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Objective knowledge, perceived knowledge, and condom use among adolescent males
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NASPAG 18th Annual Clinical Meeting
threshold effect for the relationship between activities with the highest mechanical strain and bone mineral density. Last, as seen in this urban adolescent population, future research on activities and bone mineral density need to assess the activities salient to the population.
Tampon-Related Toxic Shock Syndrome (TSS) Continues to Peak Among Adolescent Girls: A Nationwide Hospital Study Roselie A. Bright, ScD, and Judith U. Cope, MD, MPH Center for Devices and Radiological Health, Food and Drug Administration, Rockville, MD
Background: Despite the removal of certain brands of tampons from the market, tampon-related TSS may still lead to lengthy hospitalization and morbidity for adolescent girls. Importantly TSS may be confused with other acute illnesses. Because of increasing reports to the FDA and no active surveillance plan in place we further investigated national rates of TSS hospitalizations among adolescent girls. Methods: Data from the Healthcare Cost and Utilization Project (HCUP), collected by the US Agency for Healthcare Research and Quality, were used for these analyses. The HCUP Nationwide Inpatient Sample (NIS), years 1996–2001, was obtained for ages 10–19, 20–39, and 40–59. Tampon-related TSS was computed as the age-specific rate in females minus the agespecific rate in males. Weighted national estimates for each sex-specific age group were calculated by month of the year and by year. The HCUP Kids’ Inpatient Database (KID), 1997, was divided into ages 0–4, 5–9, 10–14, and 15–18 years. Numbers of TSS cases were compared by sex-specific age group. Results: The highest national annual number of tampon-related TSS hospitalizations was for 10–19 year olds, averaging 197 during the years 1996–2001. By contrast, the national average annual number of TSS hospitalization for boys age 10–19 was 76, of tamponrelated TSS hospitalizations for 20–39 year old women was 278, and of tampon-related TSS hospitalizations for 40–59 year old women was 94. TSS death rates were lowest for teens. Teen girls demonstrated a unique pattern of elevated rates during the school months. The KID data showed that TSS peaked for girls age 15–18. Below age 10 similar numbers of TSS occurred for boys and girls. The greatest numbers of TSS cases were among older adolescent females with nearly half of all female TSS cases occurring between 15 to 18 years of age.
Conclusion: These data highlight the need for health care providers to consider tampon-related TSS in the differential diagnosis of acute flu-like illness among teenage girls. Although our data suggest rates of tampon-related TSS are low, they indicate this problem has not gone away. While hospital discharge data does not establish a tampon link with TSS among adolescent females, it highlights the need for more active surveillance and an update of our understanding of this disease. Increased awareness of TSS and related conditions should be further defined for subpopulations of adolescent girls who may be at higher risk.
Objective Knowledge, Perceived Knowledge, and Condom Use Among Adolescent Males Ellen M. Rock, MD, Marjorie Ireland, Ph.D, Michael D. Resnick, Ph.D, and Clea A. McNeely, Dr.PH Division of General Pediatrics and Adolescent Health, University of Minnesota, Minneapolis, MN
Background: The role of knowledge as a protective antecedent to sexual behavior is questionable, perhaps because studies have focused only on objective knowledge. We examined the functions that both objective and perceived knowledge about condoms play in male adolescents’ condom use at first intercourse. Methods: A secondary analysis of Waves 1 and 2 of the National Longitudinal Study of Adolescent Health was undertaken. The sample included 404 adolescent males who were virgins at Wave 1 but reported being sexually experienced at Wave 2. The relationship between objective and perceived knowledge was determined using Pearson correlations. Bivariate and multivariate relationships between the knowledge variables and report of condom use at first intercourse were then examined using Student’s t-tests and multivariate logistic regression. Participants were dichotomized into high or low levels of objective and perceived knowledge; four categories were created to examine the role of discordance between knowledge domains in predicting condom use, using serial chisquare tests and multivariate logistic regression. Results: The correlation between the objective and knowledge variables was moderate (r ⫽ 0.43). Multivariate analysis revealed that higher objective knowledge and lower perceived knowledge significantly predicted condom use at first intercourse (OR ⫽ 1.48, p ⬍ 0.001, OR ⫽ 0.6, p ⫽ 0.01 respectively). Bivariate testing among the 4 groups revealed that those with
NASPAG 18th Annual Clinical Meeting
low objective but high perceived knowledge were significantly less likely to use a condom at first intercourse compared to each of the three other groups, who did not differ from each other in their report of condom use. Multivariate analysis confirmed that those with low objective but high perceived knowledge were significantly less likely to report using a condom at first intercourse (OR 0.35, p ⫽ 0.03). Conclusions: Both objective and perceived knowledge about condoms serve as antecedents to male condom use at first intercourse. However, those who believe themselves to be knowledgeable about condoms, particularly in the context of low objective knowledge, may be at greater risk of not using condoms. Addressing not only objective, but also perceived knowledge may increase the effectiveness of individual providers and programs that seek to increase rates of condom use among adolescent males.
Revisiting the IUCD in Adolescents Alina Toma, BA, and Mary Anne Jamieson, MD Queen’s University, Kingston, Ontario, Canada
Background: Intrauterine contraceptive devices (IUCDs) are commonly believed not to be appropriate for use in adolescents due to the perceived risk of pelvic inflammatory disease and future infertility. The purpose of this study was to report our experience with the IUCD in a group of properly counseled adolescents who had accepted this method of birth control in order to determine whether traditional hesitation should be reconsidered. Methods: Twenty eight patients, 21 years of age and under, who had an IUCD inserted between April 1999 and March 2003 at a single Canadian University teaching hospital supervised by a single adolescent gynecologist were identified using medical records and chart review. Patients were contacted by mail to inform them of the study and subsequently telephoned to be interviewed. Eight patients were lost to follow-up. Analysis used descriptive statistics and Chi-square calculations. Results: The average age at insertion was 18.7 years, the average time of use was 19.6 months and the average number of pregnancies prior to IUCD insertion was 1.4. Two patients used a levonorgestrel intrauterine system (LIUS) and the remainder used copper IUCDs. All but one patient had attempted at least one other method of contraception prior to IUCD insertion. There were two IUCD expulsions and five patients had their IUCD replaced. Seven patients (35%) had
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discontinued use of their IUCD at the time of the interview, with an average of 13.4 months between the time of insertion and removal. The most common reason for removal was increased bleeding but other reasons included partner dissatisfaction, pain, crampier periods and infection. The diagnosis of infection was eventually ruled out in both cases where it was factor for removal. The most common side effect as reported by patients was increased cramping but other side effects attributed by users to the IUCD included heavier periods, infection, pain, indigestion, and nuisance bleeding. Six users (30%) experienced no side effects. Although there were no pregnancies during IUCD use, three patients had a repeat pregnancy after the IUCD was removed. Eighty-five percent of users were either somewhat satisfied, satisfied or very satisfied with the IUCD. Conclusions: IUCDs are suitable and well-tolerated by well-selected adolescents who require an easy and effective long-term method of birth control. The LIUS may have a role in patients who experience intolerable increased flow and cramps associated with copper IUCDs. Consistent follow-up following insertion is an important factor in ensuring continued use and therefore preventing future unplanned pregnancies. In conclusion, this small yet novel case series serves as an encouraging start from which future investigations may proceed.
Why Lightening Strikes Twice Lisa Kelly, PA, Jeanelle Sheeder, MSPH, Stephen Scott, MD, and Catherine Stevens-Simon, MD Departments of Pediatrics and Obstetrics & Gynecology; University of Colorado Health Sciences Center, Denver, Colorado
Purpose: New teen mothers usually state that they don’t want to become pregnant again “any time soon”. Preventing rapid repeat teen pregnancies should be an easy task, particularly in comprehensive adolescentoriented maternity programs that provide intensive preand postnatal contraceptive and career counseling and access to the supplies and services needed to postpone childbearing. We studied the resumption of sexual activity during the postpartum period (defined as 3 months after delivery) as insights into factors associated with unprotected sexual intercourse during this period may be particularly helpful in developing targeted interventions. Methods: A consecutively delivered, racially and ethnically diverse group of 129, 14 to 22 year old participants in an adolescent-oriented maternity program was studied. All participants stated they wanted to remain non-pregnant for at least 2 years and understood
NASPAG 18th Annual Clinical Meeting
threshold effect for the relationship between activities with the highest mechanical strain and bone mineral density. Last, as seen in this urban adolescent population, future research on activities and bone mineral density need to assess the activities salient to the population.
Tampon-Related Toxic Shock Syndrome (TSS) Continues to Peak Among Adolescent Girls: A Nationwide Hospital Study Roselie A. Bright, ScD, and Judith U. Cope, MD, MPH Center for Devices and Radiological Health, Food and Drug Administration, Rockville, MD
Background: Despite the removal of certain brands of tampons from the market, tampon-related TSS may still lead to lengthy hospitalization and morbidity for adolescent girls. Importantly TSS may be confused with other acute illnesses. Because of increasing reports to the FDA and no active surveillance plan in place we further investigated national rates of TSS hospitalizations among adolescent girls. Methods: Data from the Healthcare Cost and Utilization Project (HCUP), collected by the US Agency for Healthcare Research and Quality, were used for these analyses. The HCUP Nationwide Inpatient Sample (NIS), years 1996–2001, was obtained for ages 10–19, 20–39, and 40–59. Tampon-related TSS was computed as the age-specific rate in females minus the agespecific rate in males. Weighted national estimates for each sex-specific age group were calculated by month of the year and by year. The HCUP Kids’ Inpatient Database (KID), 1997, was divided into ages 0–4, 5–9, 10–14, and 15–18 years. Numbers of TSS cases were compared by sex-specific age group. Results: The highest national annual number of tampon-related TSS hospitalizations was for 10–19 year olds, averaging 197 during the years 1996–2001. By contrast, the national average annual number of TSS hospitalization for boys age 10–19 was 76, of tamponrelated TSS hospitalizations for 20–39 year old women was 278, and of tampon-related TSS hospitalizations for 40–59 year old women was 94. TSS death rates were lowest for teens. Teen girls demonstrated a unique pattern of elevated rates during the school months. The KID data showed that TSS peaked for girls age 15–18. Below age 10 similar numbers of TSS occurred for boys and girls. The greatest numbers of TSS cases were among older adolescent females with nearly half of all female TSS cases occurring between 15 to 18 years of age.
Conclusion: These data highlight the need for health care providers to consider tampon-related TSS in the differential diagnosis of acute flu-like illness among teenage girls. Although our data suggest rates of tampon-related TSS are low, they indicate this problem has not gone away. While hospital discharge data does not establish a tampon link with TSS among adolescent females, it highlights the need for more active surveillance and an update of our understanding of this disease. Increased awareness of TSS and related conditions should be further defined for subpopulations of adolescent girls who may be at higher risk.
Objective Knowledge, Perceived Knowledge, and Condom Use Among Adolescent Males Ellen M. Rock, MD, Marjorie Ireland, Ph.D, Michael D. Resnick, Ph.D, and Clea A. McNeely, Dr.PH Division of General Pediatrics and Adolescent Health, University of Minnesota, Minneapolis, MN
Background: The role of knowledge as a protective antecedent to sexual behavior is questionable, perhaps because studies have focused only on objective knowledge. We examined the functions that both objective and perceived knowledge about condoms play in male adolescents’ condom use at first intercourse. Methods: A secondary analysis of Waves 1 and 2 of the National Longitudinal Study of Adolescent Health was undertaken. The sample included 404 adolescent males who were virgins at Wave 1 but reported being sexually experienced at Wave 2. The relationship between objective and perceived knowledge was determined using Pearson correlations. Bivariate and multivariate relationships between the knowledge variables and report of condom use at first intercourse were then examined using Student’s t-tests and multivariate logistic regression. Participants were dichotomized into high or low levels of objective and perceived knowledge; four categories were created to examine the role of discordance between knowledge domains in predicting condom use, using serial chisquare tests and multivariate logistic regression. Results: The correlation between the objective and knowledge variables was moderate (r ⫽ 0.43). Multivariate analysis revealed that higher objective knowledge and lower perceived knowledge significantly predicted condom use at first intercourse (OR ⫽ 1.48, p ⬍ 0.001, OR ⫽ 0.6, p ⫽ 0.01 respectively). Bivariate testing among the 4 groups revealed that those with
NASPAG 18th Annual Clinical Meeting
low objective but high perceived knowledge were significantly less likely to use a condom at first intercourse compared to each of the three other groups, who did not differ from each other in their report of condom use. Multivariate analysis confirmed that those with low objective but high perceived knowledge were significantly less likely to report using a condom at first intercourse (OR 0.35, p ⫽ 0.03). Conclusions: Both objective and perceived knowledge about condoms serve as antecedents to male condom use at first intercourse. However, those who believe themselves to be knowledgeable about condoms, particularly in the context of low objective knowledge, may be at greater risk of not using condoms. Addressing not only objective, but also perceived knowledge may increase the effectiveness of individual providers and programs that seek to increase rates of condom use among adolescent males.
Revisiting the IUCD in Adolescents Alina Toma, BA, and Mary Anne Jamieson, MD Queen’s University, Kingston, Ontario, Canada
Background: Intrauterine contraceptive devices (IUCDs) are commonly believed not to be appropriate for use in adolescents due to the perceived risk of pelvic inflammatory disease and future infertility. The purpose of this study was to report our experience with the IUCD in a group of properly counseled adolescents who had accepted this method of birth control in order to determine whether traditional hesitation should be reconsidered. Methods: Twenty eight patients, 21 years of age and under, who had an IUCD inserted between April 1999 and March 2003 at a single Canadian University teaching hospital supervised by a single adolescent gynecologist were identified using medical records and chart review. Patients were contacted by mail to inform them of the study and subsequently telephoned to be interviewed. Eight patients were lost to follow-up. Analysis used descriptive statistics and Chi-square calculations. Results: The average age at insertion was 18.7 years, the average time of use was 19.6 months and the average number of pregnancies prior to IUCD insertion was 1.4. Two patients used a levonorgestrel intrauterine system (LIUS) and the remainder used copper IUCDs. All but one patient had attempted at least one other method of contraception prior to IUCD insertion. There were two IUCD expulsions and five patients had their IUCD replaced. Seven patients (35%) had
223
discontinued use of their IUCD at the time of the interview, with an average of 13.4 months between the time of insertion and removal. The most common reason for removal was increased bleeding but other reasons included partner dissatisfaction, pain, crampier periods and infection. The diagnosis of infection was eventually ruled out in both cases where it was factor for removal. The most common side effect as reported by patients was increased cramping but other side effects attributed by users to the IUCD included heavier periods, infection, pain, indigestion, and nuisance bleeding. Six users (30%) experienced no side effects. Although there were no pregnancies during IUCD use, three patients had a repeat pregnancy after the IUCD was removed. Eighty-five percent of users were either somewhat satisfied, satisfied or very satisfied with the IUCD. Conclusions: IUCDs are suitable and well-tolerated by well-selected adolescents who require an easy and effective long-term method of birth control. The LIUS may have a role in patients who experience intolerable increased flow and cramps associated with copper IUCDs. Consistent follow-up following insertion is an important factor in ensuring continued use and therefore preventing future unplanned pregnancies. In conclusion, this small yet novel case series serves as an encouraging start from which future investigations may proceed.
Why Lightening Strikes Twice Lisa Kelly, PA, Jeanelle Sheeder, MSPH, Stephen Scott, MD, and Catherine Stevens-Simon, MD Departments of Pediatrics and Obstetrics & Gynecology; University of Colorado Health Sciences Center, Denver, Colorado
Purpose: New teen mothers usually state that they don’t want to become pregnant again “any time soon”. Preventing rapid repeat teen pregnancies should be an easy task, particularly in comprehensive adolescentoriented maternity programs that provide intensive preand postnatal contraceptive and career counseling and access to the supplies and services needed to postpone childbearing. We studied the resumption of sexual activity during the postpartum period (defined as 3 months after delivery) as insights into factors associated with unprotected sexual intercourse during this period may be particularly helpful in developing targeted interventions. Methods: A consecutively delivered, racially and ethnically diverse group of 129, 14 to 22 year old participants in an adolescent-oriented maternity program was studied. All participants stated they wanted to remain non-pregnant for at least 2 years and understood