The prevalence of obesity and thinness in children from a lower socioeconomic population receiving comprehensive health care.

The relative body weights of 1830 children from low-income families ranging in age from 2 months to 18 years were calculated using the weight-for-length index (WLI). The effects of age, sex and race on WLI were tested with a 3-way analysis of variance test. A significant age and race interaction was found for the whole sample, as well as significant age and sex interaction for blacks only. Additional analysis revealed that most of the variance in WLI could be explained by weight variations in black females. When the children were classified as obese, overweight, and thin basedon their WLI scores, black males were found to have the lowest prevalence of obesity followed by slightly higher values for the other groups. When overweight and obese children were combined into one group, black females had the highest prevalence of overweight-obese children followed by white males, black males, and white females. In contrast, white females had the highest prevalence of thinness, followed by white males, black females, and black males. Additional analysis suggested that there are important social and/or environmental factors within this particular socioeconomic group that are interacting with biological processes to influence the prevalence of obesity and thinness within each age group.

The effect of inosiplex on the survival of subacute sclerosing panencephalitis.

We studied the probability of survival of subacute sclerosing panencephalitis (SSPE) patients prognostically stratified into rapidly and slowly developing SSPE, nontreatment, and inosiplex-treated groups. Based on life table analysis, survival did not differ between treated and untreated patients with rapidly developing SSPE. The cumulative survival rates were significantly (p less than 0.05) higher and the mortality rate significantly lower in the slowly developing inosiplex-treated group.

Male adolescents involved in pregnancy: associated health risk and problem behaviors.

OBJECTIVE: Little is known about male high school students who have been involved in a pregnancy. This study was undertaken to determine whether male involvement with a pregnancy during adolescence is associated with other risk and problem behaviors. METHODS: The 1993 Massachusetts Youth Risk Behavior Survey was conducted on a random sample of 3054 9th- through 12th-grade students. The use of tobacco, alcohol, and other drugs, early and multiple sexual experiences, fighting resulting in injury, and demographic variables were compared between sexually active young men who reported being involved in pregnancy (n = 82) and their counterparts who reported not ever causing a pregnancy (n = 537). Associations were measured using chi 2 analyses and Kruskal-Wallis analysis of variance. Stepwise logistic regression was used to further analyze those variables significantly associated with involvement with a pregnancy. RESULTS: Based on logistic regression, older age and earlier ages of onset of cocaine use, initial sexual intercourse, and regular use of cigarettes were associated with being involved with a pregnancy. An increased lifetime frequency of cocaine use, lifetime frequency of alcohol use, and an increased number of lifetime sexual partners were also associated with having caused a pregnancy. Those who reported involvement with a pregnancy reported a higher frequency of being injured in a fight during the past year, drinking while driving, and having multiple sexual partners during the previous 30 days than those who had not gotten someone pregnant. CONCLUSIONS: A history of being involved with a pregnancy clustered with other health risk and problem behaviors to form a "risk behavior syndrome." These findings suggest that when risk behaviors are encountered during the routine comprehensive screening of male adolescents, strategies for pregnancy prevention among young men should also be emphasized.

Sexual behavior among Hispanic female adolescents in the United States.

The purpose of this study was to identify factors associated with sexual activity in a national representative sample of Hispanic female adolescents. The subjects included all (n = 202) 15- to 19-year-old Hispanic female adolescents from the 1982 National Survey of Family Growth subdivided into Mexican-American (n = 119), Puerto Rican (n = 34), Central/South American (n = 23), Cuban (n = 9), and other Hispanic (n = 17) background groups. A total of 42% of the young women were sexually active. More Cubans (69.0%) and Central/South Americans (55.6%) reported sexual activity than the other groups, but the differences were not statistically significant. With multiple regression analysis, a significant amount of variation (total R2 = 0.367, P less than or equal to .001) in sexual activity was explained by the following variables: not being in school (22.5%), no religious affiliation (4.4%), age (3.3%), less church attendance (3.0%), older age at menarche (1.9%), and not living with both parents at age 14 years (1.9%). These findings suggest that maintaining social continuity in the areas of school, church affiliation and involvement, and family structure, as well as physical maturity are associated with Hispanic adolescent girls not becoming sexually active.

The relationship among television watching, physical activity, and body composition of young children.

PURPOSE: Television watching has been reported to be associated with obesity, resting energy expenditure, and lower daily physical activity among both children and adolescents. However, most of these studies were based on self report or data collected in laboratory settings. This study examined the relationship among observed time of television watching, observed physical activity level and body composition among 3- or 4-year-old children. METHODS: African-American (41.4%), Mexican-American (23%), and Anglo-American (35.6%) children (N = 191, males = 90) from the Texas site of the Studies of Child Activity and Nutrition program were observed from 6 to 12 hours per day up to 4 days over 1 year. Activity level each minute of the day was measured with the Children's Activity Rating Scale (interobserver reliability = .84 +/- .001). The interobserver reliability of time of television watching was .96 +/- .08. RESULTS: The median of the longest number of consecutive minutes of television watching was 15 (range = 1 to 79). The median percent of minutes of television watching of total observed minutes was 14.8% (0% to 58%) and the median percent of minutes of inside minutes was 17.9% (0% to 80.9%). There were no gender or ethnic differences in time watching television or physical activity during television watching. Physical activity during television watching was lowest during the longest bout of television watching (mean = 1.48 +/- .28) compared to outside minutes (mean = 2.38 +/- .21), inside non-television minutes (mean = 1.96 +/- .13) and inside television minutes (mean = 1.65 +/- .18). The level of physical activity during television-watching times was highest (P < .0031) during October and November and lowest during March, April, June, and July. Longest bout of television watching and percent of minutes watching television to total observed minutes were inversely associated with mean physical activity, percent of minutes of physical activity levels 3, 4, or 5, and percent of physical activity levels 4 or 5. Percent of television watching to inside minutes was negatively correlated with physical activity levels 4 or 5. Television-watching behavior was not associated with body composition. CONCLUSIONS: Television watching was weakly negatively correlated with physical activity levels, and physical activity was lower during television-watching than non-television-watching time in this sample of children. Television viewing behavior was not associated with body composition.

Correlates of children's bicycle helmet use and short-term failure of school-level interventions.

To test the utility of school-level interventions for child bicycle safety and to identify social and behavioral factors associated with children's bicycle helmet use, a two-level intervention was conducted in two suburban elementary schools. Children (N = 209) and parents (N = 125) in school 1 and in school 2 (children, N = 470; parents, N = 364) were surveyed regarding bicycle injuries and helmet use. Children and parents in schools 1 and 2 received literature about bicycle safety and discount coupons for helmet purchase. School 1 was then the target of an intensive safety campaign, including meetings with the school safety committee and the PTA and a classroom presentation to children emphasizing helmet use. Ten months later the same survey was again administered. Children in school 1 were more likely at posttest to believe that helmets were protective (P = .003) but did not differ on other variables. Logistic regression showed that sibling helmet ownership, parental helmet use, and lower parental perceived social barriers to helmet use were independently associated with children's reported helmet use and with parental intent for the child to use a helmet at posttest.

Recommended changes in pediatric education: the impact on pediatrician involvement in health care delivery to adolescents.

In an attempt to examine the extent of implementation of the recommendations issued by the Task Force on Pediatric Education for increased emphasis on adolescent medicine during residency training, pediatricians' perceptions of their skills and abilities to provide health care to adolescents were evaluated. A sample of 558 pediatricians selected at random and 385 members of the American Academy of Pediatrics' Section on Adolescent Health (SAH) completed a 41-item questionnaire. The physicians' perceived levels of skill in ten areas were analyzed while simultaneously assessing the impact of SAH membership, year of graduation from medical school, gender, and percentage of practice time devoted to adolescents on each issue. SAH members, as expected, ranked their levels of skill significantly higher than did the other pediatricians in all areas surveyed. A significant percentage of the SAH pediatricians, however, indicated that their skills were acquired through postresidency fellowship training. There was an increasing trend among all pediatricians in their perceived levels of skill to deliver health care to adolescents during the past several decades, but there has been no appreciable increase in such perceived skill levels since the task force issued its recommendations. In fact, pediatricians graduating from medical school in the decade prior to 1976 who are not SAH members ranked their skills higher than did non-SAH pediatricians who graduated in the past 10 years. These data lead to the conclusion that the recommendations of the Task Force on Pediatric Education have not been adequately implemented.

Reliabilities of short substance abuse screening tests among adolescent medical patients.

OBJECTIVE: To determine the internal consistency and 1-week test-retest reliability of the Simple Screening Instrument for Alcohol and Other Drug Abuse (SSI-AOD), the CAGE-AA (CAGE questions adapted for adolescents), and 4 modified items from the Drug and Alcohol Problem QuickScreen (DAP-4) among adolescents. METHODS: Fifteen- to 18-year-old medical patients (n = 173) completed screening tests during a routine medical visit and then again 1 week later. Internal consistency for each test and retest was calculated using Cronbach's alpha, and 1-week test-retest reliability was calculated by using Winer's unbiased estimate of the intraclass correlation coefficient (r). RESULTS: The SSI-AOD has good internal consistency (alpha =.83) and the CAGE-AA questions acceptable internal consistency (alpha =.60). Alpha varied with gender and race, and item analysis indicated the CAGE-AA test could be improved. As expected, the DAP-4 had a lower alpha score (.46). All screening instruments studied had high 1-week test-retest reliabilities (range r =.82-.90). CONCLUSIONS: The SSI-AOD is a reliable substance abuse screening instrument among adolescent medical patients. The CAGE-AA questions must be further revised and tested before their use can be recommended. The DAP-4 questions are likely measuring different, but important, constructs.

Anabolic-steroid use, strength training, and multiple drug use among adolescents in the United States.

OBJECTIVE: This study examined the relationships between anabolic-steroid use and the use of other drugs, sports participation, strength training, and school performance among a nationally representative sample of US high school students. DESIGN: Randomized survey data from the 1991 Centers for Disease Control and Prevention Youth Risk Behavior Survey. SETTING: Public and private schools in the 50 United States and District of Columbia. PATIENTS: A total of 12,272 9th through 12th grade students. MAIN OUTCOME MEASURED: Prevalence of anabolic-steroid use. RESULTS: The frequency of anabolic-steroid use was significantly associated with the frequency of use of cocaine, the use of other drugs such as amphetamines and heroin, tobacco smoking, and alcohol use. The weighted prevalences of anabolic-steroid use were higher among male (4.08%) than female students (1.2%). Students living in the South (3.46%) reported higher prevalences than students in the Midwest (3.0%), West (2.02%), or Northeast (1.71%). Students with self-perceived below-average academic performances (5.10%) and students reporting injected drug use also reported higher anabolic-steroid use (51.57%). Based on a multiple logistic regression, the following variables were found to be significant predictors of anabolic-steroid use: injectable drug use (odds ratio [OR], 17.86), use of other drugs (OR, 4.19), male gender (OR, 2.79), alcohol use (OR, 1.38), and strength training (OR, 1.73). The variables that were significantly associated with anabolic-steroid use varied by gender and by region of the country. CONCLUSION: These data suggest that adolescent anabolic-steroid users in this country are more likely to engage in strength training, injected drug use, and the use of multiple drugs, even after controlling for sports participation and poorer academic performance. These data confirm previous findings of an association between multiple drug use and anabolic-steroid use. Also, engaging in strength-training exercises continued to be associated with anabolic-steroid use after controlling for drug use and other predictors.

Intentions to use violence among young adolescents.

OBJECTIVE: Frequent violent behavior among adolescents has been found to be associated with previous exposure to violence, personal victimization, depression, hopelessness, and older age. Although young adolescents engage in less severe violent behavior than older adolescents, their perceived normative expectations to use violence to resolve conflicts may already be established by early adolescence. This study examined the influence of exposure to violence, depression, church attendance, multiple drug use, and demographic variables on young adolescents' intentions to use violence to resolve conflict. METHODS: Young adolescents (N = 225, males = 49.4%, black = 88.7%, mean age = 12.9 +/- 1 years) in two middle schools serving low-income and working-class communities were administered a previously tested anonymous questionnaire. They were also asked how they would resolve conflict in 15 different hypothetical situations. Each situation had 10 possible responses ranging from humor or avoidance to severe violence (eg, use of a gun). The Intentions to Use Violence in Hypothetical Situations Scale had a high internal reliability (alpha = .88) and was correlated (r = .46) at the expected level for this age group with a standardized use of violence and weapon-carrying scale. RESULTS: The Intentions to Use Violence in Hypothetical Situations Scale was significantly correlated with age (r = .17), school grade (r = .14), lower church attendance (r = -.23), frequency of smoking (r = .24), alcohol use (r = .37), marijuana use (r = .36), crack cocaine use (r = .14), smokeless tobacco use (r = .20), injecting drug use (r = .16), depression (r = .12), and exposure to violence (r = .48). Based on multiple regression analysis, exposure to violence, marijuana use, frequency of church attendance, alcohol use, cocaine use, and tobacco use accounted for 36.6% of the variation in the Intentions to Use Violence in Hypothetical Situations Scale. CONCLUSION: Although the intention to use violence was associated with previous exposure to violence and current drug use, adolescents who attended religious services more often were less likely to report that they would use violence to resolve interpersonal conflict.

Aggressors or victims: gender and race in music video violence.

OBJECTIVE: To examine portrayals of violence in popular music videos for patterns of aggression and victimization by gender and race. DESIGN AND SETTING: Content analysis of 518 music videos broadcast over national music television networks, Black Entertainment Television (BET), Country Music Television (CMT), Music Television (MTV), and Video Hits-1 (VH-1) during a 4-week period at randomly selected times of high adolescent viewership. MAIN OUTCOME MEASURES: Differences in the genders and races portrayed as aggressors and victims in acts of violence. RESULTS: Seventy-six (14.7%) of the analyzed music videos contained portrayals of individuals engaging in overt interpersonal violence, with a mean of 6.1 violent acts per violence-containing video. Among the 462 acts of violence, the music video's main character was clearly the aggressor in 80.1% and the victim in 17.7%. In 391 (84.6%) of the violence portrayals, the gender of the aggressor or victim could be determined. Male gender was significantly associated with aggression; aggressors were 78.1% male, whereas victims were 46.3% female. This relationship was influenced by race. Among whites, 72.0% of the aggressors were male and 78.3% of the victims were female. Although blacks represent 12% of the United States population, they were aggressors in 25.0% and victims in 41.0% of music video violence. Controlling for gender, racial differences were significant among males; 29.0% of aggressors and 75.0% of victims were black. A logistic regression model did not find direct effects for gender and race, but revealed a significant interaction effect, indicating that the differences between blacks and whites were not the same for both genders. Black males were more likely than all others to be portrayed as victims of violence (adjusted odds ratio = 28.16, 95% confidence interval = 8.19, 84.94). CONCLUSIONS: Attractive role models were aggressors in more than 80% of music video violence. Males and females were victims with equivalent frequency, but males were more than three times as likely to be aggressors. Compared with United States demographics, blacks were overrepresented as aggressors and victims, whereas whites were underrepresented. White females were most frequently victims. Music videos may be reinforcing false stereotypes of aggressive black males and victimized white females. These observations raise concern for the effect of music videos on adolescents' normative expectations about conflict resolution, race, and male-female relationships.

High-risk behaviors among high school students in Massachusetts who use anabolic steroids.

OBJECTIVE: To assess the association between the frequency of anabolic steroid use and the frequency of other health risk and problem behaviors among high school students in Massachusetts. METHODS: The 1993 Massachusetts Youth Risk Behavior Survey was conducted on a random sample of 3054 high school students (49% male; mean age, 16 +/- 1.2 years). The frequency of lifetime anabolic steroid use was measured on an ordinal scale from 1 to 6, representing "0" to "40 or more times." Other health risk and problem behaviors measured were sexual behaviors, suicidal behaviors, frequency of not wearing a passenger seat belt, riding a motorcycle, not wearing a helmet while riding a motorcycle, driving after drinking alcohol, riding with a driver who had been drinking alcohol, fighting, and carrying a weapon. The associations between the frequency of anabolic steroid use and other high-risk behaviors were determined using the Spearman correlation coefficient for ordinal data and the Kruskall-Wallis analysis of variance for categorical data. Representative indicators of each risk behavior significantly associated with anabolic steroid use were then analyzed using a stepwise multiple-regression analysis. RESULTS: The frequency of anabolic steroid use was associated with all of the other high-risk behaviors analyzed. Using multiple-regression analysis, driving after drinking alcohol accounted for 12.5% of the variance of the model. Carrying a gun, the number of sexual partners within the past 3 months, not using a condom during last intercourse, injury in a physical fight requiring medical attention, history of a sexually transmitted disease, not wearing a helmet on a motorcycle, not wearing a passenger seatbelt, and a suicide attempt requiring medical attention accounted for an additional 9.0% of the variance. The full model accounted for greater than 21% of the variation. CONCLUSIONS: The frequency of anabolic steroid use among adolescents is associated with other high-risk behaviors, thus supporting the hypothesis that anabolic steroid use is part of a "risk behavior syndrome" rather than an isolated behavior. This finding emphasizes the need for comprehensive high-risk behavior screening and counseling among teens who use anabolic steroids.

Effect of peer counselors on adolescent compliance in use of oral contraceptives.

Poor compliance with contraceptive regimens has been shown to be an important antecedent of adolescent pregnancy. The purpose of this study was to test prospectively the effect of a peer v nurse counseling program on adolescent compliance with the use of oral contraceptives. Fifty-seven females aged 14 to 19 years from a lower socioeconomic background were randomly assigned to a peer (n = 26) or nurse (n = 31) group. At the initial visit and at 1-, 2-, and 4-month follow-up visits, subjects received Ortho-Novum 1/35 combined with a tablet marker and were counseled by a nurse or peer. Noncompliance was measured using a Guttman scale consisting of: (1) avoidance of pregnancy, (2) appointment adherence, (3) pill count, and (4) urinary fluorescence for riboflavin. At the first and second follow-ups, the adolescents counseled by a peer had a significantly (P less than or equal to .038) lower noncompliance level than the nurse-counseled group. Adolescents with more frequent sexual activity (P less than or equal to .027), with one sexual partner (P less than .04), and who worried that they might become pregnant (P less than or equal to .01) had significantly lower levels of noncompliance when counseled by a peer than by a nurse. At the fourth month follow-up, adolescents who expressed feelings of hopelessness about the future had significantly (P less than or equal to .036) higher levels of noncompliance when counseled by a nurse than when counseled by a peer. These results suggest that incorporating a peer counselor into the health care team may be an effective method of increasing adolescent compliance.

Exercise-induced cardiac dysfunction in sickle cell anemia. A radionuclide study.

Cardiac performance was studied by radionuclide angiography at rest and during exercise in 22 adolescents with sickle cell (SC) anemia and the results were compared with those in 12 control subjects. At rest, cardiac contractility was normal; cardiac output and end-diastolic volume were increased. At maximal exercise, heart rate, cardiac output response, and work capacity were reduced; the reduction was related to the degree of anemia. Left ventricular end-diastolic volume decreased with exercise most markedly in patients with ischemic exercise electrocardiograms. An abnormal ejection fraction response to exercise occurred in 4 patients; electrocardiographic signs of ischemia developed in all 4, and wall motion abnormalities in 2. Those patients who had electrocardiographic signs of ischemia had a significantly lower heart rate, ejection fraction, and cardiac output response to exercise, and a lower hematocrit level than subjects with normal results on exercise electrocardiography. The increase in cardiac output was not sufficient to maintain a normal level of exercise. The decrease in end-diastolic volume suggests that diastolic function was abnormal during exercise. Cardiac dysfunction was manifested by an abnormal ejection fraction response, wall motion abnormalities, and incomplete left ventricular filling during exercise.

Relationship between cigarette smoking and health risk and problem behaviors among US adolescents.

OBJECTIVE: To examine whether sociodemographic factors and health risk and problem behaviors explain the prevalence of cigarette smoking among US adolescents. DESIGN: Probability survey. PARTICIPANTS: A nationally representative sample of US adolescents. MAIN OUTCOME MEASURES: Weighted prevalence, adjusted odds ratio (OR), and 95% confidence intervals (CIs) for current smoking status by health risk and problem behaviors. RESULTS: The prevalence of smoking was highest among adolescents who were white, older, and who had a high school education or lived in the Northeast. When we adjusted for sociodemographic factors and health risk and problem behaviors, smoking was associated with marijuana use (OR, 3.7; 95% CI, 2.7-5.1), binge drinking (OR, 2.1; 95% CI, 1.6-2.8), and fighting (OR, 1.4; 95% CI, 1.1-1.7) among white adolescent males. Similar associations between each of these 3 behaviors and cigarette smoking were found among white adolescent females and African American and Hispanic adolescent males and females. Cigarette smoking was also associated with using smokeless tobacco, having multiple sexual partners, and not using bicycle helmets among white adolescent males and females, having multiple sexual partners among Hispanic adolescent females, and carrying weapons among Hispanic adolescent males. CONCLUSIONS: Marijuana use, binge drinking, and fighting are correlates of cigarette smoking among US adolescents. These associations, which vary by sex and race or ethnicity, suggest clustering to form a risk behavior syndrome.

The association of weapon carrying and fighting on school property and other health risk and problem behaviors among high school students.

OBJECTIVE: To examine the association between weapon carrying on school property and engaging in health risk and problem behaviors such as fighting and substance use on school property, fear of attending school, and victimization at school. DESIGN: A complex 2-stage probability survey (Massachusetts Youth Risk Behavior Survey). SETTING: High schools in Massachusetts. PARTICIPANTS: Three thousand fifty-four high school students. MAIN OUTCOME MEASURE: Number of days a weapon was carried on school property during the 30 days prior to the survey. RESULTS: The prevalence of self-reported weapon carrying on school property was 15% among male students and 5% among female students (P < .001). Weapon carrying on school property was significantly (P < .001) associated with frequency of physical fights on school property (r = 0.26), being a victim of threat or injury with a weapon on school property (r = 0.27), being a victim of stolen or damaged goods on school property (r = 0.14), not attending school owing to fear (r = 0.15), and substance use while at school, including smoking cigarettes (r = 0.20), using chewing tobacco (r = 0.18), smoking marijuana (r = 0.24), and using alcohol (r = 0.29). The association between weapon carrying and alcohol use in school was higher among students who were afraid to come to school (r = 0.49) than among students who were not afraid (r = 0.28). Students who had engaged in same-sex sexual activity (P < .001) or had been offered, given, or sold illicit drugs at school (P < .001) were more likely to carry a weapon at school. Multiple regression analysis showed that male sex and the frequencies of physical fighting, being a victim of a threat or injury, drinking alcohol, smoking cigarettes, and being offered or sold an illicit drug while on school property accounted for 21% of the variance in weapon carrying in school. When weapon carrying was dichotomized and analyzed with logistic regression, a model containing age, male sex, lower academic achievement, days not attending school owing to fear, times threatened or injured with a weapon at school, frequency of fighting at school, cigarette smoking, alcohol use, and being offered or sold illicit drugs on school property correctly classified 91.83% of the students who did or did not carry weapons. CONCLUSIONS: Weapon carrying at school was more strongly associated more with use of violence and the use of substances at school than with previous victimization and fear of attending school. However, there is a subgroup of students that seems to have been victimized at school, is afraid to come to school, is using alcohol at school, and is carrying weapons at school.

Systolic blood pressure response to exercise in black and white preadolescent and early adolescent boys.

OBJECTIVE: To investigate differences in the response of systolic blood pressure (SBP) to exercise in black and white boys while controlling for the possible confounding effects of relative body weight, body surface area, physical work capacity index, preexercise SBP, and average power output. DESIGN: Comparative and correlational. PARTICIPANTS: Eighty-seven black and 52 white boys between the ages of 5 and 16 years. Participants were recruited from day camps, community centers, and summer recreation programs in and near Augusta, Ga. INTERVENTIONS: None. MEASUREMENTS/MAIN OUTCOMES: The slope of the SBP response to exercise was not significantly different between groups. Analysis of covariance revealed race, age, relative body weight, body surface area, preexercise SBP, and average power output to be significant univariate predictors of SBP at each power output. With multiple regression analyses, the effect of race was removed, and only preexercise SBP and average power output were found to be significant predictors of exercise SBP. CONCLUSION: There were no significant differences between black and white boys in the SBP response to exercise after controlling for the effects of preexercise SBP and average power output.

Violence and weapon carrying in music videos. A content analysis.

BACKGROUND: The positive portrayal of violence and weapon carrying in televised music videos is thought to have a considerable influence on the normative expectations of adolescents about these behaviors. OBJECTIVES: To perform a content analysis of the depictions of violence and weapon carrying in music videos, including 5 genres of music (rock, rap, adult contemporary, rhythm and blues, and country), from 4 television networks and to analyze the degree of sexuality or eroticism portrayed in each video and its association with violence and weapon carrying, as an indicator of the desirability of violent behaviors. METHODS: Five hundred eighteen videos were recorded during randomly selected days and times of the day from the Music Television, Video Hits One, Black Entertainment Television, and Country Music Television networks. Four female and 4 male observers aged 17 to 24 years were trained to use a standardized content analysis instrument. Interobserver reliability testing resulted in a mean (+/- SD) percentage agreement of 89.25% +/- 7.10% and a mean (+/- SD) kappa of 0.73 +/- 0.20. All videos were observed by rotating 2-person, male-female teams that were required to reach agreement on each behavior that was scored. Music genre and network differences in behaviors were analyzed with chi 2 tests. RESULTS: A higher percentage (22.4%) of Music Television videos portrayed overt violence than Video Hits One (11.8%), Country Music Television (11.8%), and Black Entertainment Television (11.5%) videos (P = .02). Rap (20.4%) had the highest portrayal of violence, followed by rock (19.8%), country (10.8%), adult contemporary (9.7%), and rhythm and blues (5.9%) (P = .006). Weapon carrying was higher on Music Television (25.0%) than on Black Entertainment Television (11.5%), Video Hits One (8.4%), and Country Music Television (6.9%) (P < .001). Weapon carrying was also higher in rock (19.8%) and rap (19.5%) videos than in adult contemporary (16.1%), rhythm and blues (6.9%), and country (6.3%) videos (P = .002). The videos with the highest level of sexuality or eroticism were found to be less likely to contain violence (P < or = .04). CONCLUSION: Because most music videos are between 3 and 4 minutes long, these data indicate that even modest levels of viewing may result in substantial exposure to violence and weapon carrying, which is glamorized by music artists, actors, and actresses.

Gender differences in risk behaviors associated with forced or pressured sex.

OBJECTIVE: To determine whether gender-specific patterns of risk behaviors are associated with a self-reported history of ever having been forced or pressured to have sexual intercourse among sexually active adolescents. SUBJECTS AND METHODS: In 1995, 21,297 eighth- through 12th-grade students in 79 public and private schools in Vermont were anonymously surveyed. Data were analyzed for 7884 sexually active students (3931 girls and 3953 boys). Demographic variables and indicators of violence, suicide, recent substance use, sexual behavior, pregnancy, and weight control behavior were assessed. Data were analyzed with multiple logistic regression. RESULTS: Of the sexually active students, 30.3% of the girls and 9.9% of the boys reported ever being forced or pressured to have sexual intercourse. Among sexually active girls, being in 1 or more physical fights in the past year (odds ratio [OR], 1.65; 95% confidence interval [CI], 1.40-1.94), seriously considering suicide (OR, 1.97; CI, 1.69-2.31), more years of sexual activity (OR, 1.52; CI, 1.43-1.61), not using a condom at last sexual intercourse (OR, 1.28; CI, 1.09-1.49), and having been pregnant more often (OR, 1.40; CI, 1.16-1.69) were associated with having been forced or pressured to have sex. For sexually active boys, seriously considering suicide (OR, 1.64; CI, 1.23-2.20), more years of sexual activity (OR, 1.21; CI, 1.12-1.31), more male partners in the past 3 months (OR, 1.30; CI, 1.14-1.48), more female partners in the past 3 months (OR, 1.09; CI, 1.01-1.18), not using a condom at last sexual intercourse (OR, 1.37; CI, 1.03-1.82), having been involved in more pregnancies (OR, 1.64; CI, 1.29-2.08), and having vomited or used laxatives (OR, 3.44; CI, 2.18-5.43) were associated with having been forced or pressured to have sex. CONCLUSIONS: Patterns of risk behaviors differed among sexually active male and female adolescents reporting being forced or pressured to have sex. Having been forced or pressured to have sex was associated with externalizing behavior, such as fighting, among girls and with internalizing behavior, such as bulimia, among boys. These unexpected associations have notable implications for screening adolescents for a history of having been forced or pressured to have sex.

The relationship between early age of onset of initial substance use and engaging in multiple health risk behaviors among young adolescents.

BACKGROUND: Previous research based on problem-behavior theory has found that early age of onset of substance use is associated with engaging in multiple health risk behaviors among high school students. It is unknown whether these relationships begin during early adolescence. OBJECTIVE: To examine the relationships between early age of onset of cigarette, alcohol, marijuana, and cocaine use and engaging in multiple risk behaviors among middle school students. METHODS: A modified version of the Centers for Disease Control and Prevention Youth Risk Behavior Survey was administered to 2227 sixth through eighth grade students attending 53 randomly selected middle schools in North Carolina. A Health Risk Behavior Scale was constructed from 16 behaviors, including indicators of violence and weapon carrying; current substance use; nonuse of helmets when biking, in-line skating or skateboarding; not wearing a seat belt; riding with a driver who had been drinking; and suicide plans. Among this sample of middle school students, the scale had a mean (SD) of 4.1 (2.7) (range=O-15), and had a high internal reliability coefficient (alpha(=0.74). The independent variables included first time use of cigarettes, alcohol, marijuana, and cocaine at age 11 years or earlier; actual age of onset of each substance; race and ethnicity; family composition; sex; school grade; academic ranking; and older age for school grade. These data were analyzed with analysis of variance, Spearman r, and multiple linear regression. RESULTS: All the independent variables were found to be associated (P<.005) with the Health Risk Behavior Scale during the bivariate analyses. When each of these significant variables were entered into a multiple regression model, having smoked at age 11 years or younger accounted for 21.9% of the variation in the Health Risk Behavior Scale. Male sex, early marijuana or cocaine use, older age, lower academic rank, white race, and living in a 1-parent family explained an additional 19.1% of variation in the model (adjusted R2=0.41, P<.001). When the actual ages of onset of the use of substances were analyzed, in order of magnitude; age of onset of smoking; male sex; age of onset of alcohol and marijuana use; age; lower academic ranking; age of onset of cocaine use; white race; and lower academic rating accounted for 52.8% (P<.001) of the variation in the Health Risk Behavior Scale. CONCLUSION: Even when considering sociodemographic factors, early age of onset of cigarette use was the strongest correlate of the number of health risk behaviors in which these young adolescents had engaged. Early onset of use of other substances was also associated with a clustering of health risk behaviors among this sample of middle school students. The findings suggest that screening for early experimentation with tobacco and other substance use will help identify young adolescents at increased risk for engaging in multiple health risk behaviors.