Correlates of HPV knowledge among low-income minority mothers with a child 9-17 years of age.

STUDY OBJECTIVE: To assess the level of HPV knowledge among low income, minority mothers with a child between the ages of 9-17 y. DESIGN: Women who sought care at a university-based clinic and had at least 1 child aged 9 to 17 years were approached. A total of 638 mothers were recruited. Only those who had heard of HPV were included in the correlation analyses (n = 468). MAIN OUTCOME MEASURES: HPV knowledge was assessed utilizing a self-administered questionnaire consisting of 20 questions. RESULTS: There were differences between those who had heard of HPV and those who had not. More of those who had not heard of HPV were Hispanic (63%), low-income (89%), and did not graduate high school (59%). Of those who had heard of HPV, the majority did not answer 50% of questions correctly. Few knew the vaccine could prevent genital warts (19.7%). Factors independently associated with HPV knowledge included age, personal history of HPV, cervical dysplasia or cervical cancer, acquiring knowledge from ≥ 2 sources, having known someone with HPV or cervical cancer, having seen a brochure on the vaccine, and having seen an advertisement for the vaccine. CONCLUSIONS: Knowledge regarding HPV is low among low-income women with children in the target age range for HPV vaccination. Increased awareness should focus on genital warts and other cancers, since this population has virtually no knowledge of other health outcomes related to HPV infection. Educational programs tailored to this population need to be developed to increase vaccination.

Racial differences in the association between body fat distribution and lipid profiles among reproductive-age women.

AIM: The aim of this study was to examine the racial and ethnic differences in the relationship between body fat distribution variables and serum lipid profiles. METHODS: Secondary data analyses were conducted on 708 healthy women (204 blacks, 247 whites and 257 Hispanics), aged 16-33 years, seen in an outpatients clinic for contraception. Pearson correlation and multivariable linear regression techniques were used to identify racial/ethnic differences in the relationship between lipid profiles and body fat after adjusting for lean mass as well as demographic and lifestyle variables. RESULTS: All body fat distribution variables were significantly associated with total cholesterol (TC) (r=0.14 to 0.26), triglycerides (TG) (r=0.13 to 0.46), HDL cholesterol (r=-0.13 to -0.34), cholesterol-to-HDL ratio (r=0.20 to 0.50) and atherogenic index of plasma (AIP) (r=0.16 to 0.49). Significant racial/ethnic differences were observed in many associations. After adjusting for lean mass, and other demographic and lifestyle factors, the study showed that black women demonstrated significantly weaker associations than their white and Hispanic counterparts using multivariable linear regression procedures. CONCLUSION: The relationship between lipid profiles and body fat distribution variables varies by race/ethnicity in reproductive-age women. A better understanding of these racial/ethnic differences has important implications for clinical and public-health efforts in targeting the prevention of cardiovascular disease (CVD).

Morbidity in a population of low-income, female users of MDMA and other drugs.

Few previous studies have reported on the overall health of drug-using women. To investigate this, 696 low-income women aged 18-31 were recruited in a cross-sectional study from gynecological care clinics in Texas between 2001 and 2003. Compared to exclusive marijuana users and non-drug users, women who used MDMA and those who used other illicit drugs but not MDMA reported more gynecological conditions, medical conditions, depressive symptoms, and physical somatic complaints. We concluded that young, low-income women who used more than one illicit drug experience significantly more physical and psychological morbidity. Generalization of this study results may be limited to young women with low income but not to other populations.

Racial difference in the correlates of bone mineral content/density and age at peak among reproductive-aged women.

SUMMARY: Racial/ethnic differences were observed in age at peak bone density and their correlates, with whites peaking at least 5 years earlier at the femoral neck than black and Hispanic women. Race-specific standards generated in this study could be useful when interpreting bone densitometry data in young women. INTRODUCTION: The influence of race/ethnicity on bone measurements has not been widely examined. This study identifies age and amount of bone accumulated at peak density and their correlates by race/ethnicity. METHODS: Bone mineral content (BMC) and bone mineral density (BMD) of the spine and femoral neck were measured by dual X-ray absorptiometry in 708 white, black, and Hispanic reproductive-aged women. Race-specific nonlinear models were used to describe the relationship between age and bone measurements, after adjusting for body weight and height. Log-transformed bone measurements were used to determine predictors based on multiple linear regression. RESULTS: Predictors, which were race and site specific, included age, age at menarche, body weight, height, months of depot medroxyprogesterone acetate use, weight-bearing exercise, and alcohol use. Women of all races gained BMC and BMD at the spine up to 30-33 years of age. BMC and BMD of the femoral neck peaked among white women earlier (

A profile of adolescent females with a history of sexual assault in texas: familial environment, risk behaviors, and health status.

STUDY OBJECTIVE: To describe the prevalence and correlates of sexual assault among adolescent females. DESIGN: A cross-sectional study. SETTING: A university family planning clinic in south Texas. PARTICIPANTS: Female adolescents <18 years who initiated care at a university family planning clinic in south Texas between June 28, 1992, and April 28, 1994. The adolescents' lifetime sexual assault experience. MAIN OUTCOME MEASURES: Of the 791 adolescents interviewed, 167 (21%) reported a history of sexual assault. Sexual assault was found to be highly associated with multiple risky behaviors and depressive symptoms. Among assaulted adolescents, nonsexual risk behaviors (e.g., substance use) were more common among those who also experienced physical assault than among those who did not. Sexual risk behaviors (e.g., earlier age at sexual debut) and related gynecological infections (e.g., STDs) were more prevalent among women reporting forced sexual intercourse than in those who reported molestation only. Furthermore, adolescents assaulted by a stranger had participated in the most risky behaviors and reported the worst health status, while those assaulted by a date/acquaintance reported higher rates of inconsistent condom use and gynecological infections but lower rates of substance use and depressive symptoms than those assaulted by a family member. CONCLUSION: A deeper understanding of the links between the characteristics of assault, risk behaviors, and health conditions may provide opportunities to design more individualized interventions.

Exposure to violence and associated health-risk behaviors among adolescent girls.

OBJECTIVE: To examine the relationship between exposure to violence and health-risk behaviors. DESIGN: Cross-sectional survey. SETTING: University-based outpatient family planning clinic. PATIENTS: Sexually active adolescent girls younger than 18 years (N = 517) who presented for contraceptive care. MAIN OUTCOME MEASURES: Prevalence of witnessing or experiencing violence and the associations with health-risk behaviors, including high-risk sexual behaviors, substance use, and self-injury. RESULTS: Compared with adolescents who had not been exposed to violence, those who had only witnessed violence were 2 to 3 times more likely to report using tobacco and marijuana, drinking alcohol or using drugs before sex, and having intercourse with a partner who had multiple partners. Those who had experienced, but not witnessed violence were at increased risk of these same behaviors and were 2 to 4 times more likely than those who had neither witnessed nor experienced violence to report early initiation of intercourse, intercourse with strangers, multiple partners, or partners with multiple partners, tobacco, alcohol and drug use, or to have positive test results for a sexually transmitted disease. Individuals who had both witnessed and experienced violence demonstrated the greatest risk of adverse health behaviors. These adolescents demonstrated 3 to 6 times greater risk of suicidal ideation (odds ratio [OR], 3.1; 95% confidence interval [CI], 2.2-4.0) or suicide attempts (OR, 4.5; 95% CI, 2.2-9.4), self-injury (OR, 5.8; 95% CI, 2.6-12.9), and use of drugs before intercourse (OR, 6.2; 95% CI, 3.0-12.9) than those who had neither witnessed nor experienced violence. CONCLUSIONS: Adolescents exposed to violence are at increased risk of multiple adverse health behaviors. Programs designed to improve health outcomes should target this high-risk group.

A prospective, controlled study of the effects of hormonal contraception on bone mineral density.

OBJECTIVE: To compare the effect of depot medroxyprogesterone acetate (DMPA) and two types of oral contraceptives (OC) on bone mineral density (BMD) among women 18-33 years of age with those not using hormonal contraception. METHODS: Data from 155 women were analyzed. Depot medroxyprogesterone acetate was administered to 33 women; 63 women who chose oral contraception were randomly assigned to receive either a norethindrone-containing pill (n = 28) or a desogestrel-containing pill (n = 35). Fifty-nine women who did not use hormonal contraception served as controls. Lumbar spine BMD was determined using dual-energy x-ray absorptiometry at baseline and after 12 months of contraceptive use. We analyzed method-related percent change in BMD while controlling for body mass index, calcium intake, exercise, and smoking. We had approximately 90% power to detect a 2.5% difference between any two groups. RESULTS: Users of DMPA experienced a mean BMD loss of 2.74% over 12 months compared with controls who sustained a 0.37% loss (P = .01). Users of OCs generally demonstrated a gain (2.33% for norethindrone-containing pills, 0.33% for desogestrel-containing pills), which was different from controls among users of norethindrone-containing pills (P = .01), but not among users of desogestrel-containing pills (P = .99). Observed changes in BMD among DMPA users differed from women who used either type of pill (P < .002). CONCLUSION: Depot medroxyprogesterone acetate has an adverse effect on BMD, in comparison with OCs or nonhormonal methods, when used for 12 months. Results must be interpreted cautiously until it is determined whether these effects endure or are reversible.

The behavioral risks and life circumstances of adolescent mothers involved with older adult partners.

OBJECTIVE: To investigate behavioral risks and life circumstances of adolescent mothers with older (> or =5 years) adult (> or =20 years old) vs. similar-aged (+/-2 years) male partners at 12 months' postpartum. METHODS: Nine hundred thirty-one adolescent females were interviewed after delivery and were mailed surveys to complete at 12 months' postpartum. Analysis by chi(2) and t test was used to identify differences in behavioral risks (planned repeated pregnancy, substance use, and intimate partner violence) and life circumstances (financial status, school enrollment, and social support) for adolescent mothers with older adult vs similar-aged partners. Additional stratified analyses were conducted to evaluate the extent to which living with an adult authority figure or being with the father of her infant born 12 months previously might alter observed relationships. RESULTS: At 12 months following delivery, 184 adolescent mothers (20%) reported having an older adult partner, whereas 312 (34%) had a similar-aged partner. The remaining adolescent mothers (n = 239) were excluded from further analyses. Adolescent mothers with older adult partners were significantly less likely to be employed or enrolled in school and were more likely to report planned repeated pregnancies. These adolescent mothers also received less social support. No differences were observed in intimate partner violence or the mother's substance use. Adolescent mothers with older adult partners who did not live with an adult authority figure seemed to be at greatest risk. CONCLUSIONS: The negative educational and financial impact of coupling with an older vs. similar-aged partner seems greater for those mothers who no longer reside with an adult authority figure. These adolescent mothers are also at greater risk of planned rapid repeated pregnancy. Given their limited educational attainment and family support, a subsequent pregnancy may place these young women at considerable financial and educational disadvantage.

Pregnant adolescents: experiences and behaviors associated with physical assault by an intimate partner.

OBJECTIVE: To better understand the experiences and behaviors of battered pregnant adolescents and the characteristics of their intimate partners. METHODS: As part of a longitudinal multiracial/ethnic study of drug use among pregnant and parenting adolescents, 724 adolescents < or = 18 years of age completed face-to-face interviews on the postpartum unit between April 1994 and February 1996. Adolescent mothers reported on demographic characteristics, social support and peer contact, level of substance use before and during pregnancy, nonconforming behaviors, and both lifetime and concurrent exposure to violence. Information about the father of her baby included his level of substance use, gang and police involvement, and intimate partner violence. Chi-square and Student's t tests were used to identify victim, partner, and relationship characteristics associated with being assaulted by the father of her baby during the preceding year. RESULTS: Eighty-six (11.9%) adolescents reported being physically assaulted by the fathers of their babies. Assaulted adolescents were significantly more likely than nonassaulted adolescents to have been exposed to other forms of violence over the same 12-month period, including verbal abuse, assault by family members, being in a fight where someone was badly hurt, reporting fear of being hurt by other teens, witnessing violence perpetrated on others, and carrying a weapon for protection. A history of nonconforming behavior and frequent or recent substance use was more common among both battered adolescents and their perpetrator partners. The age and race/ethnicity of the pregnant adolescent and the length of her relationship with the father of her baby were not associated with assault status. CONCLUSIONS: Pregnant adolescents who are assaulted by intimate partners appear to live in violence-prone environments and to have partners who engage in substance use and other nonconforming behaviors. Comprehensive assessments are critical for all adolescent females at risk of assault, and direct questions about specific behaviors or situations must be used.

A case-control study of anatomic changes resulting from sexual abuse.

OBJECTIVE: Our goal was to identify vulvar and hymenal characteristics associated with sexual abuse among female children between the ages of 3 and 8 years. STUDY DESIGN: Using a case-control study design, we examined and photographed the external genitalia of 192 prepubertal children with a history of penetration and 200 children who denied prior abuse. Bivariate analyses were conducted by chi(2), the Fisher exact test, and the Student t test to assess differences in vulvar and hymenal features between groups. RESULTS: Vaginal discharge was observed more frequently in abused children (P =.01). No difference was noted in the percentage of abused versus nonabused children with labial agglutination, increased vascularity, linea vestibularis, friability, a perineal depression, or a hymenal bump, tag, longitudinal intravaginal ridge, external ridge, band, or superficial notch. Furthermore, the mean number of each of these features per child did not differ between groups. A hymenal transection, perforation, or deep notch was observed in 4 children, all of whom were abused. CONCLUSION: The genital examination of the abused child rarely differs from that of the nonabused child. Thus legal experts should focus on the child's history as the primary evidence of abuse.

Flunitrazepam: more than a date rape drug.

STUDY OBJECTIVE: To evaluate the independent relationship between depressive symptoms. self-esteem. and drug resistance self-efficacy, and future intentions to use flunitrazepam. DESIGN: Cross-sectional survey. SETTING: Community-based family planning clinics. PARTICIPANTS: 865 sexually active women who self-identified as Caucasian. African-American. or Mexican American. denied using flunitrazepam in the last 12 months and reported intentions to use or not use this substance in the next 12 months. INTERVENTIONS: None. MAIN OUTCOME MEASURE: An anonymous self-report measure assessed the patient's intentions to use flunitrazepam in the next 12 months: other lifetime drug use: and standardized measures of depression. self-esteem, and drug resistance self-efficacy. We hypothesized that future potential users of flunitrazepam would exhibit an increased number of depressive symptoms, lowered self-esteem, and limited drug resistance self-efficacy. RESULTS: Of the 865 subjects. 16 (1.8%) reported using flunitrazepam in their lifetime but not in the last 12 months. and 46 (5.3%) were identified as potential users. Logistic regression analyses controlling for confounding factors found that potential to use flunitrazepam was significantly associated with limited drug resistance self-efficacy (adjusted odds ratio [AOR] = 9.3) and the presence of both severe depressive symptoms and lowered self-esteem (AOR = 3.2). CONCLUSIONS: These data suggest that young women with severe depressive symptoms and diminished self-esteem are at high risk for future flunitrazepam use and may use this drug to self-medicate psychological distress.

Ethnic differences in depressive symptomatology among young women.

OBJECTIVE: To examine racial and ethnic differences in moderate to severe depressive symptoms among young women seeking reproductive health care. METHODS: Nine hundred four white, black, or Hispanic women between 14 and 26 years of age completed an anonymous questionnaire that assessed demographic and reproductive characteristics; recent substance use, including binge drinking; sexual behaviors; occurrence of assault; and depressive symptoms. Logistic regression analysis was used to develop adjusted odds ratios (OR) and 95% confidence intervals for correlates of depressive symptomatology for each racial or ethnic group. RESULTS: Twenty-one percent (68 of 321) of whites, 28% (88 of 316) of blacks, and 29% (77 of 267) of Hispanics reported moderate to severe depressive symptoms. White females with moderate to severe depressive symptoms were more likely to report sexual assault (OR = 3.1); being a high school dropout (OR = 2.6); unemployment (OR = 2.4); two or more episodes of binge drinking (OR = 2.1); and having a mother with less than a high school education (OR = 2.4). Black females with depressive symptoms were more likely to report smoking one to nine cigarettes per day (OR = 3.5); sexual assault (OR = 3.2); and unemployment (OR = 2.1). Hispanic females with depressive symptoms were more likely to report adolescent age (OR = 3.5); physical assault (OR = 3.2); and smoking one or more cigarettes per day (OR = 2.4). CONCLUSION: Twenty to 25% of young women, regardless of race or ethnicity, have moderate to severe depressive symptoms, and behavioral markers vary according to ethnicity.

Immediate recall of oral contraceptive instructions: implications for providers.

OBJECTIVE: The object of the study was to determine the patient characteristics associated with inadequate recall of oral contraceptive pill-taking instructions. STUDY DESIGN: Sexually active women aged 13 to 40 years (n = 150) attending university-based family planning clinics completed anonymous self-report measures that assessed demographic and reproductive characteristics, understanding of pill-taking instructions, and contraceptive compliance. Logistic regression was used to determine factors associated with inadequate recall for the sample, stratified by minority versus nonminority women. RESULTS: Minority women with inadequate recall were almost 6 times more likely than minority women with adequate recall not to know the name of the prescribed oral contraceptive and were 3 times more likely to have less than a high school education. In addition there were 1-fold and 2-fold increases in likelihood of inadequate recall as certainty of pill-taking instructions and general oral contraceptive knowledge, respectively, decreased. Inadequate recall was associated with poor compliance. CONCLUSION: Women with inadequate recall may be identified at the conclusion of their visit so that interventions to enhance their pill-taking skills can be provided.

PIP: This study was conducted to determine the demographic, reproductive, and behavioral characteristics associated with inadequate recall of oral contraceptive (OC) pill-taking instructions among sexually active women aged 13-40 years who received care from a community-based family planning clinic in Galveston, Texas. Preliminary analyses revealed that factors associated with inadequate recall differed according to patients' race or ethnicity. Specifically, the pattern of significant demographic and reproductive characteristics, as well as pill-taking instruction behaviors did not differ when women of Black, Mexican American, and other non-White race or ethnicity were compared with each other. However, minority women with inadequate recall were almost 6 times more likely than minority women with adequate recall not to know the name of the prescribed OC and were 3 times more likely to have less than a high school education. Furthermore, there were one- and two-fold increases in likelihood of inadequate recall as certainty of pill-taking instructions and general OC knowledge decreased. Inadequate recall was associated with poor compliance. However, these findings suggest that poor compliance with OCs may be linked to the immediate recall of pill-taking instructions. Intensive specialized patient education is needed to improve these women's abilities to adequately understand how to take OCs.

Influence of the history on physicians' interpretations of girls' genital findings.

OBJECTIVE: Because physicians customarily obtain histories before examining children in cases of possible sexual abuse, and because the resulting diagnostic opinions can influence important social and legal decisions, we investigated whether clinical histories influence physicians' interpretations of girls' genital findings. DESIGN: In mailed questionnaires, 1387 randomly selected Fellows of the American Academy of Pediatrics and all 802 members of four professional groups concerned with child abuse or pediatric gynecology were asked to interpret seven simulated cases. Respondents were asked to interpret seven additional cases in separate questionnaires mailed 4 months later. Both sets of cases involved the same seven photographs of girls' external genitalia. However, in six of the seven case pairs, the histories in the two questionnaires differed in the extent to which they suggested sexual abuse. In the remaining (control) pair, the same history was presented in both questionnaires. RESULTS: Of 2189 physicians, 1114 (50.9%) responded. Responses from 604 physicians (54.2%) were eligible for analysis. Overall, the genital findings were interpreted most consistently by the most experienced physicians and least consistently by the least experienced physicians. The proportion of physicians whose interpretations of a photograph reversed in the direction suggested by the change in the associated history from "no indication of abuse" to "probable abuse," or vice versa, ranged for experienced physicians from none to 5.6%; for moderately experienced physicians from 1.6% to 19.8%; and for inexperienced physicians from 3.6% to 27.2%. This difference between the experience groups was statistically significant in four case pairs. Mean interpretation scores for genital findings changed significantly when the histories changed in two case pairs for the experienced physicians, in five pairs for the moderately experienced physicians, and in all six pairs for the inexperienced physicians. CONCLUSIONS: In some cases and especially for less experienced physicians, diagnostic expectation appears likely to influence physicians' interpretations of girls' genital findings. Physicians should be alert to the possibility of diagnostic expectation bias and its potentially serious social and legal consequences.

Prevalence, patterns, and correlates of voluntary flunitrazepam Use.

OBJECTIVE: To determine prevalence, patterns, and correlates of voluntary flunitrazepam use in a sample of sexually active adolescent and young adult women 14 to 26 years of age. DESIGN: Cross-sectional survey. SETTING: University-based ambulatory reproductive health clinics. PATIENTS OR OTHER PARTICIPANTS: There were 904 women self-identified as white, African-American, or Mexican-American. INTERVENTIONS: None. MAIN OUTCOME MEASURE: Lifetime, frequency, patterns, and physical effects of flunitrazepam use. RESULTS: Lifetime use was reported by 5.9% (n = 53) of subjects, with frequency of use ranging from 1 to 40 times. Flunitrazepam was taken most often with alcohol (74%), and 49% took this substance with other illicit drugs. Logistic regression analyses controlling for age and race/ethnicity found that users were significantly more likely than were nonusers to report lifetime use of marijuana (odds ratio [OR] = 3.6) or LSD (OR = 5.2), having a peer or partner who used flunitrazepam (OR = 21.7), pressure to use flunitrazepam when out with friends (OR = 2.7), and a mother who had at least a high school education (OR = 2.6). Finally, 10% of voluntary users reported experiencing subsequent physical or sexual victimization. CONCLUSIONS: Voluntary use of flunitrazepam is becoming a health concern to sexually active young women who reside in the southwestern United States. Young women who have used LSD or marijuana in the past or who have a peer or partner who used this drug appear to be at the greatest risk.

The rise and fall of levonorgestrel implants: 1992-1996.

OBJECTIVE: To assess shifts over a 4-year period in attitudes of low-income US women regarding use of levonorgestrel implants. METHODS: An anonymous questionnaire was administered at two different points in time to English-speaking women of reproductive age seeking gynecologic or obstetric care in southeast Texas. The first survey, administered to 762 women in 1992, elicited information on demographic and reproductive characteristics, as well as exposure to information on implants and attitudes regarding use of this method. This same survey was administered again in 1995-1996 to 502 women. chi2, Student t, or Kruskal-Wallis nonparametric tests were used to evaluate shifts in attitudes and perceived barriers to use across the 4-year period. RESULTS: Women portrayed less positive attitudes about levonorgestrel implants when surveyed in 1995-1996 as compared with 1992. Most notably, they appeared less appreciative of the convenience associated with implant use and more concerned with potential side effects. Nulliparous and parous women surveyed in 1995-1996 were significantly less likely than those surveyed in 1992 to state that they would consider using this method for birth control (P < .001) and were more likely to state that their partner, friends, and family would object to their use of levonorgestrel implants. CONCLUSION: This study documents the decline in popular perceptions of levonorgestrel implants among low-income English-speaking women over the 4-year period following the introduction of this contraceptive method to the US market.

Strategies to promote breast-feeding among adolescent mothers.

OBJECTIVE: To identify characteristics of adolescent mothers who bottle-feed who considered breast-feeding their infants and strategies to promote breast-feeding within this special group. DESIGN: Adolescents completed an hour-long interview within 48 hours of delivery that elicited factors considered important to the mother's feeding decision and indices of mental health. SETTING: Postpartum ward of university hospital. SUBJECTS: A total of 693 adolescents 18 years old or younger (mean age, 16.7 years) from African American, Mexican American, or white race or ethnicity; 27% of Mexican American participants spoke little or no English. MAIN OUTCOME MEASURES: Factors associated with breast-feeding decision. RESULTS: Those who chose bottle-feeding (hereafter, bottle-feeders) who had considered breast-feeding were first compared with bottle-feeders who had not considered breast-feeding and then with adolescents who breast-fed. After controlling for ethnicity, bottle-feeders who had considered breast-feeding were more likely than those who had not considered breast-feeding to be impoverished (adjusted odds ratio [AOR] = 4.8), to have delayed their feeding decision until the later stages of pregnancy (AOR = 4.6), to have been encouraged to breast-feed (AOR = 4.5), to have friends who breast-fed (AOR = 2.3), and to have experienced low financial, tangible, emotional, or informational support from their families (AOR = 1.6). They were more likely to cite barriers associated with breast-feeding while returning to school or work (AOR = 2.0) and less likely to state that bottle-feeding was healthier (AOR = 0.3) as reasons for bottle-feeding. Compared with those who chose breast-feeding (hereafter, breast-feeders), this group was more likely to have made the feeding decision alone rather than relying on advice (AOR = 4.6), to have made this decision in the later stages of pregnancy (AOR = 4.4), to report fewer breast-feeding role models (AOR = 1.8) and fewer significant others who encouraged breast-feeding (AOR = 2.8), and to report at least 2 significant others who encouraged bottle-feeding (AOR= 3.2). They were also less likely to have attempted to breast-feed a previous child (AOR = 3.3). CONCLUSIONS: A subgroup of adolescent mothers who had considered breast-feeding but ultimately chose to bottle-feed may be identified in the late stages of gestation by collecting information on financial status, family support, perceived barriers to breast-feeding and attending school or working, timing of the feeding decision, prior breast-feeding experience, breast-feeding role models, and encouragement to breast-feed. We speculate that strategies to promote breast-feeding should focus on role modeling and facilitation.

Frequencies of hprt mutant lymphocytes in marijuana-smoking mothers and their newborns.

Reports of increases in the prevalence of marijuana smoking, especially among young people, have led to concerns about possible genotoxic effects from marijuana use due to exposure to the mutagenic and carcinogenic agents present in marijuana smoke. Prior studies of the adverse health consequences of marijuana smoking, using disease outcomes, have sometimes been confounded by the fact that most marijuana smokers also smoke tobacco. In the present study, the potential mutagenic effects of marijuana smoking were investigated with a somatic cell mutation assay that detects mutations occurring in vivo in the hprt gene. Subjects were volunteers recruited from a prenatal clinic that performs urine drug screens on all consenting patients. Blood samples were collected from 17 subjects whose drug screens indicated marijuana use, but who did not smoke tobacco or use cocaine or opiates, and 17 non-smokers with negative drug screens. Absence of tobacco use was confirmed by plasma cotinine tests. Cord blood samples were collected from newborns of 5 of the marijuana smokers and 5 non-smokers. Lymphocytes were isolated, cryopreserved, and later thawed and assayed with the autoradiographic hprt assay. The frequency of variant (mutant) lymphocytes (Vf) in the 17 non-smokers (+/- standard error) was 1.93 (+/- 0.17) per million evaluatable cells. The Vf of 17 marijuana smokers was more than three-fold higher, 6.48 (+/- 0.48) x 10(-6), a significant difference, p < 0.001. Cord blood lymphocytes from 5 newborns of non-smokers had a Vf of 0.85 (+/- 0.23) x 10(-6), compared to 2.55 (+/- 0.60) x 10(-6) for 5 newborns of marijuana smokers, significantly higher, p < 0.05. Because of the known association between increases in somatic mutations and the development of malignancies, this study indicates that marijuana smokers may have an elevated risk of cancer. For pregnant marijuana smokers, there is also concern for the possibility of genotoxic effects on the fetus, resulting in heightened risk of birth defects or childhood cancer.

Prevalence and risk factors of chorioamnionitis among adolescents.

OBJECTIVE: To identify the prevalence of chorioaminionitis and unique risk factors for this disorder among adolescents under 18 years of age. METHODS: At their first prenatal visit we interviewed 352 adolescents who received prenatal care and delivered an infant at our institution between April 20, 1992, and November 10, 1994, to elicit information on demographic characteristics and behavioral risk factors. Retrospective chart review confirmed the presence of chorioamnionitis using accepted clinical criteria. We determined reproductive history, evidence of sexually transmitted disease, duration of labor, use of oxytocin, an internal uterine pressure monitor or conduction anesthesia, timing and duration of ruptured membranes, type of delivery, and infant birth weight from review of subjects' charts. Logistic regression analysis was used to develop adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for risk factors of chorioaminionitis. RESULTS: Ten percent (34 of 352) of adolescents met the clinical definition for chorioamnionitis. Alcohol and tobacco use during pregnancy (OR 7.6; 95% CI 2.3, 25.8) and being married or living with a partner (OR 2.7; 95% CI 1.1, 6.5) were significantly associated with chorioamnionitis, as was conduction anesthesia (OR 4.1; 95% CI 1.1, 15.4), a second stage labor longer than 2 hours (OR 3.5; 95% CI 1.4, 8.5), and rupture of the membranes longer than 18 hours (OR 6.9; 95% CI 2.5, 18.9). Parity or preterm delivery did not differ significantly between those with or without chorioamnionitis. CONCLUSION: These data suggest that in addition to risk factors observed in adults, adolescents who concurrently use tobacco and alcohol during pregnancy, are married or living with a male partner, and have conduction anesthesia are at increased risk for chorioamnionitis.