Nutritional, health and socio-demographic determinants of anaemia in adolescent girls in Kumbungu District, Ghana.

BACKGROUND: Anaemia is a serious health problem among adolescent girls in Ghana. The aims of this study were to measure the prevalence and identify the nutritional, health, and socio-demographic determinants of anaemia in adolescent girls in Kumbungu District, Northern Region, Ghana. METHOD: An analytical cross-sectional study involving 370 adolescent girls residing in Kumbungu district, selected using multi-stage sampling procedure, was conducted. A semi-structured questionnaire, 24-hr dietary recall, food frequency questionnaire, Food Insecurity Experience scale, and anthropometry were used to gather information on socio-demographic characteristics, nutrition knowledge, dietary diversity score, food consumption score, food consumption frequency, household food insecurity, and waist and hip circumferences. Haemoglobin was measured using a portable HemoCue hg 301 + Analyzer. Anaemia in the adolescent girls was defined as haemoglobin concentration less than 12 g/dl. Chi-square test and binary logistic regression analysis were used to identify the determinants of anaemia. RESULTS: The mean (± SD) age was 13.95 (± 2.94) years, and the majority of the girls were in school (79.5%) and lived in a rural area (81.1%). The mean (± SD) haemoglobin was 11.27 (± 1.19) g/dl, and 74.6% of the respondents had anaemia, with 1.6% having severe anaemia. The health determinant of anaemia was frequency of feeling nervous in the past 6 months [Adjusted Odds Ratio (AOR): 2.12: 95% Confidence Interval (CI): 1.17-3.89; p: 0.014], and the socio-demographic determinants were residential community status (AOR: 0.42; 95% CI: 0.24-0.75; p: 0.003), and fathers' educational qualification (AOR: 2.57, 95% CI: 1.17-5.65, p: 0.019). No nutritional determinants of anaemia were identified for this study population. CONCLUSION: The prevalence of anaemia was very high and the frequency of feeling nervous in the past 6 months, residential community status, and fathers' educational qualification were associated with anaemia among adolescent girls in Kumbungu district, Ghana. The prevalence of anaemia measured highlights the need for intensification of anaemia prevention and management interventions in the district.

Hot Feelings: Sexual Transference and Countertransference with Male Mid-Adolescents and a Female Psychoanalyst.

The author focuses on the workings of the female analyst-male pair in the consulting room when sexual feelings emerge as part of the adolescent storm. The need for open-bodiedness in relation to the perception of the bodily states of both the analyst and analysand is described and discussed. The author shows how somatic countertransference, reverie, and projective identification are harnessed creatively in the service of transformation. The importance of the third to help provide an analytic space for thought and meaning, rather than enactment and impasse, is discussed. The trajectory from the analyst's wish to silence sexual transference and countertransference in the consulting room, followed by the analyst's initial reluctance to discuss the hot feelings with colleagues, and then the impact of publication anxiety when writing through the experiences and revising this paper is described.

High-Yield HIV Testing, Facilitated Linkage to Care, and Prevention for Female Youth in Kenya (GIRLS Study): Implementation Science Protocol for a Priority Population.

BACKGROUND: Sub-Saharan Africa is the region with the highest HIV burden. Adolescent girls and young women (AGYW) in the age range of 15 to 24 years are twice as likely as their male peers to be infected, making females in sub-Saharan Africa the most at-risk group for HIV infection. It is therefore critical to prioritize access to HIV testing, prevention, and treatment for this vulnerable population. OBJECTIVE: Using an implementation science framework, the purpose of this research protocol was to describe the approaches we propose to optimize engagement of AGYW in both the HIV prevention and care continuum and to determine the recruitment and testing strategies that identify the highest proportion of previously undiagnosed HIV infections. METHODS: We will compare two seek recruitment strategies, three test strategies, and pilot adaptive linkage to care interventions (sequential multiple assignment randomized trial [SMART] design) among AGYW in the age range of 15 to 24 years in Homa Bay County, western Kenya. AGYW will be recruited in the home or community-based setting and offered three testing options: oral fluid HIV self-testing, staff-aided rapid HIV testing, or referral to a health care facility for standard HIV testing services. Newly diagnosed AGYW with HIV will be enrolled in the SMART trial pilot to determine the most effective way to support initial linkage to care after a positive diagnosis. They will be randomized to standard referral (counseling and a referral note) or standard referral plus SMS text message (short message service, SMS); those not linked to care within 2 weeks will be rerandomized to receive an additional SMS text message or a one-time financial incentive (approximately US $4). We will also evaluate a primary prevention messaging intervention to support identified high-risk HIV-negative AGYW to reduce their HIV risk and adhere to HIV retesting recommendations. We will also conduct analyses to determine the incremental cost-effectiveness of the seek, testing and linkage interventions. RESULTS: We expect to enroll 1200 participants overall, with a random selection of 100 high-risk HIV-negative AGYW for the SMS prevention intervention (HIV-negative cohort) and approximately 108 AGYW who are living with HIV for the SMART design pilot of adaptive linkage to care interventions (HIV-positive cohort). We anticipate that the linkage to care interventions will be feasible and acceptable to implement. Lastly, the use of SMS text messages to engage participants will provide pilot data to the Kenyan government currently exploring a national platform to track and support linkage, adherence to treatment, retention, and prevention interventions for improved outcomes. CONCLUSIONS: Lessons learned will inform best approaches to identify new HIV diagnoses to increase AGYW's uptake of HIV prevention, testing, and linkage to care services in a high HIV-burden African setting. TRIAL REGISTRATION: ClinicalTrials.gov NCT02735642; https://clinicaltrials.gov/ct2/show/NCT02735642 (Archived by WebCite at http://www.webcitation.org/6vgLLHLC9).

Oral contraceptive use by teenage women does not affect peak bone mass: a longitudinal study.

OBJECTIVE: To determine the effect of oral contraceptive pill (OCP) use during adolescence on peak bone mass. DESIGN: Longitudinal observational study. SETTING: Academic clinical research center. PATIENT(S): Sixty-two non-Hispanic, white females in The Penn State Young Women's Health Study, who were studied for 8 years during ages 12-20. INTERVENTION(S): There were 28 OCP users, who used OCPs for a minimum of 6 months and were still using at age 20, and 34 nonusers who had never used OCPs. MAIN OUTCOME MEASURE(S): Total body bone, dedicated hip bone, and body composition measurements were made by dual-energy roentgenogram absorptiometry. RESULT(S): The OCP users and nonusers did not differ at entry in anthropometric, body composition, or total body bone measurements. By age 20, the average duration of OCP use by the user group was 22 months. At age 20, the groups remained indistinguishable in anthropometric, body composition, total body, and hip bone measures, and in age of menarche and sports exercise scores. CONCLUSION(S): Oral contraceptive pill use by healthy, white, teenage females does not affect acquisition of peak bone mass.

PIP: This longitudinal observational study determined the effect of oral contraceptive (OC) use during adolescence on peak bone mass (PBM). The sample comprised 62 non-Hispanic, White females in The Penn State Young Women's Health Study, who were studied for 8 years between the ages of 12 and 20. There were 28 OC users who used OCs for a minimum of 6 months and were still using them at age 20, and 34 nonusers who had never used the regimen. Total body bone, dedicated hipbone, and body composition measurements were made by dual-energy roentgenogram absorptiometry. There was no difference between OC users and nonusers in the anthropometric, body composition, or total body bone measurements. By age 20, the average duration of OC use by the user group was 22 months. At this age, the groups remained indistinguishable in anthropometric, body composition, total body, and hipbone measurements, and in age of menarche and sports exercise scores. These findings suggest that OC use by healthy, White, teenage females does not affect acquisition of PBM.

Sexual initiation and contraceptive use among adolescent women in northeast Brazil.

To estimate trends and determinants of sexual initiation and contraceptive use among adolescent women in Northeast Brazil, multivariate logistic hazard models are used that draw on data from three Demographic and Health Surveys conducted there between 1986 and 1996. Educational attainment is among the variables found to be associated most consistently with differential risk of engaging in first intercourse during adolescence, including premarital intercourse, and of contraceptive use during sexual initiation. Greater frequency of attending religious services and greater exposure to television are also associated with lower rates of sexual initiation and higher use of contraceptives. Seemingly diminishing returns of education on delayed sexual activity may help explain, in part, observed increases in the absolute level of adolescent sexual experience across survey periods, however. Multilevel modeling techniques pointing to the existence of cluster-level random variances underline the need for further research into community influences on individual sexual activity.

Evidence that treatment with monophasic oral contraceptive formulations containing ethinylestradiol plus gestodene reduces bone resorption in young women.

The aim of the study was to evaluate if a pill containing the same dose of the same type of progestin compound (gestodene, GES, 75 microg) but different doses of ethinylestradiol (EE2) (20 or 30 microg) differently influences specific markers of bone resorption (urinary levels of pyridinoline (PYR) and dexoxypyridinoline (D-PYR)). During the 12 months of the study a significant decrease of urinary levels of PYR and D-PYR was found in 2 groups of young post-adolescent women taking the pills with 20 and 30 microg of EE2 in comparison with control women (subjects of the same age group with normal menstrual cycle who did not use contraception). In women taking pills with 20 or 30 microg EE2, the levels of sex hormone-binding globulin (SHBG) significantly increased during treatment in comparison with baseline, whereas in the same time period no changes occurred in control women. These findings suggest that similar to the pill containing 30 microg EE2, the lower dosage of the EE2 pill (20 microg) is also capable of reducing bone resorption. Twenty and 30 microg EE2 pills exert the same biological estrogenic effect. In fact, SHBG levels significantly increased with both pills. However, an additional effect of the progestin compound that could act directly on progestin or estrogen receptors of bone cannot be excluded. Since contraception with a pill containing the lowest estrogen dose is associated with the lowest incidence of side effects, these findings further suggest a pill containing 20 microg EE2 for young post-adolescent women would be the best choice.

PIP: The aim of this study was to evaluate if a pill containing the same dose of the same type of progestin compound (gestodene, GES, 75 mcg) but different doses of ethinyl estradiol (EE2) (20 or 30 mcg) differently influences specific markers of bone resorption (urinary levels of pyridinoline (PYR) and dexoxypyridinoline (D-PYR). During the 12 months of the study a significant decrease of urinary levels of PYR and D-PYR was found in 2 groups of young postadolescent women taking the pills with 20 or 30 mcg EE2 in comparison with control women (subjects of the same age group with normal menstrual cycles who did not use contraception). In women taking pills with 20 or 30 mcg EE2, the levels of sex hormone-binding globulin (SHBG) significantly increased during treatment in comparison with baseline, whereas in the same time period no changes occurred in control women. These findings suggest that similar to the pill containing 30 mcg EE2, the lower dosage of the EE2 pill (20 mcg) is also capable of reducing bone resorption. 20 and 30 mcg EE2 pills exert the same biological estrogenic effect. In fact, SHBG levels significantly increased with both pills. However, an additional effect of the progestin compound that could act directly on progestin or estrogen receptors of bone cannot be excluded. Since contraception with a pill containing the lowest estrogen dose is associated with the lowest incidence of side effects, these findings further suggest that a pill containing 20 mcg EE2 would be the best choice for young postadolescent women.

Relationship of hormonal contraception and cervical ectopy as measured by computerized planimetry to chlamydial infection in adolescents.

BACKGROUND: Adolescents are at increased risk for chlamydial infection and its sequelae. Hormonal contraception and cervical ectopy were previously suggested risk factors for chlamydia. GOAL: To determine if chlamydia is more prevalent in female participants with greater ectopy and in hormonal contraceptive users. STUDY DESIGN: Ninety-seven adolescent females aged 11 to 20 years were recruited from two Baltimore inner-city clinics. After administering a reproductive history questionnaire, endocervical specimens were tested for Chlamydia trachomatis by polymerase chain reaction. After acetic acid application to the cervix, cervical photographs were taken, the area of ectopy was quantified by computerized planimetry, and ectopy was categorized as none (0mm2), mild (< 22mm2), and moderate (> 22mm2). The likelihood of chlamydia by ectopy and type of hormonal contraceptive use was determined by logistic regression adjusted for age and sexual partners. RESULTS: The odds of chlamydial infection was similar in persons with mild ectopy compared with no ectopy (adjusted odds ratio [OR], 0.76; 95% CI, 0.14-4.03), and in persons with moderate ectopy compared with no ectopy (adjusted OR, 1.94; 95% CI, 0.40-9.39). The likelihood of chlamydia was higher in depot-medroxyprogesterone acetate users compared with nonhormone users (adjusted OR, 5.44; 95% CI, 1.25-23.6). Oral contraceptive users did not have an increased likelihood of chlamydia (adjusted OR, 0.92; 95% CI, 0.10-8.78). CONCLUSION: Using a new, reliable, and standardized technique to quantify cervical ectopy, the authors did not find an elevated prevalence of chlamydial infection in adolescents with cervical ectopy. Depot-medroxyprogesterone acetate use may increase the risk of chlamydial infection compared with combined estrogen-progestin oral contraceptives.

The timing of norplant insertion and postpartum depression in teenagers.

BACKGROUND: This study tested the hypothesis that teenagers who have Norplant inserted during the puerperium report more depressive symptoms during the first postpartum year than their peers who do not receive Norplant. METHODS: We studied the prevalence of depressive symptoms in a group of 212 mothers aged 19 years less, in relation to the timing of Norplant insertion. The participants were divided into 3 groups: 100 (47%) had Norplant inserted during the puerperium (early Norplant users); 72 (34%) had Norplant inserted during the next 10 months (late Norplant users); and 40 (19%) used other contraceptives (40% oral contraceptives; 17% condoms; 43% nothing). Depressive symptoms were measured with the Center for Epidemiologic Studies - Depression Scale. Postpartum depression was defined as a scale score >/=16, 6-12 months after Norplant insertion or delivery. Variables examined as potential confounders were identified a priori from a review of the literature and controlled for in analysis of variance. RESULTS: At delivery, members of the 3 contraceptive groups did not differ significantly with regard to age, race, parity, educational, marital, or socioeconomic status. Late Norplant users were, however, more apt to have new boyfriends (p =. 03), to rate the support they received from the baby's father as poor (p =.004), and experience depression prior to Norplant insertion (p =.02). Contrary to the study hypothesis, late rather than early Norplant insertion was associated with postpartum depression. Multivariate analyses identified 3 independent predictors of the severity of depressive symptoms at follow-up (depression prior to Norplant insertion, a new boyfriend at delivery, and late Norplant insertion); R(2) = 41.3%. CONCLUSIONS: Contrary to the study hypothesis, puerperal Norplant insertion did not exacerbate postpartum depression. Delaying Norplant insertion may increase the risk of depression during the first postpartum year, particularly in teenagers with other psychosocial risk factors.

Teenage motherhood and infant mortality in Bangladesh: maternal age-dependent effect of parity one.

Nuptiality norms in rural Bangladesh favour birth during the teenage years. An appreciable proportion of teenage births are, in fact, second births. This study examines the relationship between teenage fertility and high infant mortality. It is hypothesized that if physiological immaturity is responsible, then the younger the mother, the higher would be the mortality risk, and the effect of mother's 'teenage' on mortality in infancy, particularly in the neonatal period, would be higher for the second than the first births. Vital events recorded by the longitudinal demographic surveillance system in Matlab, Bangladesh, in 1990-92 were used. Logistic regression was used to estimate the effects on early and late neonatal (0-3 days and 4-28 days respectively) and post-neonatal mortality of the following variables: mother's age at birth, parity, education and religion, sex of the child, household economic status and exposure to a health intervention programme. The younger the mother, the higher were the odds of her child dying as a neonate, and the odds were higher for second children than first children of teenage mothers. First-born children were at higher odds of dying in infancy than second births if mothers were in their twenties. Unfavourable mother's socioeconomic conditions were weakly, but significantly, associated with higher odds of dying during late neonatal and post-neonatal periods. The results suggest that physical immaturity may be of major importance in determining the relationship between teenage fertility and high neonatal mortality.

Association between teenage pregnancy rates and the age and sex of general practitioners: cross sectional survey in Trent 1994-7.

OBJECTIVE: To examine variations in teenage pregnancy rates in Trent region and to determine possible associations with local general practice characteristics such as the age and sex of the doctors. DESIGN: Cross sectional survey. SETTING: All 826 general practices in Trent region in existence between 1994 and 1997. SUBJECTS: All pregnancies of teenagers aged 13 to 19 between 1994 and 1997 that resulted in an admission to an NHS hospital. MAIN OUTCOME MEASURES: Pregnancy rates for teenagers aged 13 to 19 and general practice characteristics: presence of a female or young doctor (under 36 years old), number of whole time equivalent practice nurses, Townsend score, vocational training status, list size per whole time equivalent doctor, fund-holding status, and partnership size. RESULTS: On multivariate analysis, lower teenage pregnancy rates were associated with the presence of a female or young doctor and more nurse time. Practices in deprived areas had higher teenage pregnancy rates. CONCLUSION: General practices with female doctors, young doctors, or more nurse time had lower teenage pregnancy rates. The findings may have implications for the mix of health professionals within primary care.

PIP: This cross-sectional study examined variations in teenage pregnancy rates in the Trent region, UK, and determined possible associations with local general practice characteristics such as the age and sex of the doctors. The study sample included all pregnancies of teenagers, aged 13-19 years, between 1994 and 1997 that resulted in a hospital admission. It also included all 826 general practices in the Trent region between 1994 and 1997. Upon a multivariate analysis, lower teenage pregnancy rates were associated with the presence of a female or young doctor and more nurse time. Practices in deprived areas had higher teenage pregnancy rates. Overall, general practices with female doctors, young doctors, or more nurse time had lower teenage pregnancy rates. These findings may have implications for the mix of health professionals within primary care.

Girl-trafficking, HIV / AIDS, and the position of women in Nepal.

This article focuses on trafficking of young Nepalese girls and women. Trafficking is an integral part of the social and economic fabric of Nepal, as in other parts of the world. The practice causes intolerable degradation and suffering for the girls and young women involved, who are treated as a commodity. It presents a risk to their physical and mental health, and in particular to their sexual health. The article examines the connections between coercive sex work and HIV infection, and community and government responses to HIV infection among trafficked sex workers. In particular, it considers the current AIDS prevention and control program in Nepal, and criticizes it from the feminist perspective of the authors, who are a Nepalese nurse who has undertaken academic work in New Zealand related to women's health, and a New Zealand feminist academic, who is also a nurse.

Programs for adolescent girls documented in India.

PIP: This paper documents the innovative strategies from seven governmental and nongovernmental organization programs addressing a range of adolescent issues. The collaborative effort of the Population Council and the local counterparts highlight the diversity of adolescent experience and emphasizes the need to look beyond reproductive health in order to ensure girls¿ safe transition to adulthood. The review suggests that programs need to focus on developing skills that can be applied to all aspects of the lives of adolescent girls, including self-esteem and confidence enhancement and improving their access to information. Moreover, the assessment also showed that the health needs of adolescent girls, especially the married ones, are often unmet. Considering the importance of an integrated approach, some of the programs evaluated were able to provide a strategy by collaborating with existing local services. It is documented that the strong links with the community were invaluable for the success of these integrated programs. Addressing the needs of other family members, particularly the boys are also emphasized. Experience of the program has shown that targeting boys prior to adolescence is a prudent strategy. Similarly, the training program for staff members is crucial in shaping a girl-friendly environment. Finally, the paper emphasizes the importance of crafting new programs that respond to the needs of specific communities and populations.^ieng

Incentives help delay marriage among Bangladeshi girls.

PIP: In Bangladesh, especially in the rural areas, education has been affordable only for the wealthy. In view of such a situation, the Bangladesh government instituted two incentive programs. One scheme provides wheat to parents of poor primary school boys and girls, and the other offers scholarship money to female secondary school students. Both programs eliminate school fees and provide free books. Aside from the above, a nongovernmental organization, Bangladesh Rural Advancement Committee, administered another program for primary-school students that also provides books and stationery, as well as eliminates fees. This paper assessed the effects of these programs on various aspects of the boys¿ and girls¿ lives. Overall, findings showed that the three programs created significant influence on increasing the number of children who were attending a grade appropriate for their age, although impacts on the number of hours spent in school activities are different. With shorter hours spent in school, depending on grade, children still had the time to make significant contributions to the family economy. Finally, the research shows that the secondary school scholarships had an immediate effect in delaying marriage. If sustained, these delays can have considerable long-term implications for women's status, as early marriages have long been strongly associated with gender inequality.^ieng

In Mexico, abortion rights strictly for the books.

PIP: This paper characterizes the Mexican abortion laws using the case of a girl aged 14 years, Paulina Ramirez Jacinta, who was raped, became pregnant, and chose to terminate the unwanted pregnancy, yet was denied an abortion. This case clearly showed that Mexican abortion law, despite its legality, is highly restrictive in nature and, in a way, violated the human rights of Paulina. Even though it permits first-trimester abortion procedures for rape victims or women whose lives are endangered by the pregnancy, many pregnant women still resort to illegal abortion. To further aggravate the restrictive nature of the law, Baja California state Rep. Martin Dominguez Rocha made a proposal to eliminate the rape exception in the state's penal code. The case of Paulina will be handled by the lawyers at the Center for Reproductive Law and Policy in order to arrive at a settlement favorable to Paulina.^ieng

Socializing influences and the value of sex: the experience of adolescent school girls in rural Masaka, Uganda.

PIP: To explore the socializing influences which have shaped rural adolescent schoolgirls' views and values about sex in a high HIV prevalence area of Uganda, detailed qualitative data were obtained over a 1-year period from 15 schoolgirls aged 14-17 years. The girls were chosen for their willingness to participate actively in a series of role plays, focus group discussions, and one-to-one interviews. Results indicated that the girls have been subjected to a wide range of influences, including parents, social functions, other young children, nature, their paternal aunt, peers, school, and various media, such as pornography. Moreover, there was disagreement about the relative values of sex and virginity. Some were determined to retain their virginity but the majority felt that sex benefits them socially and personally. Notably, peer pressure was a major factor influencing the opinions of many girls, while traditional influences are in decline. Given the small sample size of the study, care should be taken in generalizing from the results. However, the data suggest that sex has a high value for at least a substantial minority of adolescent girls in rural Misaka, Uganda. Policy makers and health educators should therefore consider how best to devise safe messages about sex that are relevant and applicable to this vulnerable segment of the population.^ieng

Geographical variations in AIDS knowledge and attitude among adolescent girls of Jamaica.

This article examines geographical differences in AIDS knowledge and attitudes. Data from a survey of 900 adolescent girls in the Caribbean nation of Jamaica indicate significant differences across geography in AIDS knowledge and attitude. Adolescent girls in more central areas have access to different and more sources of information than those in more remote areas. They are also more likely to know persons with AIDS, be more knowledgeable about the clinical manifestations of AIDS, and be more realistic in assessing their susceptibility of HIV. The implications of geographical differences for AIDS education efforts are discussed.

PIP: This paper examines geographical differences in AIDS knowledge and attitudes among adolescent girls in Jamaica. A total of 900 respondents aged 14-17 were chosen; 714 of them were from urban areas, and 186 were from rural areas. Questions covered awareness of AIDS existence, information sources, the number of persons with AIDS the respondent was aware of, knowledge of AIDS transmission, and knowledge of risks. Findings showed that geography influenced the levels of knowledge and attitudes of adolescent girls toward AIDS. Young women who lived in more central areas were had an advantage over girls in remote areas with respect to access to AIDS information. It was concluded that efforts toward the dissemination of AIDS information to adolescents in rural areas should be implemented and that these should incorporate the development of educational resources for AIDS education. The results of this survey suggest generally that geographic type should be considered in educational efforts.

Correlates of first intercourse among women in Jamaica.

This study examines retrospective reports of factors anticipated to impact first intercourse in a random sample of 897 Jamaican women, and contributes to our understanding of the relationship between sexual risk, knowledge, and economic and demographic correlates of first intercourse. A relationship between initiation of intercourse prior to the age of consent (16 years) and factors occurring at or around the time of first intercourse was found. Early initiators were more likely to have had less early family stability and to have experienced menarche at a younger age than late initiators. Although early initiators of intercourse were more likely to report lower socioeconomic status, less STD knowledge, and greater numbers of pregnancies, they were no more likely to report more sexual partners than women who engaged in first intercourse after the age of consent, and had a greater number of long-term relationships. Regardless of age of first intercourse, women need to be made aware of the risks of sexual contact so that they can make informed decisions about the consequences of sexual activity. Overall, results are consistent with work conducted in other parts of the Caribbean and America regarding the age at which young women engage in first intercourse. Findings suggest the need for further work exploring expectations at first intercourse such as marriage, economic support, or relationship stability. Implications of these findings are discussed within the context of economic and structural factors that both increase and decrease risks.

PIP: This study examines retrospective reports of factors anticipated to impact first intercourse among 897 women selected randomly in Jamaica. Three groups of factors were associated with early vs. late initiation of intercourse. A significant association was noted between family structure in childhood and age of first intercourse. Women growing up in one-parent families were more likely to engage in intercourse before the age of 16. The age of menarche was also significantly associated with age of intercourse. The characteristics of the first sexual partner and the characteristics of the relationship were significantly associated with the age of intercourse. On the other hand, there are four sets of variables assessing current demographic characteristics, current relationship status, and factors such as religiosity and knowledge on sexually transmitted diseases (STDs). It was observed that early initiators of intercourse were more likely to report lower socioeconomic status, less STD knowledge, and a greater number of pregnancies. This study identifies some of the circumstances of first intercourse, which highlight the need to develop health and educational intervention programs that offer more options to young adolescents who may consider early childbearing to stabilize relationships.

Cultural factors affecting diet and pregnancy outcome of Mexican American adolescents.

PURPOSE: To describe the nutrition knowledge, cultural beliefs, food intake, and attitudes about weight gain of Mexican American adolescents and their relationship to pregnancy weight gain and infant's birth weight. METHODS: A convenience sample of 46 pregnant adolescents, who were self-identified as Mexican American, primigravidas, and aged 13-18 years, was eligible. Two personal interviews were conducted with each participant, at the second trimester (18-22 weeks' gestation) and third trimester (30-34 weeks' gestation). The measurements were nutrient intake, nutrition knowledge, and attitudes toward weight gain. The proxy measure for acculturation was the length of residence in the United States [Group 1 (G1), n = 14; 3-12 months), G2 (n = 19; 12-48 months), and G3 (n = 13; 48-216 months). Descriptive statistics and analysis of variance were performed on the data as appropriate. Qualitative methods were used to describe cultural beliefs, behaviors, and attitudes during pregnancy. RESULTS: The mean age of the sample was 16.34 +/- 1.56 years. A total of 21.74% (n = 10) was American-born and 78.26% (n = 36) was Mexican-born. G3 was significantly (p < .05) the youngest at the time of conception, gained the most weight during pregnancy, was more knowledgeable about nutrition, was more educated, and was single and living with parents. There were no differences regarding the adequacy of diets during pregnancy among the three groups, and all diets adhered to up to 85% of the mean adequacy ratio (MAR). The mean total weight gain was 31.83 +/- 9.88 lb. There were no statistically significant differences of birth weight; the mean value for the three groups was 7.23 +/- 0.98 lb. CONCLUSIONS: The most powerful factors that reportedly contributed to good food practices during pregnancy were maternal concern about the well-being of the baby, role of motherhood, and family support system. It was found that with acculturation, adolescents lost most of the traditional Mexican cultural beliefs related to pregnancy, and their attitudes about weight gain were more negative. There was no relationship between nutrition knowledge and diet adequacy during pregnancy; they chose the traditional foods thought most nutritious by parents and family, for the benefit of their baby.

PIP: A study was conducted to describe the cultural beliefs, nutrition knowledge, food intake, and attitudes about weight gain of Mexican American adolescents, and their relationship to pregnancy weight gain and infant's birth weight. A convenience sample of 46 pregnant adolescents, who were self-identified Mexican American primigravidas aged 13-18 years, were recruited from 6 San Francisco Bay Area and San Jose clinic sites. Data were collected over an 18-month period from Winter 1994 to Spring 1995. Results showed that acculturation affected nutritional knowledge, attitudes about weight gain during pregnancy, and the psychosocial and educational level of pregnant Mexican American adolescents. There were no differences in the quality of diet and pregnancy outcomes, gestational weeks at delivery, or birth weight among acculturated, versus the nonacculturated adolescents. Both benefited from cultural protective factors related to their dependence on the family for emotional, economic, and social support. Nutrition recommendations should emphasize the importance of maintaining traditional food habits and nutritive value information of American foods.

High school athletic participation, sexual behavior and adolescent pregnancy: a regional study.

PURPOSE: To determine whether high school athletic participation among adolescents in Western New York was associated with reduced rates of sexual behavior and pregnancy involvement. METHODS: A secondary analysis of data from the Family and Adolescent Study, a longitudinal study of a random sample of adolescents (ages 13-16 years) from 699 families living in households in Western New York. A general population sample was obtained with characteristics closely matching the census distributions in the area. Interview and survey methods provided data on athletic participation, frequency of sexual relations during the past year, and risk for pregnancy. Bivariate correlations were used to examine relationships among athletic participation, demographic and control variables, and measures of sexual behavior and pregnancy rates. Next, path analyses were done in order to test for hypothesized relationships between athletic participation, sexual behavior, and pregnancy involvement while controlling for age, race, income, family cohesion, and non-athletic forms of extracurricular activity. Variables that were significantly associated with sexual behavior and/or pregnancy involvement were presented for both sexes within the resulting multivariate models. RESULTS: Lower income and higher rates of sexual activity were associated with higher rates of pregnancy involvement for both sexes. Family cohesion was associated with lower sexual activity rates for both sexes. For girls, athletic participation was directly related to reduced frequency of sexual behavior and, indirectly, to pregnancy risk. Male athletes did not exhibit lower rates of sexual behavior and involvement with pregnancy than male non-athletes. Boys who participated in the arts, however, did report lower rates of sexual behavior and, indirectly, less involvement with pregnancy. CONCLUSIONS: Female adolescents who participated in sports were less likely than their non-athletic peers to engage in sexual activity and/or report a pregnancy. Among male adolescents, athletic participation was unrelated to sexual behavior and pregnancy involvement. Teen pregnancy prevention efforts for girls should consider utilizing sport as a strategic tool.

PIP: A longitudinal study using a random sample of adolescents, aged 13-16 years, was conducted in western New York to determine if athletic participation was associated with a reduced rate of sexual behavior and pregnancy. 699 families were interviewed and surveyed, and bivariate correlations were used to examine the relationships among athletic participation, demographic and control variables, and measures of sexual behavior and pregnancy rates. Findings showed that high rates of pregnancy involvement for both sexes were associated with low income and high sexual activity. Higher levels of family cohesion reduced rates of sexual activity for both sexes. Girls' athletic participation was directly proportional to reduced frequency of sexual behavior and, indirectly, to pregnancy risk. However, lower rates of sexual behavior and pregnancy involvement among adolescent male athletes were not discovered. Female adolescents who participated in sports were less likely than their nonathletic peers to engage in sexual activity and/or report a pregnancy. Among male adolescents, athletic participation was unrelated to sexual behavior and pregnancy involvement.

Pseudocyesis in an adolescent using the long-acting contraceptive Depo-Provera.

PIP: A case report documents a Hispanic adolescent, 17 years of age, with pseudocyesis, who became amenorrheic using Depo-Provera to prevent a second pregnancy. Pseudocyesis includes classic symptoms of pregnancy such as nausea, breast enlargement and pigmentation, abdominal distention, and amenorrhea in nonpregnant women. It demonstrates the to control one's physical aspect at the level of hypothalamus. The involvement that contributed to her pseudocyesis--in this case, of her mother and boyfriend -- was not unusual. The abrupt resolution was brought on by normal menstrual period that began after she voluntarily missed her Depo-Provera injection. However, her ambivalence about a pregnancy became clear after she and her family received counseling. While the agenda had been to help her prevent a pregnancy, hers had not been as clear and uncomplicated. Her subsequent conception was a very positive one for her and her family, which helped to resolve the situation.^ieng