Volume 24, Issue 2

No abstract available.

The act of adolescent suicide continues to threaten adolescent populations in New York City (NYC). Consistent positive correlations have been found between a plethora of risk factors present in NYC adolescent populations and suicidal ideations and behaviors. Psychiatric conditions that may contribute to the rate of adolescent suicide in NYC include depression, bipolar disorder, substance abuse and schizophrenia. Unique factors that have been found to contribute to increased rates of completed suicides in NYC include the phenomena of railway suicides and suicide tourism. Homelessness and income inequality in NYC have also been consistently correlated with increased suicidality; with one study finding suicide attempts reported by a significant percentage of new admissions to homeless shelters. Adolescent populations in NYC that have been identified as particularly vulnerable to suicidality include runaway youth, homosexual youth, victimized adolescents and adolescents with a recent history of posttraumatic stress disorder (PTSD). Longitudinal studies in NYC have found that physical and sexual abuse is highly predictive of adolescent suicidality, with variations by ethnic group. Currently, there is a disturbing lack of sufficient research on adolescent suicide in NYC, specifically regarding causal factors, the effects of television on suicide, comorbid suicidality and drug abuse, and cultural factors contributing to suicide. This dearth of literature may be related to the ethical problems inherent in suicide research, self reports and/or post mortem analyses.

Background: Prenatal substance use is a major public health problem and a social morbidity, with consequences on the drug user and the offspring. Objective: This review focuses on the child and adolescent outcomes following in utero drug exposure. Methods: Studies on the effects of specific substances, legal and illegal; i.e., tobacco or nicotine, alcohol, marijuana, cocaine, opiates, and methamphetamine were evaluated and analyzed. Results: In general, manifestations of prenatal exposure to legal and illegal substances include varying deficits in birth anthropometric measurements, mild-to-moderate transient neurobehavioral alterations in infancy and long-term behavioral problems noted from early childhood to adolescence. Severity of expression of behavioral problems is influenced by environmental factors. Further, behavioral alterations following in utero drug exposure often exist with mental health co-morbidities. Conclusion: Because of the long-term consequences of prenatal drug exposure on child and adolescent mental health, health providers need to promote substance use prevention, screen for exposure effects and provide or refer affected youths for intervention services. Preventive measures and treatment should consider other factors that may further increase the risk of psychopathology in the exposed children.

Evidence-based medicine (EBM) is defined as “the integration of best research evidence with clinical expertise and patient values.” EBM is based on three equally important key factors: i) the best available scientific evidence; ii) the physician’s experience and intuition; and, iii) the preferences and values of the patient. EBM uses a hierarchy of evidence and critical appraisal of the sources, which makes it possible to balance high quality evidence with documented effectiveness. A treatment that is more safe and effective, but less well documented may very well be the treatment of choice. Ethics (not putting the patient at risk of harm with a treatment if this can be avoided at all) is an important part of EBM. Many pharmaceutical drugs have a number needed to treat (NNT) of approximately 20 [NNT=20, confidence interval CI (5–50)] and the number needed to harm is less well understood and documented. The adverse effect profile of pharmacological agents can be more harmful than non-drug medicine. Most EBM-treatments are likely to be non-drug treatments in the future. There are six steps to the practice of EBM: i) the patients and the physician must work together to define the problem; ii) the patients and the physician must explore the patient’s values and preferences; iii) the information about the possible alternative medical interventions must be discussed and critically appraised; iv) the best, relevant evidence must be applied to the patient as a treatment or cure; v) together, the patient and the physician must evaluate how useful the intervention was; and vi) if the intervention did not help sufficiently, the process must begin again. In this review, we explain, in our opinion, how non-drug EBM should be practiced.

Predicting and preventing suicide represent very difficult challenges for clinicians. The awareness of adolescent suicide as a major social and medical problem has increased over the past years. However, many health care professionals who have frequent contact with adolescents are not sufficiently trained in suicide evaluation techniques and approaches to adolescents with suicidal behavior. Suicide prevention efforts among adolescents are restricted by the fact that there are five key problems related to the evaluation and management of suicidality in adolescents: 1. Many clinicians underestimate the importance of the problem of adolescent suicidal behavior and underestimate its prevalence. 2. There is a misconception that direct questioning of adolescents about suicidality is sufficient to evaluate suicide risk. 3. Another misconception is that adolescents with non-psychiatric illnesses do not need to be evaluated for suicidality. 4. Many clinicians do not know about or underestimate the role of contagion in adolescent suicidal behavior. 5. There is a mistaken belief that adolescent males are at lower suicide risk than adolescent females. Educating medical professionals and trainees about the warning signs and symptoms of adolescent suicide and providing them with tools to recognize, evaluate, and manage suicidal patients represent a promising approach to adolescent suicide prevention.

HIV serodiscordance is a sexual partnership in which one partner is infected with HIV while the other is not. Managing emotional and sexual intimacy in HIV serodiscordant unions can be difficult due to concerns about HIV transmission and the challenge of initiating and maintaining safe sex. In situations where couples are jointly aware of their HIV status, women in serodiscordant unions may face increased risk of partner violence. We conducted an investigation to assess risk factors for HIV serodiscordance and determine if HIV serodiscordance is associated with incident sexual violence among a cohort of women attending HIV post-test club services at three AIDS Information Centers (AICs) in Uganda. Using a prospective study of 250 women, we elicited information about sexual violence using structured face-to-face interviews. Sexual violence and risk factors were assessed and compared among HIV positive women in HIV discordant unions, HIV negative women in discordant unions, and HIV negative women in negative concordant unions. Multivariable logistic regression was used to assess the association between participants’ serostatus and sexual violence. HIV negative women in serodiscordant relationships (36.1±11.1 years, range: 19–65 years) were significantly older than either HIV positive women in serodiscordant relationships (32.2±9.0 years, range: 18–56 years), or HIV negative women in concordant relationships (32.3±11.0 years, range: 18–62), (p=0.033). Early age at sexual debut was associated with a 2.4-fold increased risk of experiencing sexual violence (OR 2.4, 95% CI 1.27–4.65). Based on unadjusted analysis, HIV positive women in discordant relationship were at highest risk for sexual violence compared to HIV negative women in discordant unions, and HIV negative women in negative concordant unions. HIV negative women in discordant relationships and those in concordant negative relationships showed no increased risk for sexual violence. However, couples’ HIV serostatus was not significant related to incident sexual violence after controlling for potential confounding covariates. Nevertheless, the results were able to elucidate the sexual violence risk factor profile of participants based on couples’ HIV serostatus. Couple counseling protocols at HIV voluntary counseling and testing centers in Uganda should identify those at risk for sexual violence and develop interventions to reduce its incidence.

Background: The purpose of this study was to evaluate the knowledge, attitudes, and practices about HIV/AIDS of high school students in Panama City, Panama and the impact of a peer-to-peer intervention project. Methods: There were 659 participants in two public and two private schools, one of each got the intervention and the other serving as control. A questionnaire was used as a pretest and post-test to measure the effects of the intervention. The intervention consisted of 12 weekly sessions led by professionally trained peers using four different modalities: theater, group dynamics, videos, and discussions. Results: The difference in the knowledge scores of the questionnaire resulted in an improvement in both the private (ES=0.63) and the public (ES=0.52) schools with the intervention. Another important finding was that the idea of abstinence as disease prevention for high school students rose from 7% to 60% (public school) and from 27% to 62% (private school) in response to an open-ended question. Conclusions: There were other significant positive findings that demonstrate the efficacy of this peer-to-peer model educating high school students about lowering the risks of contracting HIV/AIDS. This model could also be used to prevent or mitigate other risky behaviors.

Introduction: Advertising plays a major role in smoking behavior and forming brand preferences. Additionally, the most advertised tobacco brands have also been the most preferred. Maintaining brand loyalty in Latin America remains a priority for the tobacco industry. Objective: The purpose of this study was to explore tobacco brand preference trends from 2003 to 2006, and explore marketing and advertising factors that might be associated with these trends. Study group: Data for this study came from Mexican adolescents residing in cities that participated in the Global Youth Tobacco Survey in both 2003 and 2006 and reported smoking either Marlboro or Camel cigarettes in the past 30 days. Methods: Respondents reported the brand name of their preferred cigarette during the past 30 days. Multivariate regression analysis was used to determine differences by brand preference and exposure to tobacco marketing and advertising, which was assessed using six items. Results: In 2003, most adolescents preferred Marlboro. By 2006, older boys preferred Camel cigarettes to Marlboro, while girls’ preference for Camel was similar to their preference for Marlboro. Adolescents that preferred Camel cigarettes in 2003 also reported greater exposure to tobacco marketing and advertising. Conclusion: Findings indicate that there are ongoing shifts in youth brand preference in Mexico, and that these shifts might be related to marketing and advertising practices. There is an ongoing need for monitoring marketing and advertising practices in an effort to protect adolescents from tobacco company exploits.

Aim: The aim was to examine the effects of spirituality on recent cigarette and alcohol use, intentions to use cigarette and alcohol, and perceived risks of cigarette/alcohol use in a sample of Russian adolescents. Methods: Cross-sectional data were obtained from 362 10th graders from Ufa, Russia. Results: Adolescents scoring higher on spirituality were significantly more likely to report lower levels of intentions to use cigarettes or alcohol. However, spirituality was not associated with recent cigarette/alcohol use or perceived risks. Analyzed separately for ethnic Russians and non-Russians, the relationship between spirituality and intentions were significant only among ethnic non-Russians. Conclusions: Our data suggests that the protective effects of spirituality on substance use may not be universal and may depend on subjects’ national, ethnic, or religious background.

Health-related physical fitness has decreased with age; this is od immense concern to adolescents. School-based health intervention programs can be classified as either population-wide or high-risk approach. Although the population-wide and risk-based approaches adopt different healthcare angles, they all need to focus resources on risk evaluation. In this paper, we describe an exploratory application of cluster analysis and the tree model to collaborative evaluation of students’ health- related physical fitness from a high school sample in Taiwan (n=742). Cluster analysis show that physical fitness can be divided into relatively good, moderate and poor subgroups. There are significant differences in biochemical measurements among these three groups. For the tree model, we used 2004 school-year students as an experimental group and 2005 school-year students as a validation group. The results indicate that if sit-and-reach is shorter than 33 cm, BMI is >25.46 kg/m 2 , and 1600 m run/walk is >534 s, the predicted probability for the number of metabolic risk factors ≥2 is 100% and the population is 41, both results are the highest. From the risk-based healthcare viewpoint, the cluster analysis can sort out students’ physical fitness data in a short time and then narrow down the scope to recognize the subgroups. A classification tree model specifically shows the discrimination paths between the measurements of physical fitness for metabolic risk and would be helpful for self-management or proper healthcare education targeting different groups. Applying both methods to specific adolescents’ health issues could provide different angles in planning health promotion projects.

Body dissatisfaction has been extensively studied but, recently, the importance of body satisfaction and its attributing factors has received significant recognition. Also, there is an increasing awareness of the need for research examining body dissatisfaction and satisfaction in youth other than North American females. Thus, the current research examined the prevalence of, and the individual, social, and familial factors associated with, body-weight satisfaction among New Zealand male and female adolescents (n=9107). Data were analysed from Youth ’07, a nationally representative survey of New Zealand secondary school students. Overall, half of students were happy with their weight, with significantly more males than females reporting body-weight satisfaction. Students happiest with their weight were most likely to report healthy and supportive social and family environments, as well as higher levels of well-being. These findings are consistent with a growing body of research that suggests creating positive peer and family environments may lead to better developmental outcomes, such as body satisfaction, and also higher levels of well-being.

Objective: The purpose of the study was to assess common mental disorders and the related use and need for mental health care among clinically not yet active and clinically active medical students. Methods: All medical students (n=2266) at one Dutch medical university were approached. Students from study years 1–4 were defined as clinically not yet active and students from study years 5 and 6 as clinically active. An electronic survey was used to detect common mental disorders depression (BSI-DEP), anxiety (BSI-ANG), stress (4DSQ) and post-traumatic stress disorder (IES). The use of mental health services in the past 3 months and the need for mental health services were asked for. The prevalence of common mental disorders, the use and need for mental health services and differences between groups were calculated. Results: The response rate was 52%: 814 clinically not yet active and 316 clinically active students. The prevalence of common mental disorders among clinically not yet active and clinically active students was 54% and 48%, respectively. The use of mental health services was 14% in clinically not yet active and 12% in clinically active students with common mental disorders (n.s.). The need for mental health services by clinically not yet active and clinically active students was 52% and 46%, respectively (n.s.). Conclusions: The prevalence of probable common mental disorders are higher among clinically not yet active than among clinically active students. The need of mental health services exceeds use, but is the same in the two groups of students.

Background: Ultra-orthodox, Jewish adolescent boys are considered to have relatively high smoking rates, but are generally not targeted by Israel’s smoking prevention programs. Objective: The objective of this trial was to test the effectiveness of a religion-based tobacco control intervention in reducing smoking prevalence among these youth. Methods: The study population participants were 340 boys from 63 religious boys’ schools in Jerusalem. The intervention consisted of a mailing that included a pamphlet describing the health effects of and rabbinical prohibitions on smoking. A cluster randomized trial was conducted between March and May, 2005. The primary endpoint was current smoking status. Secondary endpoints were future intent to smoke and attitudes towards smoking. Generalized estimating equations and mixed models of analysis of variance were used to perform the analyses. Results: The intervention did not significantly affect current smoking, intent to smoke or attitudes towards smoking. Prevalence of smoking and future intent to smoke were higher in schools without enforced smoking regulations [odds ratio (OR) 2.74, p=0.026, OR 3.38, p=0.018]. Increased smoking prevalence was associated with a high prevalence of smoking among friends (p=0.031) and not finding smoking repulsive (p=0.024). Conclusions: This study adds to the public health literature linking smoke-free schools and peer influences to adolescent smoking. Pamphlets containing rabbinic prohibitions on smoking initiation did not affect smoking behavior or intent to smoke.

Background: Disorders of sex development (DSD) belong to uncommon pathologies; in addition, there are especially rare forms, such are ovotesticular disorders (OT), Turner syndrome and early malignisation of intraabdominal located gonads in the cases of androgen insensitivity syndrome. Objective: In this article we present four rare cases of DSD in female phenotype adolescents: two cases of ovotesticular DSD with 46,XX and 46,XY karyotypes; one familial case of androgen insensitivity syndrome (AIS) with early malignancy (19-year-old) of intra-abdominally-located testicle in older siblings, and a case of spontaneous menstruation in a patient with Turner syndrome and mosaic karyotype 45,X/47,XXX. Rare cases of DSD are connected with diagnostic and management difficulties and so description of each such case and collection of data in this field is very important from a scientific, as well as a practical, point of view. Determination of prognosis and adequate management of each individual patient are also essential. Study of this issue is especially sensitive in the case of adolescent patients in order to avoid physiological stress, to reduce health risks and to improve quality of life.