Attitudes and Beliefs Pertaining to Sexual and Reproductive Health Among Unmarried, Female Bhutanese Refugee Youth in Philadelphia.

PURPOSE: We explored attitudes and beliefs pertaining to sexual and reproductive health (SRH) among unmarried, female, resettled Bhutanese refugees 16-20 years. METHODS: Fourteen interviews were analyzed using the constant comparison method, and major themes were identified. RESULTS: SRH was stigmatized for unmarried youth, making seeking information about SRH or accessing family planning difficult. There were many misconceptions about access to SRH. CONCLUSIONS: Universal, culturally, and linguistically appropriate comprehensive SRH education is recommended for female Bhutanese refugee youth. Terminology used should take into account differences in conceptualization of concepts like dating. Educators and health care providers should clearly describe consent and confidentiality laws regarding adolescent SRH services.

Parental Concerns Influencing Decisions to Seek Medical Care for a Child's Short Stature.

AIMS: To examine parental concerns about child growth and factors that drive parents' decisions whether to intervene medically with their child's height. METHODS: Parents of 9- to 14-year-old pediatric primary care patients of various heights, oversampled for those with short stature, participated in exploratory focus groups and nominal group technique sessions. Growth concerns expressed by the groups were incorporated into a survey, completed by 1,820 parents, and rated for their degree of impact on medical decision-making. Ordinal logistic regression modeled concern scores against parent traits. Explanatory focus groups clarified the survey results. RESULTS: Research team consensus and factor analysis organized the 22 distinct concerns expressed by the parent groups into 7 categories. Categories rated as having the greatest influence on parental decision-making involved: treatment efficacy and side effects, child health and psychosocial function. Level of concern was highly associated with parental education and parenting style. CONCLUSION: Psychosocial issues are influential, but parental decision-making is most impacted by concerns about treatment and child health. By discussing the real risks and benefits of hormone treatment and addressing parents' perceptions of what is needed for physical and psychosocial health, clinicians can be highly effective educators to assure that treatment is used only as medically indicated.

Internet informs parents about growth hormone.

BACKGROUND: Parents' knowledge influences decisions regarding medical care for their children. METHODS: Parents of pediatric primary care patients aged 9-14 years, irrespective of height, participated in open focus groups (OFGs). Moderators asked the question, 'How do people find out about growth hormone (GH)?' Because many parents cited the Internet, the top 10 results from the Google searches of 'growth hormone children' and 'parents of children who take growth hormone' were examined. Three investigators independently performed content analysis and then reached a consensus. The results were tabulated via summary statistics. RESULTS: Eighteen websites were reviewed, most with the purpose of education (56%) and many funded by commercial sources (44%). GH treatment information varied, with 33% of the sites containing content only about US FDA-approved indications. Fifty-six percent of the sites included information about psychosocial benefits from treatment, with 44% acknowledging them as controversial. Although important to OFG participants, risks and costs were each omitted from 39% of the websites. CONCLUSION: Parents often turn to the Internet for GH-related information for their children, although its content may be incomplete and/or biased. Clinicians may want to provide parents with tools for critically evaluating Internet-based information, a list of prereviewed websites, or their own educational materials.

Variation in teen driver education by state requirements and sociodemographics.

OBJECTIVES: There is renewed attention on national standardization of formal driver education (DE) instruction and momentum toward realigning DE with its original goal of producing safer teen drivers. However, teen DE participation rates and how they differ among sociodemographic groups and in states with and without DE requirements remain largely unknown. Thus, our objective was to estimate national teen participation rates in formal classroom and behind-the-wheel DE instruction in relevant demographic subgroups and also estimate subgroup-specific participation rates by presence of a state DE requirement. METHODS: Data were collected via the National Young Driver Survey, administered to a nationally representative sample of 5665 public school 9th- through 11th-graders in Spring 2006. Analyses were restricted to 1770 students with driver licenses. Survey data were weighted to reflect national prevalence estimates. RESULTS: Overall, 78.8% of students reported participating in formal DE. However, in states without DE requirements, more than 1 in 3 students had no formal DE before licensure, and more than half had no behind-the-wheel training. Hispanics, blacks, males, and students with lower academic achievement participated in DE at markedly lower levels than counterparts in states with requirements. Notably, 71% of Hispanic students in states with no requirement received a license without receiving formal DE. CONCLUSIONS: Considerable racial/ethnic, socioeconomic, and gender disparities in DE participation may exist in states with no DE requirements. State DE requirements may be an effective strategy to reduce these disparities.

Unlicensed teenaged drivers: who are they, and how do they behave when they are behind the wheel?

OBJECTIVE: The objective of this study was to determine the prevalence and associated risk factors for unlicensed driving among 9th- through 11th-graders. METHODS: A nationally representative school-based survey of 5665 9th-, 10th-, and 11th-graders ascertained whether students engaged in unlicensed driving and determined associated driving behaviors, risk behaviors, and demographic factors. Unlicensed driving, defined as not having any type of license and "driving on [one's] own" as opposed to learning to drive, or not driving yet was ascertained. RESULTS: One (4.2%) in 25 US 9th- through 11th-graders reported that they drove at least 1 hour/week without a license. Unlicensed drivers were more likely to identify as being black or Hispanic, to live in rural or central city districts, and to report lower grades in school. No relationship was found between license status and reported crashes; however, unlicensed teenaged drivers were less likely to report seat belt use, more likely to report driving while under the influence of alcohol or drugs, and more likely to report more trips without a purpose. One fourth (28%) of them had taken a driver's education class, and one half (50%) reported parents as most helpful in learning to drive. Two thirds (66%) of the unlicensed drivers reported most often using a vehicle that others usually drive. CONCLUSIONS: Considering the high burden of teen crashes, it is important to reach and deliver effective anticipatory guidance to unlicensed teenaged drivers who are at high risk for unsafe driving practices. Parents and driver's education instructors have contact with many of these unlicensed drivers. Clinicians, particularly those in rural and central city districts, should discuss unlicensed driving starting before the legal age of driving while screening for other health risk behaviors. Additional research is needed for better understanding of barriers to licensing among the teen population of licensing age.

Voices of Asian American youth: important characteristics of clinicians and clinical sites.

OBJECTIVE: The purpose of this work was to explore clinician and site characteristics that are important to Chinese and Vietnamese immigrant and first-generation youth. METHODS: A 3-stage mixed qualitative-quantitative design consisting of exploratory focus groups, a survey, and explanatory focus groups was used to ensure that all of the ideas were generated, prioritized, and explained by youth. Adolescents of Chinese and/or Vietnamese descent and aged 13 to 18 years were recruited in community centers and schools. In stage 1, 55 adolescents in 8 focus groups shared their views on factors that attract or deter them from seeking care. In stage 2, youth responded to a survey including 27 teen-generated items regarding clinicians and sites. In stage 3, 87 teens in 11 groups explained the top-rated items and offered suggestions on how to meet their needs. All of the stages were conducted in English, Mandarin Chinese, and Vietnamese. RESULTS: Most of the 245 survey respondents (77%) were born in Asia, and 70% had lived in the United States for <3 years. The 27 items were divided into 6 priority ranks by the marginal homogeneity test. Clinician cleanliness and experience shared first rank. Second rank was shared by Asian teens being treated like other teens, site cleanliness, clinician honesty, and clinician friendliness and attitude. The third rank was shared by respect, privacy, completeness, clinicians explaining their actions, and lower health care costs. Interspersed among ranks 5 and 6 were items specific to the needs of Asian youth: the clinician would offer more explanation because Asian families might not ask questions; the clinician would not assume that Asian teens are drug and sex free; the clinician would understand that Asian families may use traditional healing; the clinician would not assume that Asians do not know English; adolescents would not translate for parents; and the teen would be able to choose an Asian clinician. There was little variation in ratings by age, gender, ethnicity, or socioeconomic status. However, 11 of 27 items differed by acculturation. Examples include the greater importance ascribed by more acculturated youth to not being judged, to not having to translate, and to the clinician addressing behavioral issues. Acculturation also affected the youths' views regarding confidentiality and translation. CONCLUSIONS: Asian American adolescents value the same concerns as all adolescents: respect, honesty, competency, cleanliness, privacy, and nonjudgmental service. However, they also have unique perspectives, and youth at varying levels of acculturation differ in some of their views.

Quantitative assessment of the SR Ca2+ leak-load relationship.

Increased diastolic SR Ca2+ leak (J(leak)) could depress contractility in heart failure, but there are conflicting reports regarding the J(leak) magnitude even in normal, intact myocytes. We have developed a novel approach to measure SR Ca2+ leak in intact, isolated ventricular myocytes. After stimulation, myocytes were exposed to 0 Na+, 0 Ca2+ solution +/-1 mmol/L tetracaine (to block resting leak). Total cell [Ca2+] does not change under these conditions with Na+-Ca2+ exchange inhibited. Resting [Ca2+]i declined 25% after tetracaine addition (126+/-6 versus 94+/-6 nmol/L; P<0.05). At the same time, SR [Ca2+] ([Ca2+](SRT)) increased 20% (93+/-8 versus 108+/-6 micromol/L). From this Ca2+ shift, we calculate J(leak) to be 12 micromol/L per second or 30% of the SR diastolic efflux. The remaining 70% is SR pump unidirectional reverse flux (backflux). The sum of these Ca2+ effluxes is counterbalanced by unidirectional forward Ca2+ pump flux. J(leak) also increased nonlinearly with [Ca2+](SRT) with a steeper increase at higher load. We conclude that J(leak) is 4 to 15 micromol/L cytosol per second at physiological [Ca2+](SRT). The data suggest that the leak is steeply [Ca2+](SRT)-dependent, perhaps because of increased [Ca2+]i sensitivity of the ryanodine receptor at higher [Ca2+](SRT). Key factors that determine [Ca2+](SRT) in intact ventricular myocytes include (1) the thermodynamically limited Ca2+ gradient that the SR can develop (which depends on forward flux and backflux through the SR Ca2+ ATPase) and (2) diastolic SR Ca2+ leak (ryanodine receptor mediated).

How to reach sexual minority youth in the health care setting: the teens offer guidance.

PURPOSE: To explore factors sexual minority youth believe make them feel safe in a health care setting. METHODS: Participants in three urban programs serving lesbian/gay/bisexual/transgendered and questioning (LGBTQ) youth engaged in a four-stage process to generate, prioritize, and explain their own ideas. In Stage III, 94 youth, aged 14 to 23 years, completed a survey comprised of the 34 highest rated items generated in earlier stages. Using a Likert scale, they answered, "How important are each of the following ideas in making you feel safe as an LGBTQ youth when you go for health care?" In Stage IV, youth discussed the results in focus groups. The Marginal Homogeneity Test divided the items into priority ranks and the Kruskal-Wallis test explored subgroup differences in item ratings. RESULTS: The 34 items were divided into six ranks. Five items shared the top rank: the clinician maintaining privacy, demonstrating cleanliness, offering respect, being well-educated, and being honest. The second rank was shared by the following: the clinician not talking down to patients, being a good listener, not downplaying patients' fears, being professional, holding a nonjudgmental stance of the LGBTQ lifestyle, and not assuming every LGBTQ youth has HIV. Interspersed among other ranks were items specific to the needs of sexual minority youth: the clinician not assuming LGBTQ sexual behavior was painful or dangerous; the clinician being educated about the gay lifestyle; clinician sensitivity to the needs of same-sex partners; staff sensitivity to the needs of closeted youth; having a choice of an LGBTQ provider; and the clinician not assuming heterosexuality. Youth who had not publicly disclosed their sexuality rated health information being offered in a private place higher (p =.01). CONCLUSIONS: LGBTQ youth value the same clinician characteristics desired by all adolescents: privacy, cleanliness, honesty, respect, competency, and a nonjudgmental stance. They clearly describe what attracts them (e.g., clinicians educated about their lifestyle) and what offends them (e.g., equating their sexuality with HIV). Clinicians need to achieve and convey a higher comfort level in addressing the special needs of sexual minority youth.