundred twenty subjects provided a menstrual history, had a physical examination, and a follicular phase fasting blood drawn for LH, FSH, testosterone, sex hormone binding globulin (SHBG), 17-OH progesterone (17-OHP), androstenedione (Δ4 A), glucose, and insulin. We prospectively categorized subjects into four groups: G I (n = 42) had normal menses and normal physical exam; G II (n = 41) had normal menses and abnormal physical exam, that is, signs indicating possible hyperandrogenism and/or insulin resistance, including at least one of obesity, hirsutism, acne, or acanthosis nigricans; G III (n = 15) had abnormal menses and normal physical exam, and G IV (n = 22) had HA with BOTH abnormal menses and abnormal physical exam, that is, girls most likely to develop polycystic ovary syndrome. Hormonal levels and additional clinical and physical characteristics of interest were compared among the four groups. Results Group IV subjects had significantly higher waist circumference measurements, independent of overweight status, than all other groups. As hypothesized, Group IV subjects had significantly higher androgen levels and significantly lower SHBG levels than all other groups. FAI, SHBG, and waist circumference had the highest diagnostic accuracy for predicting Group IV status (i.e., HA phenotype). Conclusions Markers of insulin resistance and hyperandrogenemia, including waist circumference, FAI, and SHBG, best associate with irregular menstrual cycles and the HA phenotype in ethnic minority adolescent girls.
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