Interest in a new test for caries risk in adolescents undergoing orthodontic treatment.

It has been reported that patients undergoing orthodontic treatment present a high risk of caries. Recently, an immediate chair-side test was proposed, displaying the intra-oral lactic acid production of cariogenic bacteria. The aim of this 12-month follow-up prospective cohort study was to evaluate the association between having a high score on this test and caries occurrence in 110 young patients scheduled for orthodontic treatment. Caries occurrence was studied by Kaplan-Meier curves and Multivariate Cox models allowed the examination of its association with covariates. Fifty four patients developed at least one carious lesion during the follow-up period. At baseline, approximately 70% of the patients presented a high risk of caries according to the test and this number came close to 80% by the study's completion. According to the Kaplan-Meier estimator, 51% (CI(95%) 0.40, 0.60) of the sample would have developed at least one carious lesion during the follow-up. The test score was then associated with age, DMFT, and caries occurrence. This study showed that a high test score at baseline associated with a high DMFT predicted a high risk of caries (RR = 2.6). Taking the patient's age into consideration, an increase of 1 year resulted in a 10% decrease of the risk of caries occurrence (RR = 0.89). Within the limits of this longitudinal study, it may be concluded that this test is useful to evaluate the risk for dental caries in adolescents with orthodontic treatment. Furthermore, the distribution of the lesions in our sample suggests specific clinical approaches for this group of patients.

High-risk adolescents and female condoms: knowledge, attitudes, and use patterns.

PURPOSE: To explore data on high-risk male and female adolescents' attitudes towards female condoms, compared with male condoms. METHODS: Exploratory survey research was utilized with a convenience sample of 65 high-risk adolescents at an emergency homeless shelter. A peer-led intervention was conducted and pre-test and post-test interviews explored barriers to female condom use. The intervention consisted of 15- to 30-minute small group sessions, discussing female condoms' construction; purpose of the rings; efficacy preventing pregnancy and sexually transmitted infection (STIs); and how to lubricate, insert, and use. Content and Chi-square analyses were utilized. RESULTS: Sixty-three percent used male condoms as their primary contraceptive method; almost half (48%) said they always used male condoms, but 44% reported having sex without a male condom at least once in the 2 weeks prior to pre-test. Ninety-five percent had heard of the female condom, half 'good' and 24% 'bad' things, but only 15% had ever used one. At post-test all respondents gave reasons they might use female condoms in the future, and 77% gave reasons why they might not. Most (73%) adolescents said they would still prefer the male to the female condom. The major potential barriers to adolescents' female condom use were not having female condoms available and/or females feeling uncomfortable inserting them. CONCLUSIONS: Female condoms should be offered to adolescents as an additional choice rather than as replacements for male condoms. Further research is needed to assure access, availability, and comfort with female condoms and male participation in their use.

PIP: The aim of this study was to explore data on high-risk male and female adolescents' attitudes towards the female condom as compared with the male condom. Exploratory survey research was utilized with convenience sample of 65 high-risk adolescents at an emergency homeless shelter. A peer-led intervention was conducted and pre- and post-test interviews explored barriers to female condom use. The intervention consisted of 15- to 30-minute small-group sessions, discussing the female condom's construction; purpose of the rings; its efficacy in preventing pregnancy and sexually transmitted infections; and how to lubricate, insert, and use it. Content and Chi-square analyses were utilized. 63% used the male condom as their primary contraceptive method; almost half (48%) said they always used a male condom, but 44% reported having sex without using one at least once in the 2 weeks prior to the pre-test. 95% had heard of the female condom (half had heard "good" things and 24% had heard "bad" things), but only 15% had ever used one. At post-test all respondents gave reasons they might use a female condom in the future, and 77% gave reasons why they might not. Most (73%) adolescents said they would still prefer the male condom to the female condom. The major potential barriers to adolescents' female condom use were not having a female condom available and/or females feeling uncomfortable inserting them. The female condom should be offered to adolescents as an additional choice rather than as a replacement for the male condom. Further research is needed to assure access to, availability of, and comfort with the female condom and male participation in its use.

Closing the ecological gap: the public/private dilemma.

Numerous health behavior theories and models address human and environmental factors that affect health status. Although ecological models have called for multilevel intervention strategies, all too often health professionals remain unsure which levels of intervention to target: individual, institutional/organizational, community, public-policy or some combination of these. The decision is often influenced by general societal perceptions of how much control individuals have over health risks. These perceptions, in turn, influence health professionals' own perceptions. The question raised here is how do these perceptions of how public or private a health issue is affect the intervention levels we target? Frequently intervention levels are discussed as if they exist on a continuum, with private individual interventions at one end, and societal policies and laws at the other. This article offers a 'public/private health matrix' based on two axes, one representing individual rejectability of health risks, the other showing how publicly or privately supplied or regulated these risks are. The 10 leading causes of death and two childhood illnesses in the US are used to demonstrate how the matrix might help analyze the public/private nature of different health risks and risk-reducing strategies, and to demonstrate how such distinctions may influence the levels of intervention health professionals target.

Adolescent abstinence and condom use: are we sure we are really teaching what is safe?

This article reviews existing research on condom and abstinence method- and user-failure rates, and the use of this research in determining sexuality education curricula. Latex condoms effectively prevent pregnancies and most sexually transmitted diseases or infections (STIs), with method-failure rates between 0.5% and 7%, but with user-failure rates between 12% and 70%. Total abstinence presumably has a method-failure rate of zero, but research on periodic abstinence indicates user-failure rates between 26% and 86%. No researchers have attempted to establish total abstinence user-failure rates. Abstinence-only curricula evaluations have demonstrated changes in adolescents' attitudes but little change in sexual behaviors. Comprehensive sexuality education curricula have demonstrated attitudinal changes and delays in adolescents' sexual activity. Since inconsistent use of either condoms or abstinence threatens adolescents' health, this article urges more scientific research on total abstinence user-failure rates, better and clearer dissemination of research findings, and encourages funders to require educators to show thorough knowledge of research findings.

One method for assessing HIV/AIDS peer-education programs.

This study offers a new evaluation methodology for peer-education programs. Peer educators' knowledge, self-esteem, peer pressure, and the number of friends, neighbors, and relatives given HIV/AIDS information were compared before and after training using self-administered questionnaires. Significant changes were observed in knowledge, peer pressure, self-efficacy, numbers of people given condoms, number of formal and informal HIV/AIDS presentations, and numbers of HIV/AIDS discussions with friends and neighbors.

Teachers' receptiveness and comfort teaching sexuality education and using non-traditional teaching strategies.

This article reports on the comfort level of 97 eighth grade teachers using non-traditional teaching strategies in sexuality education classes. Most were comfortable teaching sexuality education and undeterred by external factors such as students' religious beliefs, lack of administrative support, or parental protest. However, a quarter to a third of teachers reported never or rarely using activities such as roleplays, small-group discussions, and problem-solving exercises. Multiple regression indicated that only gender was a significant predictor of such usage. The greatest perceived barriers to teaching sexuality education and using alternative teaching strategies were lack of materials, lack of time, and difficulty with facilitation under traditional classroom structure. Although more research is needed to better understand barriers to using alternative strategies, teachers in two focus groups (n = 19) suggested 1) restructuring classroom settings to match the demands of new teaching strategies, and 2) "experience appropriate" curricula.

Lifetime sexual behaviors among predominantly minority male runaways and gay/bisexual adolescents in New York City.

Lifetime sexual behaviors were examined among two samples of predominantly minority, male adolescents in New York City aged 12 to 18 (M = 16.3), believed to be at high risk for HIV infection: 59 runaway males in two residential shelters and 60 males attending a community agency (HMI) for gay and bisexual youths. Interviews regarding psychosexual milestones indicated that 93% of these youths had engaged in oral, anal or vaginal intercourse and/or anilingus, with a median of 11.0 female partners among runaway males and a median of 7.0 male partners among HMI males. Both groups initiated sexual activity at a relatively early mean age of 12.6 years. Each group reported a unique developmental sequence of psychosexual milestones. Consistent condom use was reported by 13% of the youths. One quarter of the youths reported involvement in prostitution. These findings detail the need for AIDS prevention programs for these youths.

Reducing HIV sexual risk behaviors among runaway adolescents.

OBJECTIVE: Reductions in runaways' sexual risk behaviors were evaluated in response to an intensive program to prevent human immunodeficiency virus (HIV) infection and the acquired immunodeficiency syndrome (AIDS). DESIGN: In a nonrandomized control trial, sexual risk behaviors among 78 runaways at one residential shelter who received up to 30 HIV/AIDS intervention sessions were compared with 67 runaways at a nonintervention shelter with sexual behaviors assessed at baseline and 3 and 6 months. SETTING: Runaways were recruited from the only two publicly funded shelters in New York, NY. PARTICIPANTS: The runaways were aged 11 to 18 years, 64% female, and predominantly black or Hispanic. INTERVENTION: The intervention addressed general knowledge about HIV/AIDS, coping skills, access to health care and other resources, and individual barriers to safer sex. MAIN OUTCOME MEASURES: Consistent condom use, a high-risk pattern of sexual behavior, and sexual abstinence over a 3-month time frame were assessed. MAIN RESULTS: As the number of intervention sessions increased, runaways' reports of consistent condom use increased significantly (at 3 months, unique R2 = .06, P less than .05; at 6 months, unique R2 = .09, P less than .05), and their reports of engaging in a high-risk pattern of sexual behavior decreased significantly (at 3 months, unique R2 = .03, P = .06; at 6 months, unique R2 = .04, P less than .05). Abstinence did not change. CONCLUSIONS: The demonstrated effectiveness of the intensive HIV/AIDS program highlights the importance of enlarging the scope of most current HIV/AIDS prevention programs.

The application of the free-market economic model in Chile and the effects on the population's health status.

After the military coup in 1973, probably the most dogmatic application ever of free-market economic policies was implemented in Chile. The military junta has credited the drop in infant mortality since then to the free-market model. This article explores whether lower infant mortality rates are due to improvements in the socioeconomic conditions created by the free-market, or whether they are due to state-sponsored health care services. It concludes that the socioeconomic conditions since 1973 have generally deteriorated, while government supplemental feeding programs and maternal and child health care services have increased. It appears that the free-market has not been the primary determinant of the decline in infant mortality. Rather, state intervention appears to have been more important. Other morbidity statistics, however, indicate a decline in the population's health status since 1973.