Volume 26, Issue 1

Background: As adolescent pregnancy and sexually transmitted infections (STIs) are major sources of morbidity, preventing them is an important health goal for Portuguese society. Objective: To review data on the knowledge, attitudes and statistics on sexual and reproductive health. Methods: A systematic review was conducted including peer-reviewed articles addressing issues influencing the sexuality of Portuguese adolescents (aged 13 to 19), published up to 2011 and conducted in any type of setting. After crossing-cleaning the reference list, 33 articles were included. Results: The rate of sexual activity by Portuguese adolescents is high (44%–95%), but there has been an increase in the age of intercourse debut (currently 15.6 years). Early commencement of sexual intercourse is associated with smoking and regular alcohol consumption. Condoms are the most frequently chosen contraceptive method for first (76%–96%) and subsequent (52%–69%) sexual encounters. The perception of a double standard in sex still exists in teenage culture for both genders and influence behavior. There are significant differences between migrant and native adolescents: African adolescents initiate sexual intercourse at earlier ages and are more likely to have unprotected sex. Only one-third of Portuguese teenagers have ever visited a health facility to seek counseling concerning contraception or STIs, and less than half have ever attended classes on reproductive health. Very few (12%) have knowledge about Chlamydia trachomatis infection. The prevalence of STIs in Portuguese youth is unknown. The adolescent fertility rate is still high (14.7 births per 1000 females aged 15–19 years), but it, as well as the rate of abortion, is steadily decreasing. Conclusions: There is still a long way to go towards promoting a resourceful young population. Citizens and institutions must focus on increasing both the competence of youths and external supports. Information must be provided systematically and health services must have greater accessibility. Studies addressing cultural and environmental determinants that contribute to the molding of the sexual conduct of Portuguese adolescents must be held to produce new and effective culturally sensitive health interventions.

Objective: This study aims to assess the knowledge, attitude, and practice of tobacco use and its cessation among children in schools of Delhi. Methods: A cross-sectional study involving 1094 schoolchildren (577 boys and 517 girls), 12–15 years old, was conducted using the modified Global Youth Tobacco Survey questionnaire. Mann-Whitney U-test and Kruskal-Wallis test were applied (p<0.05). Results: Among these, 132 boys (22.87%) and 120 girls (23.21%) were smokers. “Ever smokers” were 13.80% and “current smokers” were 9.23%, whereas 76.97% were “never smokers”. Conclusion: Interventions that raise awareness at a young age, equip students to overcome peer influence, and provide counseling to quit using tobacco need to be designed.

Purpose: To describe and compare adolescent and parent perspectives on communication, family adaptability and cohesion, as well as relationships among these variables, during the first month of an adolescent’s cancer diagnosis. Methods: Seventy adolescent-parent dyads were enrolled as part of a larger multi-site study. The adolescents ranged in age from 11 to 19, and 61% were males. Parents were predominately mothers (83%). Dyads were predominately non-Hispanic Caucasian (63%). Measures included the Parent-Adolescent Communication Scale and the Family Adaptability and Cohesion Evaluation Scale (FACES II). Paired t-tests, Pearson correlations, intra-class correlation coefficients and multiple linear regression analyses were completed. Results: Adolescent scores on communication, family adaptability and cohesion were significantly lower than parent scores. The inter-dyadic agreement between adolescents and parents was low. Communication, family adaptability and cohesion were examined separately for adolescents and for parents, and significant relationships were found. Both adolescent- and parent-perceived communication was significantly associated with family adaptability and cohesion outcomes. Conclusions: Differences were found in adolescent and parent perceptions of communication, family adaptability and cohesion. When both adolescents and parents had better perceived communication, this was associated with better perceived family adaptability and cohesion. Results suggest that the development of interventions to enhance adolescent-parent communication could help foster better family adaptability and cohesion, which may ultimately impact their psychological adjustment. In addition, understanding the degree to which adolescents and parents disagree on their perceptions, including the results that parents generally have more favorable perceptions, may be a useful starting point when developing interventions.

Background: Bullying is common among young students, and cyberbullying has increased due to the use of technology. This study investigates the prevalence of bullying and cyberbullying among high school students and the emotional effects of bullying on students. Methods: Students at East Chapel Hill High School, Chapel Hill, North Carolina completed the Gatehouse Bullying Scale and the Peer Relations Questionnaire. They answered questions regarding how often they had experienced certain types of bullying in school and the emotional effects the bullying had on them. Results: The combined results from both surveys indicated that the prevalence of bullying was 55% with 18% of respondents reporting cyberbullying. Teasing and name-calling were the most common types of bullying, as 40% of students reported having been teased or called names. The most serious type of bullying, being threatened with harm, hit, or kicked, occurred in 20% of boys and 8% of girls, with 25% of respondents reported “quite upset” by the experience. The majority (79%) of students who had been bullied did not share with anyone about being bullied, and of those who did, only 50% were taken seriously. Conclusions: Bullying is still prevalent among high school students, and cyberbullying is becoming more widespread. Most victims do not share their bullying experience, and if they did, only half believe they are taken seriously. Both bullying among students in school and cyberbullying deserve attention due to their potentially devastating effects on victims.

Introduction: Management of adolescent obesity in clinical practice has been usually centered on the promotion of healthy eating and an active lifestyle, with a weak evidence base. In search of creative and more effective interventions, our objective was to evaluate the immediate and follow-up effectiveness of a residential camp program for obese adolescents. Methods: A total of 28 obese adolescents (15 girls), mean age 13.3±1.7 years and body mass index (BMI) 30.3±5.4 kg/m 2 , who were attending a tertiary health unit, enrolled in a 2-week camp. The activities were prepared and supervised by different specialists. All adolescents were assessed for anthropometric and psychosocial variables including body image, self-esteem, quality of life and depressive symptoms. Evaluations were conducted on the first and last day of the camp and at 6 months’ follow-up. The effect of treatment was analyzed using analysis of variance (ANOVA) mixed models. Results: At the end of the camp, weight was reduced by –2.7±1.2%, BMI by –0.8±0.4 units and waist circumference by –2.8±9.8 cm. A reduction in depressive symptoms was identified, with greater reductions in BMI associated with a more significant improvement in depressive symptoms. At the 6 months’ follow-up only girls maintained BMI reduction, with boys having increased their BMI. Discussion: In the short-term the camp was effective in reducing BMI and improving depressive symptoms. Only girls were able to proceed with BMI reduction at 6 months. These gender differences should be further explored. Ongoing research is examining the maintenance of these improvements.

Background: Teenage pregnancies are associated with negative outcomes. Prevention requires understanding them and their families. Objectives: This study aimed to describe personal and family attributes of pregnant teenagers in Sri Lanka. Methods: This was a community-based study in Sri Lanka among 510 pregnant teenagers. Results: Half (50%) of the subjects were 19 years of age at the time of pregnancy. A majority (79.8%) had studied up to grades 6–11. Confidence in decision-making (80.7%) and in refusing unnecessary requests (88.3%) was “excellent” in a majority. Mean age of marriage/co-habiting was 17.6 years. For 31%, marriage/cohabiting was a sudden decision taken jointly with their partner (81.6%) and 83% reported being “legally” married. Substantial proportions of mothers (17.6%) and fathers (13.9%) had not attended school, and 33.1% mothers had worked abroad. Teenagers reported the death of a parent (14.1%), parental separation (10.9%) and being brought up by relatives (20%). Only a few rated strictness of rules/regulations (32.4%), freedom to discuss problems regarding puberty (25.5%), love affairs (12.7%) and sexuality (26.7%) as excellent/good. Of the spouses, 12.9% were <20 years, 71.9% had low education and 98.8% were employed. A majority had “planned” the pregnancy, and for 79.8%, the reason was “husband’s wish to have a baby”. Conclusions: Pregnant teenagers were mostly in their late teens, from poor families and with low formal education. Though teenagers showed confidence in decision-making, the decision to have a pregnancy had mostly been their spouses. Parents and spouses of the teenagers were also young, less educated and poor. There was evidence of poor parenting practices.

Background: The necessity of referring adolescents with anorectal malformation (ARM) from pediatric units to adult care is unclear. The issue requires knowledge about the health of the adolescent. Objective: To examine the physical outcome, sexual health and quality of life (QoL) in adolescents with ARM. Methods: At medical counseling, 24 adolescents with ARM, 15–21 years of age, answered questionnaires about physical outcome according to the Krickenbeck follow-up and QoL according to SF 36 and gastrointestinal quality of life (Giqli). Matched control groups were used; 15 adolescents participated in deep interviews about sexual health and body imaging. Results: Fecal soiling, constipation and gas incontinence were much higher for ARM patients compared with controls (p<0.05). QoL regarding large bowel function was lower for both genders compared with controls (p<0.05). Females scored lower in physically related QoL (p<0.05). Social and sexual adaption to the symptoms was obvious in the deep interviews. Conclusion: Adolescents with ARM have considerable intestinal symptoms, which influence QoL and require adaption in intimate situations. A referral to adult care seems to be important, and continuous cooperation between the pediatric surgeon and adult care is suggested.

Background: Adolescents are developmentally normatively interested in information about sexuality and other health-related issues. In the absence of available health programming, identifying the sources of information that youth are currently accessing will help adolescent health researchers understand where youth ‘are,’ thereby informing where and how future interventions can be targeted. This is particularly important in resource-limited settings, such as Iran, where funding for public health programming is scant. This study aimed to examine primary and preferred sources of adolescents’ health information queries and identify health topics in which they are most interested. Methods: In 2011, a random sample of 915 adolescents, aged 14–18 years, completed anonymous, self-administered questionnaires. Results: Mothers (51.11%) and same-sex friends (40.11%) were both the primary as well as the preferred source of health information for adolescents. More than one in three adolescents identified media information sources, including books (39.6%) and the Internet (37.9%), as their primary and preferred sources. The most common topic adolescents sought information about was sexuality issues. Younger adolescents preferred receiving information from parents, whereas older adolescents preferred friends as sources for information [X 2 =9.3, p=0.009]. No age differences were noted in using media sources (p>0.05). Conclusions: These findings indicate future interventions should integrate some if not all of these sources [both people (mothers, same-sex friends) and media (books, the Internet)] to deliver evidenced-based health information.

Aim: To explore the experiences of alpine skiing at the elite level after anterior cruciate ligament (ACL) injury and reconstruction. Design: A qualitative approach where semi-structured interviews were conducted, and an analysis of the manifest content was performed. Participants: Five ski high school students, two male and three female skiers, who had suffered ACL injuries and undergone ACL reconstructions. Results : Seven categories were identified. The participants described their perceived opportunities with regard to returning to alpine skiing after ACL injury and reconstruction as something positive to do with self-belief, being mentally and physically prepared, regaining confidence in their own ability, being given time and using active strategies. In contrast, perceived barriers to a return to elite alpine skiing gave rise to negative feelings, for example, fear, disheartenment, a total lack of or ambivalent confidence in their own ability and the use of passive strategies. Conclusion: The two male skiers returned to alpine skiing. They reported confidence in their own ability, active strategies and support on all levels, as well as enhanced physical ability. The female skiers did not return to their pre-injury level of competitive alpine skiing. They stated a lack of support on all levels, deterioration in their physical ability and two out of three reported passive strategies and no or ambivalent confidence in their own ability. The most important factors were family support, support on all levels, access to a physiotherapist and time given.

Background: It has been suggested that autistic patients have elevated blood androgens, and although signs of precocious puberty have been reported in autistic patients, such a relation has not yet been clarified. Objectives: To assess serum androgen levels in a group of Egyptian male autistic children and adolescents and their relation to disease severity. In addition, the risk for association of androgens with autism was estimated. Methods: In comparison to 20 controls, 30 male autistic children were studied. All subjects were subjected to clinical evaluation, intelligence quotient (IQ) assessment and measurement of serum free testosterone (FT), dehydroepiandosterone (DHEA) and Δ4-androstenedione (Δ4-A). Results: Androgens were higher in autistic patients than in controls and increased with increased autistic severity. Of the patients, 11 (36.66%) had high FT, 9 (30%) had high DHEA, 12 (40%) had high Δ4-A and 8 (26.66%) showed elevation of all androgen levels. FT (OR: 38.45, 95% CI: 2.14–688.93, p=0.013) and Δ4-A (OR: 13.6, 95%CI: 2.25–22.89, p=0.04) had a significant risk for association with autism. Conclusions: Hyperandrogenemia is prevalent in autistic patients and increases with autistic severity. Thus, androgen levels should be assessed in autistic patients with signs of early puberty. Further studies are warranted regarding trials of anti-androgen therapy in such patients.

The health effects of eating disorders (EDs) in adolescence have been widely studied, but their impact on present adolescent psychosocial adjustment and development have been overseen. This study aimed to investigate the association between EDs and career aspirations in middle adolescence. The participants were 147 adolescents diagnosed with EDs. Participants reported on their future career aspirations, and these were coded according to the International Standard Classification of Education of 1997. Of the participants, 83 adolescents were followed up longitudinally, and their aspirations were reassessed and compared for stability across the two assessments. Moreover, participants’ career aspirations were compared to those of healthy (non-ED) best-friend controls. Health-related and social-behavioral science careers were chosen significantly more by adolescents with an ED as compared to their non-ED counterparts. For adolescents with an ED, career choices were consistent across reassessments. These findings suggest that adolescents with an ED gravitate toward careers associated with their pathology, namely, both facets of their mind-body pathology. This finding may indicate restricted identity development for adolescents with an ED. Suggestions for treatments protocols to include identity exploration are discussed.

Background: Sexual initiation in adolescence has significant health implications; identifying associated risk and protective factors is critical for context-specific evidence-based interventions. This study examined the influence of religiosity on sexual debut among in-school adolescents in Lagos State, Nigeria. Methods: Data was obtained from 1350 randomly selected in-school adolescents using a self-administered questionnaire. Internal and external religiosity, defined based on the extant literature, were the independent variables. The dependent variable was “ever had sex.” The association between religiosity and the age of sexual debut was assessed using Cox regression and controlling for relevant covariates. The hazard ratio (HR) and 95% confidence interval (CI) were calculated. Results: Of the participants, 19.8% of the females and 26.6% of the males have had sex (p<0.004). Internal religiosity was protective against sexual debut among females (HR=0.63, 95% CI=0.44–0.91), whereas external religiosity was protective among the males (HR=0.70, 95% CI=0.51–0.71). Age was positively associated with sexual debut among both male (HR=1.11, 95% CI=1.001–1.24) and female adolescents (HR=1.26, 95% CI=1.11–1.42). Early pubertal development (HR=1.11; 95% CI=1.001–1.24) was also a risk factor for male adolescent sexual initiation. In addition, knowledge of HIV/AIDS risk (HR=0.47; 95% CI=0.30–0.72) was a protective factor against sexual debut among adolescent females, whereas the positive perspective of friends’ involvement in sex (HR=1.014; 95% CI=1.21–2.58) was a risk factor. Conclusion: The protective effect of internal and external religiosity with regards to sexual debut varied by gender among Nigerian in-school adolescents; the gender differences as well as other significant factors should be taken into account in evidence-based programming to address adolescent sexual health challenges in Nigeria.

Background: Menstrual disorders are common sources of morbidity among adolescent girls and often cause anxiety for these girls and their families. Objective: This paper aims to determine the patterns of menstruation as well as the prevalence of menstrual disorders and their consequences among adolescent girls in Osogbo, South Western Nigeria. Subjects: Adolescent school girls aged 10–19 years comprised the sample. Methods: The study employed a descriptive cross-sectional design. A pre-tested, self administered, semi-structured questionnaire was used to elicit information from 402 adolescents selected from private secondary schools in the Osogbo Local Government Area (LGA) of Osun State, using a multistage sampling technique. Data were analyzed using SPSS version 15. Results: A total of 391 (97.8%) respondents had heard about menstruation before, with the three most important sources of information being their mothers (81.8%), teachers (7.4%), and peer groups (6.1%). The mean age at menarche was 12.5±1.0 years. Menstrual bleeding lasted between 2–7 days in 81.1% and cycle length lasted for 21–35 days in 81.6% of the respondents. The three most important menstrual disorders they experienced were dysmenorrhea (77.8%), menorrhagia (57.4%) and metrorrhagia (18.6%), among others. Menstrual disorders, especially dysmenorrhea, interfered with the daily activities of the respondents. Conclusion: The prevalence of menstrual disorders among adolescents in the Osogbo LGA is high. Measures should be undertaken to educate the adolescents and their mothers about menstrual disorders and to mitigate their effects on the social and academic lives of these adolescents.

The present work examines how a group of Italian parents and their adolescent children view work, study, and leisure in order to check for possible relations between the ideas of parents and their children’s. A total of 160 adolescents and 160 parents were recruited. Semi-structured interviews that assessed the participants’ concepts about work, study, and leisure were conducted. The analyses carried out demonstrate that there are connections between the parents’ and adolescents’ perceptions regarding work, study, and leisure. The results confirm the importance of considering both constructs and the parents’ perspectives on them, and of involving parents in their children vocational guidance actions.

Background: Adolescent girls have little knowledge about health information, especially about more sensitive issues. We know little about the perspectives of adolescents about their educational health needs. Objective: The aim of this study is to explore the perceptions of Iranian female adolescents about their educational health needs. Subjects: The study participants were 67 female adolescents aged 12–19 years currently in junior high and high schools in the city of Sari, located in northern Iran. Methods: The present study is a qualitative study of thematic analysis. The 67 female adolescents participated in eight focus group discussions (FGDs). The participants were selected from schools in Mazandaran, Iran. The sampling methods were purposeful sampling and a maximum variance sampling method. All tape-recorded data was fully transcribed, and thematic analysis was performed to identify key themes. Results: The findings of this research around adolescent health education needs emphasized four overarching themes, including appropriate content, suitable method, well-informed sources and an appropriate age for education. Conclusion: Our results show that the promotion of reproductive health knowledge and life skills are the most important health education needs. Education about these issues via parents, schools and health care providers could promote the health status of adolescents.

Although the vast majority of youths with an eating disorder (ED) are treated as outpatients, some require treatment in an inpatient unit. The purpose of this study was to determine the attitudes of nurses and pediatric residents towards adolescents and young adults with ED. Methods: Nursing questionnaires were distributed through a nurse manager and resident questionnaires were distributed in coordination with the chief residents. Results: A total of 82 individuals (32 nurses and 50 pediatric residents) completed the survey. Only two nurses and six residents had not worked with a patient with an ED in the previous year. The vast majority of nurses and residents recognized that fear of gaining weight, refusal to maintain body weight and, disturbed body image were frequent signs occurring in patients with an ED. Both nurses and residents believed that emotional problems, influence of friends and family, family pressure, influence of the media, and being self-induced were the most likely causes of EDs. Genetics and influence of other medical problems were deemed less likely causes. The majority of residents identified having different rules for different patients and poor communication as factors that make it difficult to take care of ED patients. More than half of all nurses and residents (58.2%) thought that ED patients were responsible for their disease “always” or “in most cases”. Residents (68.8%) were more likely than nurses (45.2%) to frequently feel frustrated with ED patients (χ 2 , p<0.0370). Conclusion: Adolescents with an ED provide a unique challenge to nurses and residents caring for them.

The purpose of this study was to examine self-reported thoughts of suicide, HIV risk behaviors and history of sexually transmitted infections (STIs) in a sample of adolescent juvenile offenders in Georgia. Participants were 2260 juvenile offenders housed at selected youth development campuses (YDCs) in the state of Georgia. Self-reported measures of suicide ideation, HIV risk, and past occurrence of STIs were collected. Significance tests were conducted using univariate logistic regressions to examine the independent associations of lifetime self-reported thoughts of suicide and dichotomized HIV risk behaviour correlates prior to incarceration. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were presented. Significant differences were observed between juveniles in several factors for increased risk, including having been previously incarcerated (p<0.04), having had more than five alcoholic drinks in the same day (p<0.007), and having performed oral sex (p<0.028). We suggest that interventions for juvenile offenders that report thoughts of suicide, and that focus on HIV risk reduction should be developed based on the consideration of targeting factors that increase risk to specific STIs.

The main objective of this study was to discover the association between the intake of certain foods and the occurrence of obesity among adolescent girls in Saudi Arabia. A cross-sectional multistage sampling method was conducted among girls aged 12–19 years in Jeddah, Saudi Arabia. The total sample was 512. Obesity was calculated based on the International Obesity Task Force standards. Findings revealed that obese girls were less likely to eat fruit, vegetables, meat, chicken and dairy products than non-obese girls, but the differences were not statistically significant. However, the risk of being obese was greater for those who consumed chocolates and sweets (odds ratio=1.57) and fast foods (odds ratio=1.35) more than three times a week. Thus, programs to promote a healthy lifestyle for schoolchildren should include appropriate intervention on changing dietary habits.

Numerous cases of self-inflicted foreign bodies in the male urethra have been reported. A case of a self-inflicted urethral injury or hemangioma in an adolescent that presented a dilemma is described here. An adolescent male of 14 years presented with a complaint of intermittent urethral bleeding for a week. He attributed this to blunt trauma sustained while playing in school. On examination, there was no sign suggestive of any trauma or any abnormal lesion on the genitalia or surrounding area. On cystourethroscopy, there was a solitary hemorrhagic lesion of 0.5 cm with a bluish base on the ventral surface of the pendular urethra, 1 cm proximal to the fossa navicularis, which was ablated using Ho:YAG laser fiber (365 μm) through a working channel mounted in an OIU (optical internal urethrotomy) sheath. The absence of any sign of external trauma or presentation after 1 week of the incident suggests an element of falseness in the history. It may be due to embarrassment or fear, which contributes to self-insertion of foreign bodies into the urethra as the primary cause, especially in adolescent males. However, the trauma can be coincidental, with the bleeding of the urethra caused by a urethral lesion like a hemangioma and might present after a long gap of 1 week due to a lack of understanding or lack of severe symptoms. Most patients of self-inflicted injuries are too ashamed to admit that they inserted any object. A psychiatric evaluation is recommended for all these adolescents, with appropriate medical therapy when indicated.

Cyclical vomiting syndrome (CVS) is a disorder that occurs mostly in children, adolescents and young adults in which episodes of nausea and vomiting occur up to six to 12 times per year. In the past decade, one specific cause of cyclical vomiting syndrome, referred to as cannabinoid hyperemesis syndrome (CHS), has been described in a subset of patients who report chronic marijuana use. Of interest, almost all of these patients report compulsive bathing in hot water as part of the syndrome. In this report, we present the case of a 20-year-old female with CHS, review the issues generally encountered in CVS and discuss the known details of CHS. This is an important syndrome that needs to be considered as a potential diagnosis when patients present with cyclical vomiting.