Exposure to violence and victimization and the use of violence by adolescents in the United States.

Violence by adolescents in the United States is of growing concern. Despite a decrease in the rate of violence and death by firearms, firearm injuries are the second leading cause of death among Americans age 15 to 24 and the third leading cause of death among 10- to 14-year-old children. Although there are many factors associated with the use of violence by youths, exposure to violence and victimization has consistently been a predictor of the use of violence, as well as intentions to use violence, carrying a gun, and having attitudes accepting of the use of violence and aggressive behavior to resolve conflict. Adolescents' families, friends, neighborhoods, schools, and the media provide sources of exposure and victimization related to the use of violence. The cultural transmission of deviant behavior theory establishes a framework for understanding the influence of exposure to violence and victimization from these sources on adolescents' use of violence.

Reliability of the Problem Oriented Screening Instrument for Teenagers (POSIT) in adolescent medical practice.

PURPOSE: To determine the internal consistency and 1-week test-retest reliability of the Problem Oriented Screening Instrument for Teenagers (POSIT) among adolescent medical patients. METHODS: A research assistant administered the POSIT to a consecutive sample of 15- to 18-year-old patients arriving for routine medical care at a hospital-based adolescent medical practice. Each subject returned for a retest 1 week later. Internal consistency for each scale on test and retest was calculated using Cronbach alpha, and 1-week test-retest reliability by the intraclass correlation coefficient (r) and the kappa coefficient (kappa). RESULTS: The Substance Use/Abuse, Mental Health Status, Educational Status, and Aggressive Behavior/Delinquency scales had favorable alpha scores (>.70). Others, including Physical Health Status, had lower alpha scores. High intraclass correlation coefficients were found for all 10 POSIT scales (r =.72 to.88), although (r) was lower for males on two of the scales. Kappa coefficients for all scales indicated good reproducibility beyond chance (kappa =.42 to.73). CONCLUSIONS: This study provided supportive evidence for the reliability of the POSIT in primary care medical settings, although some POSIT scales could likely be improved. The 20- to 30-min administration time is most practical in settings that are dedicated to adolescent medicine, and computerized administration and scoring are needed.

The effect of late doses on the achievement of seroprotection and antibody titer levels with hepatitis b immunization among adolescents.

OBJECTIVE: To determine the effect of varying dosing schedules and predictor variables on the seroprotection rates and geometric mean titer levels resulting from the hepatitis B vaccination series among adolescents. METHODS: Adolescents received the hepatitis B vaccination series at varying schedules according to their natural adherence patterns. Data collected included participants' medication use; chronic illness; use of cigarettes, alcohol, and marijuana; age; race/ethnicity; and body mass index. Participants' dates of vaccinations were recorded and titer levels for hepatitis B surface antibody were drawn ~12 and 24 months after study enrollment. The data for 498 participants were analyzed using chi(2) tests, Student t tests, logistic regression models, and analysis of variance. RESULTS: Seroprotection rates among adolescents were not affected by late vaccinations. The only factors affecting the achievement of seroprotection ~12 and 24 months after the first vaccination were body mass index and the number of immunizations received. Increased time between doses 1 and 2 and doses 2 and 3 showed a trend toward correlating with increasing titer levels. CONCLUSIONS: Although adolescents at risk of acquiring hepatitis B should receive the hepatitis B vaccination series in a timely fashion, late doses are not detrimental, and may be beneficial, to achieving high antibody levels against the hepatitis B virus.

Evaluation of a peaceful conflict resolution and violence prevention curriculum for sixth-grade students.

PURPOSE: To evaluate a Social Cognitive Theory-based violence prevention curriculum among sixth-grade students. METHODS: The evaluation was conducted using a quasi-experimental pretest-posttest control group design. Students were pretested 2 weeks before the intervention started and were posttested 2 weeks after it ended. The study was conducted in four middle schools serving children and adolescents living in or around public housing in a southeastern city. The participants included all sixth-grade students who were predominantly African-American (88.7%), 41% lived in public housing, and 80% lived in homes with an employed head of household. The intervention schools had 292 students, and the control schools 412 students. The Peaceful Conflict Resolution and Violence Prevention Curriculum is a 13-module skills-building curriculum based on Social Cognitive Theory. It taught identification of situations that could result in violence; avoidance, confrontation, problem-solving, and communication skills; conflict resolution skills; the conflict cycle; the dynamics of a fight; and how to express anger without fighting. MAIN MEASURES: The primary outcome variable was a five-item scale assessing the frequency of fighting and weapon carrying behaviors (alpha =.72) and a scale measuring intentions to use violence in 11 hypothetical situations (alpha = .81). Levels of exposure to violence and victimization (alpha = .82) and depression (alpha = .86) were also assessed. The data were analyzed with general linear modeling with repeated measures. RESULTS: At pretest, the intervention and control groups did not differ in gender, age, depression, exposure to violence, or any other demographic variable. A group x time interaction effect (p = .029) was found in the use of violence scale. From pretest to posttest there was a decrease in the use of violence by students in the intervention group and an increase in the use of violence in the control group. Most of the changes were accounted for by changes in the frequencies of carrying concealed guns and fighting resulting in injuries requiring medical treatment. A group x time interaction effect (p = .002) was also found for the intention to use violence scale. Students in the intervention group did not change their mean scores from pretest to posttest, whereas students in the control group increased in their mean intention to use violence scale scores. Neither interaction effect was influenced by gender, exposure to violence, or level of depression. CONCLUSION: The Peaceful Conflict Resolution and Violence Prevention curriculum appears to have positive short-term effects on self-reported use of violence and intentions to use violence by these middle-school students.

Exposure to violence and intentions to engage in moralistic violence during early adolescence.

This study examined young adolescents'intentions to use moralistic violence and their violence exposure, examining male-female differences. Sixth-grade students (n=702) from Georgia middle schools servicing impoverished communities participated. Data were obtained on the students' exposure to violence, family structure and education level, church attendance, gang interest, drug use, and depression status. The dependent variable, intention to use moralistic violence, was measured with an 11-item scale. Linear regression models were run separately for males and females. Males had significantly higher mean intention to use moralistic violence than females (p=0.002). Males reported being exposed to violence more than females, but exposure decreased as attendance to religious services increased. For these 11-12-year-olds, unconventional peer social norms, such as witnessing violence, increased their intention to use violence while involvement in conventional activities, such as church attendance, decreased it. The protective effect was greater for males than females.

Endocrinologic and psychological effects of short-term dexamethasone in anorexia nervosa.

Patients with anorexia nervosa (AN) have hyperactivity of their hypothalamic-pituitary-adrenal (HPA) axis, sometimes accompanied by elevations of cortisol. We examined whether the normal effects of short-term dexamethasone treatment upon HPA axis suppression and appetite stimulation are observed in these patients. Five young women with AN and ten healthy female controls received one week of high-dose oral dexamethasone (2 mg/m2/d) preceded and followed by hormonal evaluation of sensitivity to glucocorticoids and psychological assessments. No differences in hormone levels of the HPA axis were observed between the two groups and control groups at baseline, after dexamethasone suppression, or following ACTH stimulation testing. However, fasting insulin levels were significantly lower in the AN group, both before and after dexamethasone therapy and their serum leptin levels were also significantly lower. The AN group had significantly lower scores on the Anorexia Nervosa Subtest and the Beck Depression Inventory after dexamethasone compared to controls. On daily analog scales, AN patients had higher anxiety scores while on dexamethasone. Normal sensitivity to glucocorticoids was observed in all parameters examined except for mild abnormalities in pancreatic beta-cell function. These data suggest that AN may represent a state of partial glucocorticoid resistance, as in other states of restricted food intake. Furthermore, these pilot data, including the effects of dexamethasone upon psychological outlook in AN, suggest that glucocorticoids are not an effective therapy for these patients.

Is race or ethnicity a predictive factor in Shaken Baby Syndrome?

OBJECTIVE: Previous studies have concluded that shaken baby syndrome occurs more often among Whites than among Blacks. The purpose of this study was to determine whether race is a predictive factor in Shaken Baby Syndrome when population and referral patterns are considered. METHODS: A retrospective medical record review of closed head injuries due to child abuse during the time period January 1992 to July 1997 was conducted at three pediatric tertiary care medical centers in North Carolina. Patients included children, ages 0-4 years, identified from medical record reviews and child abuse databases. Only North Carolina residents were included. The specific rates of shaken baby syndrome in Whites versus non-Whites in the referral area were computed. RESULTS: The difference in the rate of shaken baby syndrome from the referral area was not statistically significant among Whites versus non-Whites (26.7/100,000 versus 38.6/100,000, p = .089) Most of the perpetrators were male (68%), and most victims (76%), lived with their mothers and biologic father or mother's boyfriend. CONCLUSION: Race was not a significant factor in predicting shaken baby syndrome in the referral area studied, and therefore is not a useful factor in targeting groups for intervention.

Exposure to violence and victimization, depression, substance use, and the use of violence by young adolescents.

OBJECTIVE: To examine the relationships among exposure to violence; tobacco, alcohol, and other substance use; depression; church attendance; and the use of violence among very young adolescents. METHODS: An 86-item confidential questionnaire was administered to 722 sixth grade students (mean age = 11.9+/-0.8 years) attending 4 middle schools serving neighborhoods in and around public housing. RESULTS: Boys had a higher mean violence scale score than girls (P < or =.0001), and students living in public housing had higher violence scale scores than other students (P< or =.0001). Self-reported use of violence was significantly associated with exposure to violence (r =.45); age (r =.28); frequency of church attendance (r = -.14); depression (r =.28); the probability of being alive at age 25 (r = -.09); the frequency of use of cigarettes (r =.39), alcohol (r =.37), and multiple substances (r =.38); and interest in a gang (r =.37). When all of these variables were analyzed with multiple linear regression, multiple substance use, exposure to violence, interest in a gang, male gender, cigarette smoking, and depression level accounted for 49.7% of the variation in the use of violence scale. CONCLUSION: Recent multiple substance use and lifetime exposure to violence and victimization were the strongest correlates with the frequency that these youth reported using violence and carrying weapons.

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.

The association between adolescent spirituality and voluntary sexual activity.

PURPOSE: The purpose of this study was to describe the spectrum of adolescent spirituality and to determine the association between dimensions of spirituality and voluntary sexual activity (VSA) in adolescents. DESIGN: A sample of 141 consecutive youth aged 11-25 years presenting to an urban, hospital-based adolescent medicine clinic completed a 153-item instrument assessing sociodemographics, psychosocial parameters, and eight specific aspects of spirituality including: (1) religious attendance, (2) religious importance, (3) intrinsic and (4) extrinsic religious motivation, (5) belief in God, (6) belief in divine support, (7) existential aspects of spirituality, and (8) spiritual interconnectedness. Adolescents were also asked about VSA. RESULTS: Sixty-one percent of respondents were African-American and 67.4%, female; mean age was 16.0+/-2.4 years. Adolescent religious attendance was equally distributed across the categories from "none" to "weekly or greater" attendance. Over 90% felt religion was somewhat important in their lives. Over 85% reported belief in God. Fifty-six percent of respondents reported a history of VSA. Greater importance of religion (p = 0.035) and higher spiritual interconnectedness with friends (p = 0.033) were inversely associated with VSA. A multiple logistic regression model including age, gender, race, socioeconomic status, and specific denomination of religious faith, importance of religion, and spiritual interconnectedness found that spiritual interconnectedness with friends (OR = 0.92, 95% CI = 0.85, 0.99) and age (OR = 1.75, 95% CI = 1.34, 2.28) were independent predictors of VSA. CONCLUSIONS: Spirituality is a common facet of adolescents' lives. Younger age and higher spiritual interconnectedness, particularly interconnectedness among spiritual friends, are independently associated with a lower likelihood of VSA.

Gender differences in risk behaviors among adolescents who experience date fighting.

OBJECTIVE: Although dating violence frequently begins during adolescence, few studies have focused on date fighting in middle and high school students. Fewer studies have studied gender differences in date violence. This study examines whether gender-specific patterns of risk behaviors exist among adolescents who report date fighting. DESIGN: The study was conducted on data collected from 21 297 students in grades 8 through 12 participating in the Vermont 1995 Youth Risk Behavior Survey. Data were analyzed on 20 724 students (females = 50.1%) who reported: 1) never having been involved in a physical fight (n = 8737); 2) that their last physical fight was with a girlfriend, boyfriend, or other dating partner (n = 432); and 3) that their last fight was with someone other than a dating partner (n = 11 555). Indicators of violence (weapon carrying, being threatened, and fighting), suicide attempts, substance use, sexual behavior, and pregnancy were analyzed with chi(2) tests. Significant variables were analyzed with stepwise logistic regression. RESULTS: Of the males, 1.8% and of the females, 4.2% reported that their last fight was with a boyfriend, girlfriend, or dating partner. Risk behaviors significantly associated among females who only experienced date fighting included the number of male sexual partners in the past 3 months (adjusted odds ratio: 1. 48; 95% confidence interval: 1.26-1.74), number of suicide attempts in the past 12 months (1.55; 1.30-1.85), riding in a car with a drinking driver (1.23; 1.10-1.37), injection of illegal drugs (2.87; 1.10-7.50), use of alcohol before last sexual encounter (1.53; 1. 27-1.86), number of pregnancies (1.66; 1.26-2.21), forced sex (2.92; 2.18-3.91), and inhalant use (1.19; 1.06-1.34). Risk behaviors significantly associated among males who experienced only date fighting were sexual activity (4.11; 2.24-7.53), number of male partners in the past 3 months (1.40; 1.12-1.75), number of times of getting someone pregnant (1.68; 1.17-2.40), experiencing forced sex (2.38; 1.11-5.13), and the number of times threatened with physical violence in past 12 months (1.82; 1.53-2.17). When compared with adolescents who reported fighting with someone other than a date, risk factors significantly associated with date fighting among females were the number of male sexual partners in the past 3 months (1.21; 1.10-1.34), older age (1.21; 1.10-1.34), carrying a weapon in the past 30 days (.77;.66-.90), experiencing forced sex (1.70; 1. 30-2.22), condom non-use (1.96; 1.60-2.41), and number of times of being threatened with physical violence in past 12 months (1.11; 1. 01-1.22). The risk factors among males were the number of male sexual partners in the past 3 months (1.43; 1.28-1.60), experiencing forced sex (1.91; 1.02-3.60), and older age (1.34; 1.14-1.57). CONCLUSIONS: The patterns of risk behaviors differed among male and female adolescents reporting dating violence. Females who reported date fighting were more likely than were nonfighters to have attempted suicide, to engage in sexual and human immunodeficiency virus risk behaviors (use of injectable drugs), to have been pregnant, experienced forced sex, and to have ridden in a car with a drinking driver. Sexual behaviors, including same-gender sexual partners, forced sex, and having been threatened with physical violence, were associated with date fighting among males. These findings are important in screening adolescents at risk for date violence.date fighting, adolescence, risk behaviors, gender.

Predictors of time to completion of the hepatitis B vaccination series among adolescents.

OBJECTIVES: To determine adolescents' completion rates and factors affecting completion time of hepatitis B (HBV) vaccination. METHODS: Prior to vaccination, participants from a hospital-based and school-based adolescent clinic completed questionnaires assessing sociodemographic variables, family/friend experience with HBV and the vaccine, likelihood of completing the vaccinations, HBV and vaccine knowledge, risk behaviors, chronic illness, and access to clinic. Vaccination times were recorded. RESULTS: Twenty-six months after initiation of the study, 72% of 896 eligible participants had completed the vaccination series. The independent predictors of shorter time to completion were: higher estimated mean household income [odds ratio (OR) = 1.15, 95% confidence interval (CI) = 1.06-1.25), white race (OR = 1.27, 95% CI = 1.01-1.58), female gender (OR = 1.58, 95% CI = 1.31-1.92], and not having smoked cigarettes (OR for smoking in the past 30 days = 0.74, 95% CI = 0.60-0.92). Site of care, risk factors for acquiring HBV, disease and vaccine knowledge, and self-reported desire to complete the series were not associated with completion time. CONCLUSIONS: The primary factors associated with completion of immunization may not be amenable to intervention; mandated strategies for immunization may be more likely to result in protection for adolescents.

Middle school students' sources of acquiring cigarettes and requests for proof of age.

OBJECTIVES: To identify where and how middle school students acquire cigarettes and to describe factors associated with being asked for identification during their purchase. METHODS: A modified version of the Centers for Disease Control and Prevention's Youth Risk Behavior Survey was administered to 2227 sixth- through eighth-grade students attending 53 randomly selected middle schools in North Carolina in 1995. Data were analyzed with Chi-square tests, Cramer V, Kruskal-Wallis nalysis of variance, and multiple logistic regression using the likelihood ratio approach. RESULTS: Of the students who had smoked during the previous 30 days, 497 (22.8%) were the focus of the analyses. Fifty-eight percent of current smokers were male and 69% were white. The most frequent source of cigarettes was borrowing (32.1%). Only 16.9% of the students had purchased cigarettes from a store, and 3.9% had purchased cigarettes from a vending machine. Females were more likely (p < .006) than males to borrow or to have someone else buy cigarettes for them. Males were more likely (p < .006) than females to buy cigarettes from a store or vending machine or to steal them. Students who purchased cigarettes from a store or vending machine were more likely (p < .032) than other smokers to be 21 year older than expected for their school grade. Among the 197 students who had purchased cigarettes during the previous 30 days, only 14.2% had been asked for proof of age. Students who acquired cigarettes from a store were more likely than students who acquired them by other means not to have been asked for proof of age; while having been asked for proof of age was associated with acquiring cigarettes by other means (V = .44, p < .0001). Having been asked for proof of age was associated with earlier age of onset of smoking (V = .34, p < .0001), greater number of smoking days, and number of cigarettes smoked per day (V = .35, p < .0001). When analyzed with multiple logistic regression, only earlier age of onset of smoking remained a significant correlate of not having been asked for proof of age. CONCLUSION: In North Carolina, it was easy for young adolescents to purchase cigarettes illegally, especially for more experienced smokers. However, being asked for proof of age forced these youth to acquire cigarettes using other methods, and this was associated with less smoking. Prevention efforts should include enforcing existing laws requiring youth to provide proof of age when attempting to buy cigarettes.

Adolescent tobacco use and cessation.

Over one third of high school students in the United States smoke cigarettes, and close to 10% use spit tobacco. Tobacco use clusters with alcohol use, other substance abuse, and other health risk behaviors among teenagers. Public health and law enforcement policy changes, combined with effective substance use prevention programs in both elementary and middle school, are needed to prevent the early age of onset of tobacco use by youth. Primary care providers can play a key role in identifying children and adolescents who smoke or use spit tobacco and helping them discontinue their tobacco use.

Choice of feeding method of adolescent mothers: does ego development play a role?

STUDY OBJECTIVES: The purpose of this study was to determine whether, among childbearing adolescents, ego development was associated with intention to breast-feed and with actual breast-feeding behavior at birth and at 2 weeks postpartum. In addition, we sought to determine whether positive attitudes toward breast-feeding influenced pregnant adolescents' intentions to breast-feed and actual breast-feeding at the hospital and at 2 weeks postpartum. We hypothesized that adolescents with higher levels of ego development and positive attitudes toward breast-feeding would be more likely to intend to breast-feed and to actually breast-feed. DESIGN: Prospective cohort study of pregnant adolescents who completed questionnaires, Loevinger's Sentence Completion Tests, and attitudes toward breast-feeding scales before delivery and a follow-up questionnaire at 2 weeks postpartum assessing feeding practice in the hospital and at 2 weeks postpartum. SETTING: Two adolescents' clinics and two "teen-and-tot" clinics in urban teaching hospitals. PARTICIPANTS: Fourteen- to 22-year-old pregnant adolescents who had never given birth and who planned to carry their pregnancy to term and parent their children. MAIN OUTCOME MEASURES: 1) Intended feeding practice during pregnancy, 2) feeding method in the hospital, and 3) feeding method at 2 weeks postpartum. RESULTS: Of the 125 subjects enrolled in the study, 106 were at 2 weeks postpartum or more. Of these 106 participants, 75% (n = 78) completed more than 75% of the attitudes toward breast-feeding scale and Loevinger's Sentence Completion Test and are included in these analyses. Mean age at entry was 17.8 +/- 1.5 years (range, 14.3 to 21.8 years). Mean gestational age at enrollment was 21.2 +/- 11.6 weeks (range, 4 to 41 weeks). Of the 78 participants, 12% (n = 9) were at the preconformist, 85% (n = 66) at the conformist, and 4% (n = 3) at the postconformist level of ego development as determined by the Sentence Completion Test. Attitudes toward breast-feeding, intention to breast-feed, breast-feeding in the hospital, and breast-feeding at 2 weeks postpartum were not significantly associated with adolescents' stages of ego development. Almost three fourths of the adolescents intended to breast-feed, and 85% tried breast-feeding in the hospital. A total of 97% (56 of 58) of those who intended to breast-feed tried breast-feeding in the hospital compared with 40% (4 of 10) of those who did not intend to breast-feed (P < .0001). At 2 weeks postpartum, 58% of the participants were still breast-feeding. Of those participants who intended to breast-feed, 67% (39 of 58) were breast-feeding at 2 weeks postpartum compared with 10% (1 of 10) who did not intend to breast-feed (P = .001). The mean breast-feeding attitude score was 53.7 +/- 11.6 (range, 25 to 72). The mean breast-feeding attitude score was higher for those who intended to breast-feed than for those who intended to formula-feed (P = .009), but the score was not associated with breast-feeding in the hospital or at 2 weeks postpartum. CONCLUSION: Adolescent mothers were predominantly in ego stages 4 and 5, the conformist level. Because ego development was not associated with outcome measures in this study, ego development may not be a crucial factor when designing interventions to facilitate breast-feeding among adolescents. Attitudes toward breast-feeding were associated with the intention to breast-feed but not behaviors; the intention to breast-feed was significantly associated with breast-feeding behaviors.

Primary care physicians' use of screening echocardiography.

OBJECTIVE: To survey primary care physicians to understand their reasons for using echocardiography to screen for congenital heart disease in children and to assess their understanding of the costs associated with cardiology services. DESIGN: A questionnaire. PARTICIPANTS: Eight hundred sixty-seven pediatricians and family physicians in our region were surveyed, 494 (57%) responded and 466 were used for the analysis. RESULTS: The majority of pediatricians and family physicians in our area do not know the relative costs associated with cardiology consultation and echocardiography. They also believe it likely that a cardiologist will routinely obtain an echocardiogram as part of their evaluation of a child with a murmur, although this is not the case. The availability and convenience of specialist appointments was found to significantly influence the decision to order an echocardiogram. Family physicians were significantly more likely than pediatricians to order an echocardiogram for a variety of clinical indications. CONCLUSIONS: Improving primary care physicians' knowledge of the costs associated with cardiology services and current cardiology practice patterns, in addition to improving the availability of cardiology referrals, may reduce the number of expensive and unnecessary echocardiograms. echocardiography, heart murmur, congenital heart disease, cost-effectiveness.

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.

Weapon carrying on school property among middle school students.

OBJECTIVE: To examine the association between carrying a weapon at school and the age of onset of substance use, other indicators of violence, and other health risk behaviors among middle school students. DESIGN: In 1995, a modified version of the Centers for Disease Control and Prevention Youth Risk Behavior Survey was administered to 2227 students (49% were female) attending 53 (of 463) randomly selected middle schools in North Carolina. Weapon carrying on school property during school hours was measured with 2 questions assessing carrying a gun and carrying other weapons such as knives or clubs. The Youth Risk Behavior Survey also assessed other indicators of violence, drug use, suicide plans and attempts, and being threatened with a weapon at school. Variables significantly (P< or =.001) associated with gun and other weapon carrying by chi2 tests were analyzed with stepwise logistic regression using the likelihood ratio approach. Odds ratios (ORs) were adjusted for all other variables in the model and 95% confidence intervals (CIs) were computed. RESULTS: Our study showed that 3% of students had carried a gun and 14.1% had carried a knife or club to school. Gun carrying was associated with increased age (OR, 1.57 [95% CI, 1.15-2.14]); male sex (OR, 5.62 [95% CI, 2.42-13.03]); minority ethnicity (OR, 3.30 [95% CI, 1.55-5.05]); and earlier age of onset of cigarette (OR, 0.85 [95% CI, 0.74-0.97]), alcohol (OR, 0.81 [95% CI, 0.71-0.94]), marijuana (OR, 0.81 [95% CI, 0.71-0.92]), and cocaine use (OR, 0.73 [95% CI, 0.62-0.86]). Knife or club carrying was associated with age (OR, 1.32 [95% CI, 1.14-1.53]); male sex (OR, 2.39 [95% CI, 1.77-2.32]); and ear-lier age of onset of cigarette (OR, 0.88 [95% CI, 0.84-0.94]), alcohol (OR, 0.81 [95% CI, 0.76-0.86]), and marijuana use (OR, 0.77 [95% CI, 0.72-0.83]). Gun carrying was also associated with frequency of cigarette (OR, 1.34 [95% CI, 1.14-1.57]), alcohol (OR, 4.59 [95% CI, 1.27-16.58]), cocaine (OR, 2.96 [95% CI, 1.29-6.82]), and marijuana use (OR, 3.66 [95% CI, 1.67-8.06]) after adjusting for male sex and minority ethnicity. Carrying a knife or club was associated with carrying a gun (OR, 1.83 [95% CI, 1.31-2.55]); being threatened with a weapon at school (OR, 1.65 [95% CI, 1.10-2.49]); fighting (OR, 4.62 [95% CI, 2.56-8.37]); frequency of alcohol (OR, 2.91 [95% CI, 1.88-4.50]) and cigarette use (OR, 1.20 [95% CI, 1.10-1.31]); and a suicide plan (OR, 1.54 [95% CI, 1.07-2.20]). CONCLUSIONS: Middle school students are more likely to carry a knife or club (14.1%) than a gun (3%) to school. Young adolescents who initiate substance use early and engage in it frequently are more likely to carry guns and other weapons to school, after adjusting for age, sex, and ethnicity. Being threatened with a weapon at school and fighting were only associated with knife or club carrying at school. These findings suggest that school-based prevention programs targeting both violence prevention and substance use should be introduced in elementary school.

Effect of flow rate and insulin priming on the recovery of insulin from microbore infusion tubing.

BACKGROUND: A retrospective medical record review of 13 consecutive, hyperglycemic, extremely low birth weight (ELBW) infants treated with continuous insulin infusions revealed a 14- to 24-hour delay (mean, 19 hours) in blood glucose normalization despite stepwise increases in insulin infusion rates. OBJECTIVE: This in vitro study examined the effects of flow rate and insulin priming on insulin recovery from polyvinyl chloride (PVC) tubing and polyethylene (PE)-lined PVC tubing infused with a standard insulin stock solution. METHODS: Stock insulin solution (0.2 U/mL) was infused through microbore PVC or PE-lined tubing at flow rates of 0.05 and 0.2 mL/h. To determine if saturation of nonspecific binding sites would alter effluent insulin concentration, we compared insulin recovery from tubing previously flushed with the stock solution and tubing primed with 5 U/mL of insulin for 20 minutes. Effluent samples, which were collected at baseline and at six time points during a 24-hour period, were immediately frozen at -20 degreesC. Insulin concentration was measured by IMx immunoassay. Data were analyzed using general linear modeling with repeated measures. RESULTS: At 0.05 mL/h flow rate, insulin recovery from unprimed PVC tubing at 1, 2, 4, and 8 hours was 17%, 11%, 27%, and 55%, respectively, with 100% recovery at 24 hours. From insulin-primed tubing, insulin recovery was approximately 70% at 1, 2, and 4 hours, and close to 100% at 8 hours. At a faster flow rate of 0.2 mL/h, insulin recovery at 1, 2, 4, and 8 hours was 22%, 38%, 67%, and 75% vs 42%, 85%, 91% and 95% from unprimed and insulin-primed PVC tubing, respectively. Similar results were obtained from unprimed and insulin-primed PE-lined tubing at 0.2 mL/h flow rate. CONCLUSIONS: Priming of microbore tubing with 5 U/mL of insulin solution for 20 minutes to block nonspecific binding sites enhances delivery of a standard insulin stock at infusion rates typically used to treat hyperglycemic ELBW infants. We conclude that priming the tubing with a higher concentration of insulin before initiation of standard insulin infusion therapy should accelerate achievement of steady-state insulin delivery and correction of hyperglycemia in ELBW infants.

Adolescent males involved in pregnancy: associations of forced sexual contact and risk behaviors.

PURPOSE: To determine whether sexually active adolescent males who report being the victim of forced sexual contact and engaging in health risk and problem behaviors are more likely to report getting someone pregnant. METHODS: In 1995, 4159 students in Grades 9-12 in 59 randomly selected public high schools in Massachusetts were anonymously surveyed using the Youth Risk Behavior Survey (YRBS). Data were analyzed for 824 sexually active males. Demographic variables and indicators of sexual behavior, pregnancy, violence, and suicide were assessed. Data were analyzed with multiple logistic regression. RESULTS: A total of 12.0% of sexually active males reported having been involved in a pregnancy. The proportion of males who reported getting a partner pregnant increased with age. Of the sample, 8.1% gave a history of having had sexual contact against their will. Of those who reported forced sexual contact, 36.4% reported having been involved in a pregnancy; of the males who did not report a history of forced sexual contact, 9.4% were involved in a pregnancy (CV = 0.23; p < 0.00001). Based on multiple logistic regression, forced sexual contact [odds ratio (OR) 3.56; 95% confidence interval (CI) 1.79-7.09], frequency of weapon carrying on school property (OR 1.39; 95% CI 1.18-1.64), number of cigarettes smoked per day (OR 1.22; 95% CI 1.08-1.38), number of sexual partners in the previous 3 months (OR 1.43; 95% CI 1.25-1.65), and condom nonuse at last intercourse (OR 1.80; 95% CI 1.06-3.02) correctly classified 89.9% of the males who were involved in a pregnancy. CONCLUSION: This study highlights the association between health-risk and problem behaviors, forced sexual contact, and involvement in pregnancy among sexually active male high school students. In our analysis, a history of forced sexual contact was associated with a higher risk of high school males' involvement in pregnancy. These results strongly suggest the importance of screening sexually active males for a history of forced sexual intercourse and health risk and problem behaviors in the effort to prevent teenage pregnancy and childbearing.

PIP: The hypothesis that adolescent males who cause a pregnancy are more likely to have been victims of forced sexual contact and to have engaged in health risk and problem behaviors in the recent past than their sexually active counterparts who have not been involved in a pregnancy was investigated through use of a subset of data from the Massachusetts (US) 1995 Youth Risk Behavior Survey. 99 (12%) of the 824 sexually active male survey respondents reported having caused a pregnancy. A history of forced sexual contact was reported by 8.1%. Among those acknowledging forced sexual conduct, 36.4% had caused a pregnancy; of those without such a history, only 9.4% were involved in a pregnancy (p 0.00001). In addition, males who were involved in a pregnancy reported a greater likelihood of engaging in 16 health risk and problem behaviors in the previous 1, 3, and 12 months than those not involved in a pregnancy. Multiple logistic regression analysis identified 5 significant, independent predictors of having impregnated a female adolescent: number of sex partners in the previous 3 months (adjusted odds ratio (OR), 1.43; 95% confidence interval (CI), 1.25-1.65); history of forced sexual contact (OR, 3.56; 95% CI, 1.79-7.09); carrying weapons on school property (OR, 1.39; 95% CI, 1.18-1.64); cigarettes smoked/day (OR, 1.22; 95% CI, 1.08-1.38); and condom nonuse at last intercourse (OR, 1.80; 95% CI, 1.06-3.02). This model correctly classified 89.9% of sexually active male students who had been involved in a pregnancy. These findings suggest a need to screen sexually active males for these risk factors, especially a history of forced sexual contact, as part of interventions aimed at preventing adolescent pregnancy.