Dating Violence Affects All Adolescents

quent contraceptive use: A prospective analysis of nonpregnant African American females. Am J Obstet Gynecol 2002;186:251–2. Many clinicians assume that adolescents want to avoid pregnancy, yet there is increasing evidence that this is not always the case. Even less well understood is how emotions and motivations affect contraceptive behaviors. This prospective study examined the relationships between desire for pregnancy and contraceptive use in 14- to 18-year-old, sexually active, non-pregnant, African American adolescents. Questionnaires and interviews were administered on two occasions, 6 months apart, to assess desire for pregnancy and contraceptive and condom use. After excluding adolescents who had positive pregnancy tests at baseline or follow-up and those who did not return for follow-up, the sample included 375 adolescent females from low-income sites in Birmingham Alabama, a community with high rates of teen pregnancy. Ambivalence was defined as any response other than “not at all” on a five-point visual analog scale assessing the current desire for pregnancy. Twenty-two percent of the participants were ambivalent about pregnancy at baseline. The adolescents with ambivalence were more likely to have had at least one episode of recent sexual intercourse without using a condom or contraceptive and were less likely to be using hormonal contraception. Of the behaviors assessed, the only statistically significant finding was not using contraception during the last sexual encounter (59.7% among those with ambivalence versus 29.4% for those not desiring pregnancy, 95% CI 2.22– 6.20). It makes sense that adolescents who aren’t certain they want to avoid pregnancy would not be consistent in using contraception. However, these young women are frequently risking not only pregnancy, but also sexually transmitted infections. Although this study is limited by the homogenous sample and self-report study techniques used, its findings are important and warrant further study. For now, perhaps providers should begin by assessing sexually active adolescents’ desire for pregnancy. Assuming pregnancy is undesirable may be incorrect, and care can be enhanced by recognition that ambivalence about pregnancy may play a role in contraceptive and safer sex behaviors. DATING VIOLENCE AFFECTS ALL ADOLESCENTS Freedner N, Freed LH, Yang W, Austin SB. Dating violence among gay, lesbian, and bisexual adolescents: Results from a community survey. J Adolesc Health 2002;31:469 –74. This recent study is novel in its focus on dating violence among homosexual and bisexual adolescents. The analysis included 521 surveys completed by adolescents attending a rally advocating the rights of gay, lesbian, bisexual, and transgender youth. The study looked at five types of abuse— control, emotional, scared for safety, physical, and sexual— and found that at least one form of abuse had been experienced by 37.1% of the female respondents and 41.5% of the male Journal of Midwifery & Women’s Health • www.jmwh.org

respondents. Bisexual respondents were more likely to have a history of abuse than gay or lesbian participants. Although further research is needed to corroborate the results of this small study, the findings indicate that intimate partner violence is not uncommon among gay, lesbian, and bisexual adolescents. At the very least, this study is a reminder that intimate partner violence is not a problem exclusive to heterosexual relationships. TATTOOS AND BODY PIERCINGS: MARKS AND MARKERS? Carroll ST, Riffenburgh RH, Roberts TA, Myhre EB. Tattoos and body piercings as indicators of adolescent risk-taking behaviors. Pediatrics 2002;109:1021–7. Roberts TA, Ryan SA. Tattooing and high-risk behavior in adolescents. Pediatrics 2002;110:1058 – 63. Tattoos and body piercings (i.e., excluding the earlobes) are increasingly common. To date, reports in the health care literature have focused on the medical risks and complications (e.g., infections) of these procedures. Two recent studies have examined whether adolescents with body piercings and tattoos engage in more high-risk behaviors than their peers without these body modifications. Carroll et al. surveyed 484 young people between the ages of 12 and 22 who presented to an adolescent clinic for dependents of military personnel. The questionnaire asked about tattoos and body piercings and used 45 items from the CDC’s Youth Risk Behavior Survey to construct indices for assessment of the following risk-taking behaviors: eating disorders, drug use, violence, sexual behavior, and suicidal ideation/attempts. Of those surveyed, 13.2% reported a tattoo and 26.9% reported body piercings. Both procedures were more common in females than males. Significantly greater risk or degrees of involvement were found for every risk-taking behavior except violence among those with at least one tattoo or body piercing. Roberts and Ryan conducted a secondary analysis of the National Longitudinal Study of Adolescent Health, which was conducted by surveying a nationally representative sample of 11 to 21 year olds in 1995 and 1996. Significant associations were found between the presence of a permanent tattoo and the four high-risk behaviors examined: sexual involvement, substance use, violent behavior, and school problems. Together, these studies indicate there is an association between tattoos and body piercings and high-risk behaviors. This does not mean that an adolescent with either of these body adornments necessarily engages in high-risk activity nor does it mean that the adolescent who has had neither procedure is risk-free. It simply means that the clinician should consider not only medical but also behavioral risks when a tattoo or body piercing is reported in the history or found on examination. REFERENCE 1. Coleman L, Coleman J. The measurement of puberty: A review. J Adolesc 2002;25:535–50.

235