Parental Monitoring and Its Associations With Adolescent Sexual Risk Behavior: A Meta-analysis.

Pediatrics. 2015 Dec;136(6):e1587-99. doi: 10.1542/peds.2015-0305.

Dittus PJ, Michael SL, Becasen JS, Gloppen KM, McCarthy K, Guilamo-Ramos V.

CONTEXT: Increasingly, health care providers are using approaches targetingparents in an effort to improve adolescent sexual and reproductive health.Research is needed to elucidate areas in which providers can target adolescentsand parents effectively. Parental monitoring offers one such opportunity, givenconsistent protective associations with adolescent sexual risk behavior. However,less is known about which components of monitoring are most effective and mostsuitable for provider-initiated family-based interventions.
OBJECTIVE: We performed a meta-analysis to assess the magnitude of associationbetween parental monitoring and adolescent sexual intercourse, condom use, andcontraceptive use.
DATA SOURCES: We conducted searches of Medline, the Cumulative Index to Nursingand Allied Health Literature, PsycInfo, Cochrane, the Education ResourcesInformation Center, Social Services Abstracts, Sociological Abstracts, Proquest, and Google Scholar.
STUDY SELECTION: We selected studies published from 1984 to 2014 that werewritten in English, included adolescents, and examined relationships betweenparental monitoring and sexual behavior.

DATA EXTRACTION: We extracted effect size data to calculate pooled odds ratios(ORs) by using a mixed-effects model.

RESULTS: Higher overall monitoring (pooled OR, 0.74; 95% confidence interval[CI], 0.69-0.80), monitoring knowledge (pooled OR, 0.81; 95% CI, 0.73-0.90), and rule enforcement (pooled OR, 0.67; 95% CI, 0.59-0.75) were associated withdelayed sexual intercourse. Higher overall monitoring (pooled OR, 1.12; 95% CI,1.01-1.24) and monitoring knowledge (pooled OR, 1.14; 95% CI, 1.01-1.31) wereassociated with greater condom use. Finally, higher overall monitoring wasassociated with increased contraceptive use (pooled OR, 1.42; 95% CI, 1.09-1.86),as was monitoring knowledge (pooled OR, 2.27; 95% CI, 1.42-3.63).

LIMITATIONS: Effect sizes were not uniform across studies, and most studies were cross-sectional.
CONCLUSIONS: Provider-initiated family-based interventions focused on parentalmonitoring represent a novel mechanism for enhancing adolescent sexual andreproductive health.

Brief alcohol interventions for adolescents and young adults: a systematic review and meta-analysis.

J Subst Abuse Treat. 2015 Apr;51:1-18. doi: 10.1016/j.jsat.2014.09.001. Epub 2014

Sep 16.

Tanner-Smith EE, Lipsey MW.

This study reports findings from a meta-analysis summarizing the effectiveness of brief alcohol interventions for adolescents (age 11-18) and young adults (age 19-30). We identified 185 eligible study samples using a comprehensive literature search and synthesized findings using random-effects meta-analyses with robust standard errors. Overall, brief alcohol interventions led to significant reductions in alcohol consumption and alcohol-related problems among adolescents (g = 0.27 and g = 0.19) and young adults (g = 0.17 and g = 0.11). These effects persisted for up to 1 year after intervention and did not vary across participant demographics, intervention length, or intervention format. However, certain intervention modalities (e.g., motivational interviewing) and components (e.g., decisional balance, goal-setting exercises) were associated with larger effects. We conclude that brief alcohol interventions yield beneficial effects on alcohol-related outcomes for adolescents and young adults that are modest but potentially worthwhile given their brevity and low cost.

Primary Care Behavioral Interventions to Reduce Illicit Drug and Nonmedical Pharmaceutical Use in Children and Adolescents: U.S. Preventive Services Task Force Recommendation Statement

Acceso a texto completo

http://www.ncbi.nlm.nih.gov/pubmed/24615535?dopt=Abstract

Virginia A. Moyer, MD, MPH, on behalf of the U.S. Preventive Services Task Force*
Ann Intern Med. 2014 May 6;160(9):634-9. doi: 10.7326/M14-0334

Description: Update of the 2008 U.S. Preventive Services Task Force (USPSTF) recommendation on screening for illicit drug use.

Methods: The USPSTF reviewed the evidence on interventions to help adolescents who have never used drugs to remain abstinent and interventions to help adolescents who are using drugs but do not meet criteria for a substance use disorder to reduce or stop their use.

Population: This recommendation applies to children and adolescents younger than age 18 years who have not been diagnosed with a substance use disorder.

Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of primary care–based behavioral interventions to prevent or reduce illicit drug or nonmedical pharmaceutical use in children and adolescents. (I statement)

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The U.S. Preventive Services Task Force (USPSTF) makes recommendations about the effectiveness of specific preventive care services for patients without related signs or symptoms.

It bases its recommendations on the evidence of both the benefits and harms of the service and an assessment of the balance. The USPSTF does not consider the costs of providing a service in this assessment.

The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision making to the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms.

Validityof Brief Screening Instrument for Adolescent Tobacco, Alcohol, and Drug Use.

Kelly SM, Gryczynski J, Mitchell SG, Kirk A, O'Grady KE, Schwartz RP. Validityof Brief Screening Instrument for Adolescent Tobacco, Alcohol, and Drug Use.Pediatrics. 2014 Apr 21. [Epub ahead of print] PubMed PMID: 24753528; PubMedCentral PMCID: PMC4006430.

BACKGROUND AND OBJECTIVE: The National Institute on Alcohol Abuse and Alcoholism 
developed an alcohol screening instrument for youth based on epidemiologic data. 
This study examines the concurrent validity of this instrument, expanded to
include tobacco and drugs, among pediatric patients, as well as the acceptability
of its self-administration on an iPad.
METHODS: Five hundred and twenty-five patients (54.5% female; 92.8% African
American) aged 12 to 17 completed the Brief Screener for Tobacco, Alcohol, and
other Drugs (BSTAD) via interviewer-administration or self-administration using
an iPad. Diagnostic and Statistical Manual, Fifth Edition substance use disorders
(SUDs) were identified using a modified Composite International Diagnostic
Interview-2 Substance Abuse Module. Receiver operating characteristic curves,
sensitivities, and specificities were obtained to determine optimal cut points on
the BSTAD in relation to SUDs.
RESULTS: One hundred fifty-nine (30.3%) adolescents reported past-year use of ≥1 
substances on the BSTAD: 113 (21.5%) used alcohol, 84 (16.0%) used marijuana, and
50 (9.5%) used tobacco. Optimal cut points for past-year frequency of use items
on the BSTAD to identify SUDs were ≥6 days of tobacco use (sensitivity = 0.95;
specificity = 0.97); ≥2 days of alcohol use (sensitivity = 0.96; specificity =
0.85); and ≥2 days of marijuana use (sensitivity = 0.80; specificity = 0.93).
iPad self-administration was preferred over interviewer administration (z = 5.8; 
P < .001).
CONCLUSIONS: The BSTAD is a promising screening tool for identifying problematic 
tobacco, alcohol, and marijuana use in pediatric settings. Even low frequency of 
substance use among adolescents may indicate need for intervention.

A Systematic Review of Effective Interventions for Reducing Multiple Health Risk Behaviors in Adolescence.

Am J Public Health. 2014 Mar 13. [Epub ahead of print]

Hale DR(1), Fitzgerald-Yau N, Viner RM.

We systematically searched 9 biomedical and social science databases (1980-2012) for primary and secondary interventions that prevented or reduced 2 or more adolescent health risk behaviors (tobacco use, alcohol use, illicit drug use, risky sexual behavior, aggressive acts). We identified 44 randomized controlled trials of universal or selective interventions and were effective for multiple health risk behaviors. Most were school based, conducted in the United States, and effective for multiple forms of substance use. Effects were small, in line with findings for other universal prevention programs. In some studies, effects for more than 1 health risk behavior only emerged at long-term follow-up.

Integrated prevention programs are feasible and effective and may be more efficient than discrete prevention strategies. (Am J Public Health. Published online ahead of print March 13, 2014: e1-e23. doi:10.2105/AJPH.2014.301874).

Preventing HIV among young people: research priorities for the future.

J Acquir Immune Defic Syndr. 2013 Jul;63 Suppl 2:S155-60. doi: 10.1097/QAI.0b013e31829871fb.
Pettifor A, Bekker LG, Hosek S, DiClemente R, Rosenberg M, Bull SS, Allison S,
Delany-Moretlwe S, Kapogiannis BG, Cowan F; HIV Prevention Trials Network (HPTN) 
Adolescent Scientific Committee.

OBJECTIVE: To review the current state of knowledge on the prevention of sexual
transmission of HIV in adolescents and to highlight the existing gaps and
priority areas for future research.
BACKGROUND: A disproportionate burden of HIV infections falls on adolescents, a
developmental stage marked by unique neural, biological, and social transition.
Successful interventions are critical to prevent the spread of HIV in this
vulnerable population.
METHODS: We summarized the current state of research on HIV prevention in
adolescents by providing examples of successful interventions and best practices,
and highlighting current research gaps.
RESULTS: Adolescent interventions fall into 3 main categories: biomedical,
behavioral, and structural. The majority of current research has focused on
individual behavior change, whereas promising biomedical and structural
interventions have been largely understudied in adolescents. Combination
prevention interventions may be particularly valuable to this group.
CONCLUSIONS: Adolescents have unique needs with respect to HIV prevention, and,
thus, interventions should be designed to most effectively reach out to this
population with information and services that will be relevant to them.

PMCID: PMC3746811 [Available on 2014/7/1]
PMID: 23764629  [PubMed - indexed for MEDLINE]

Primary care-relevant interventions for tobacco use prevention and cessation in children and adolescents: a systematic evidence review for the U.S. Preventive Services Task Force.

Primary Care Interventions to Prevent Tobacco Use in Children and Adolescents, Topic Page. U.S. Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/uspstf/uspstbac.htm

The U.S. Preventive Services Task Force (USPSTF) recommendations on primary care interventions to prevent tobacco use in children and adolescents.

Current Recommendation

• The USPSTF recommends that primary care clinicians provide interventions, including education or brief counseling, to prevent initiation of tobacco use in school-aged children and adolescents.

• Grade: B Recommendation.

Release Date: August 2013

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This article was first published in:

Patnode CD, O'Connor E, Whitlock EP, Perdue LA, Soh C, Hollis J.

Ann Intern Med. 2013 Feb 19;158(4):253-60. 

BACKGROUND: Interventions to prevent smoking uptake or encourage cessation among young persons might help prevent tobacco-related illness.

PURPOSE: To review the evidence for the efficacy and harms of primary care-relevant interventions that aim to reduce tobacco use among children and adolescents.

DATA SOURCES: Three systematic reviews that collectively covered the relevant literature; MEDLINE, PsycINFO, the Cochrane Central Register of Controlled Trials, and the Database of Abstracts of Reviews of Effects through 14 September 2012; and manual searches of reference lists and gray literature.

STUDY SELECTION: Two investigators independently reviewed 2453 abstracts and 111 full-text articles. English-language trials of behavior-based or medication interventions that were relevant to primary care and reported tobacco use, health outcomes, or harms were included.

DATA EXTRACTION: One investigator abstracted data from good- and fair-quality trials into an evidence table, and a second checked these data.

DATA SYNTHESIS: 19 trials (4 good-quality and 15 fair-quality) that were designed to prevent tobacco use initiation or promote cessation (or both) and reported self-reported smoking status or harms were included. Pooled analyses from a random-effects meta-analysis suggested a 19% relative reduction (risk ratio, 0.81 [95% CI, 0.70 to 0.93]; absolute risk difference, -0.02 [CI, -0.03 to 0.00]) in smoking initiation among participants in behavior-based prevention interventions compared with control participants. Neither behavior-based nor bupropion cessation interventions improved cessation rates. Findings about the harms related to bupropion use were mixed.

LIMITATIONS: No studies reported health outcomes. Interventions and measures were heterogeneous. Most trials examined only cigarette smoking. The body of evidence was largely published 5 to 15 years ago.

CONCLUSION: Primary care-relevant interventions may prevent smoking initiation over 12 months in children and adolescents.

PMID: 23229625 [PubMed - indexed for MEDLINE]

Asymptomatic Sexually Active Adolescents and Young Adults Should Not Be Screened for Herpes Simplex Virus

Hayley D. Mark, PhD, MPH, RN

JAMA Pediatr. 2013;():1-2. doi:10.1001/jamapediatrics.2013.462.

Herpes simplex virus (HSV) types 1 and 2 are highly prevalent in the general population of the United States. The seroprevalence of HSV-2 and HSV-1 were 17% and 58%, respectively, in a cohort aged 14 to 49 years who participated in the National Health and Nutrition Examination Survey from 1999 to 2004.1 Seroprevalence is substantially less among adolescents and young adults. Approximately 80% of infected individuals are unaware of their infection and the majority of infections are transmitted by these individuals.2

Type-specific serological assays for HSV became commercially available in 1999, making possible wide-scale screening for HSV-1 and HSV-2. However, the value of HSV screening is controversial. Proponents argue that on detection, asymptomatic carriers can be counseled to use prevention methods and, thus, reduce the possibility of transmission to uninfected partners. Opponents point out the possibility that large numbers of asymptomatic individuals may receive a diagnosis of a stigmatized, chronic infection, with substantial transmission potential, but there are no substantial data to support the effectiveness of HSV screening in changing sexual behaviors or preventing transmission.

The important questions that a clinician must consider in determining the value of HSV screening among asymptomatic sexually active adolescents and young adults are derived from the Wilson and Jungner classic public health report3 on criteria for use of a screening test and include the following: (1) Is the disease an important public health problem? (2) Is an accurate screening test available and is it acceptable to the population? (3) Does screening improve health outcomes and symptoms or reduce transmission of disease? (4) Are the costs and risks of screening less than the benefits?

Cambios en la prevalencia del tabaquismo en los adolescentes en España

Villalbí, Joan R.; Suelves, Josep M.; García-Continente, Xavier; Saltó, Esteve; Ariza, Carles; Cabezas, Carmen

Publicado en Aten Primaria. 2012;44:36-42. - vol.44 núm 01

Resumen

Objetivo

Analizar la información sobre consumo de tabaco en adolescentes a partir de diversas encuestas escolares.

Diseño

Se extraen de diversos estudios los datos relativos a prevalencia de fumadores diarios al final de la escuela secundaria obligatoria por sexo, analizando tendencias.

Emplazamiento

Se revisan los 5 estudios representativos de adolescentes en España: Encuesta Estatal sobre Uso de Drogas en Estudiantes de Secundaria (ESTUDES); Estudio de Comportamientos de los Escolares Relacionados con la Salud (ECERS-HBSC); Sistema de Vigilancia de Factores de Riesgo asociados a Enfermedades No Transmisibles dirigido a población Juvenil (SIVFRENT-J); estudio de Factores de Riesgo en Estudiantes de Secundaria (FRESC); Estudio de Monitorización de las Conductas de Salud de los Adolescentes (EMCSAT).

Resultados

La prevalencia de fumadores diarios varía entre estudios, en varones entre 8,5 y 13,3% y en chicas entre 12,7 y 16,4%. Aunque se aprecian oscilaciones en algunos estudios, la tendencia entre 1993 y 2008 es de descenso. Con los datos más recientes se puede estimar un declive anual ponderado de la prevalencia de tabaquismo en la adolescencia del 6,47% anual para los varones y 6,96% para las chicas.

Conclusiones

Hay un patrón de descenso de la prevalencia de fumadores diarios adolescentes en España a partir de los diversos estudios existentes, que ofrecen datos consistentes, aunque hay que mantener la vigilancia debido a la existencia de oscilaciones. Esto concuerda con la información derivada de las ventas y de encuestas en población adulta. En cualquier caso, sería deseable que el ritmo de cambio fuera más acentuado y constante.

Palabras clave Encuestas. Adolescentes. Prevalencia. Tabaco. Valoración.

Introducción

Introducción En los últimos años se han producido avances en las políticas de control del tabaquismo en España. De forma concomitante, se ha documentado una disminución de la prevalencia en la población general, en buena parte asociada a una mayor densidad de abandonos precoces entre los fumadores¹. Al avanzar en el control del tabaquismo, es razonable que disminuya también su incidencia entre los menores, contribuyendo así al declive de la epidemia. Este proceso no está bien estudiado en España, y periódicamente trascienden a los medios de comunicación y en medios profesionales visiones contradictorias sobre la situación. El objetivo de este trabajo es analizar la evolución del tabaquismo en la población adolescente a partir de las fuentes de información existentes con carácter representativo poblacional, datos válidos y series largas para valorar los procesos de cambio en curso. Su hipótesis es que los progresos en las políticas de prevención y los cambios seculares se están traduciendo en un menor consumo de tabaco entre adolescentes. Material y métodos Se analizan los datos relativos al tabaco en la adolescencia en 5 encuestas escolares de ámbito poblacional y de aplicación sistemática y mantenida a lo largo del tiempo existentes en España, que publican datos desagregados para adolescentes, concentrando el análisis en la franja de edades de escolarización obligatoria para garantizar su representatividad²: Encuesta Estatal sobre Uso de Drogas en Estudiantes de Secundaria (ESTUDES); Estudio de Comportamientos de los Escolares Relacionados con la Salud (ECERS-HBSC); Sistema de Vigilancia de Factores de Riesgo Asociados a Enfermedades No Transmisibles dirigido a...

Composite measures quantify households' obesogenic potential and adolescents' risk behaviors.

Pediatrics. 2011 Aug;128(2):e308-16. Epub 2011 Jul 4.

Grunseit AC, Taylor AJ, Hardy LL, King L.

OBJECTIVE: The aims of this study were to generate composite measures quantifying a household's obesogenic potential and to examine the relationship of the composite variables with older children's eating, physical activity (PA), and small screen recreation.

METHODS: Data were from surveys with 1685 child-parent pairs in which the child was in grade 6, 8, or 10 (mean age: 14 years). Composite measures of the obesogenic household environment were generated from 11 measures using nonlinear  principal components analysis. Associations between the composite measures and the children's healthy and unhealthy food intake, PA, and screen time were tested (adjusting for demographic characteristics).

RESULTS: Two scales were generated: (1) obesogenic control, which clustered together factors that mitigate risk; and (2) obesogenic risk. Higher scores on the control scale were associated with higher adolescent intake of healthy foods, lower intake of unhealthy foods, higher PA, and less screen time. Higher scores on the risk scale were associated with lower adolescent intake of healthy foods,  higher intake of unhealthy foods, lower PA, and more screen time. There were significant 2-way interactions between the scales for soft drink consumption and  PA.

CONCLUSIONS: Household obesogenic potential may be quantified as 2 factors reflecting cumulative risk and control practices. These factors have both additive associations with obesogenic behaviors and, in some cases, modify each other, suggesting that a healthy home environment requires attention to both. Health promotion messages could incorporate these 2 different but interacting factors that parents can use to modify the obesogenic potential of their household.

The Association of BMI Status With Adolescent Preventive Screening

Pediatrics. 2011 Aug;128(2):e317-23. Epub 2011 Jul 18.

Jasik CB, Adams SH, Irwin CE Jr, Ozer E.

OBJECTIVE: To examine the relationship between BMI status (normal, overweight, and obese) and preventive screening among adolescents at their last checkup.

METHODS: We used population-based data from the 2003-2007 California Health Interview Surveys, telephone interviews of adolescents aged 12 to 17 years with a checkup in the past 12 months (n = 9220). Respondents were asked whether they received screening for nutrition, physical activity, and emotional distress. BMI  was calculated from self-reported height and weight: (1) normal weight or underweight (<85th percentile); (2) overweight (85th-94th percentile); and (3) obese (>95th percentile). Multivariate logistic regression models tested how screening by topic differed according to BMI status, adjusting for age, gender, income, race/ethnicity, and survey year.

RESULTS: Screening percentages in the pooled sample (all 3 years) were higher for obese, but not overweight, adolescents for physical activity (odds ratio: 1.4; P  < .01) and nutrition (odds ratio: 1.6; screening did not differ P < .01). Stratified analysis by year revealed higher screening for obese (versus normal-weight) adolescents for nutrition and physical activity in 2003 and for all 3 topics in 2005. However, by 2007, screening did not differ according to BMI status. Overall screening between 2003 and 2007 declined for nutrition (75%-59%;  P < .01), physical activity (74%-60%; P < .01), and emotional distress (31%-24%;  P < .01).

CONCLUSIONS: Obese adolescents receive more preventive screening versus their normal-weight peers. Overweight adolescents do not report more screening, but standards of care dictate increased attention for this group. These results are discouraging amid a rise in pediatric obesity and new guidelines that recommend screening by BMI status.

PMCID: PMC3146353 [Available on 2012/8/1] PMID: 21768313  [PubMed - in process]

Interventions to reduce sexual risk for human immunodeficiency virus in adolescents: a meta-analysis of trials, 1985-2008.

OBJECTIVE: To provide an updated review of the efficacy of behavioral interventions to reduce sexual risk of human immunodeficiency virus (HIV) among adolescents.
DESIGN: We searched electronic databases, leading public health journals, and the document depository held by the Synthesis of HIV/AIDS Risk Reduction Project. Studies that fulfilled the selection criteria and were available as of December 31, 2008, were included.
SETTING: Studies that investigated any behavioral intervention advocating sexual risk reduction for HIV prevention, sampled adolescents (age range, 11-19 years), measured a behavioral outcome relevant to sexual risk, and provided sufficient information to calculate effect sizes.
PARTICIPANTS: Data from 98 interventions (51,240 participants) were derived from 67 studies, dividing for qualitatively different interventions and gender when reports permitted it.
MAIN OUTCOME MEASURES: Condom use, sexual frequency, condom use skills, interpersonal communication skills, condom acquisition, and incident sexually transmitted infections (STIs).
RESULTS: Relative to controls, interventions succeeded at reducing incident STIs, increasing condom use, reducing or delaying penetrative sex, and increasing skills to negotiate safer sex and to acquire prophylactic protection. Initial risk reduction varied depending on sample and intervention characteristics but did not decay over time.
CONCLUSIONS: Comprehensive behavioral interventions reduce risky sexual behavior and prevent transmission of STIs. Interventions are most successful to the extent that they deliver intensive content.

Effects of a Brief Intervention for Reducing Violence and Alcohol Misuse Among Adolescents: A Randomized Controlled Trial [Original Contribution] Walton, M. A., Chermack, S. T., Shope, J. T., Bingham, C. R., Zimmerman, M. A., Blow, F. C., Cunningham,

Context Emergency department (ED) visits present an opportunity to deliver brief interventions to reduce violence and alcohol misuse among urban adolescents at risk of future injury.

Objective To determine the efficacy of brief interventions addressing violence and alcohol use among adolescents presenting to an urban ED.

Design, Setting, and Participants Between September 2006 and September 2009, 3338 patients aged 14 to 18 years presenting to a level I ED in Flint, Michigan, between 12 pm and 11 pm 7 days a week completed a computerized survey (43.5% male; 55.9% African American). Adolescents reporting past-year alcohol use and aggression were enrolled in a randomized controlled trial (SafERteens).

Intervention All patients underwent a computerized baseline assessment and were randomized to a control group that received a brochure (n = 235) or a 35-minute brief intervention delivered by either a computer (n = 237) or therapist (n = 254) in the ED, with follow-up assessments at 3 and 6 months. Combining motivational interviewing with skills training, the brief intervention for violence and alcohol included review of goals, tailored feedback, decisional balance exercise, role plays, and referrals.

Main Outcome Measures Self-report measures included peer aggression and violence, violence consequences, alcohol use, binge drinking, and alcohol consequences.

Results About 25% (n = 829) of screened patients had positive results for both alcohol and violence; 726 were randomized. Compared with controls, participants in the therapist intervention showed self-reported reductions in the occurrence of peer aggression (therapist, –34.3%; control, –16.4%; relative risk [RR], 0.74; 95% confidence interval [CI], 0.61-0.90), experience of peer violence (therapist, –10.4%; control, +4.7%; RR, 0.70; 95% CI, 0.52-0.95), and violence consequences (therapist, –30.4%; control, –13.0%; RR, 0.76; 95% CI, 0.64-0.90) at 3 months. At 6 months, participants in the therapist intervention showed self-reported reductions in alcohol consequences (therapist, –32.2%; control, –17.7%; odds ratio, 0.56; 95% CI, 0.34-0.91) compared with controls; participants in the computer intervention also showed self-reported reductions in alcohol consequences (computer, –29.1%; control, –17.7%; odds ratio, 0.57; 95% CI, 0.34-0.95).

Conclusion Among adolescents identified in the ED with self-reported alcohol use and aggression, a brief intervention resulted in a decrease in the prevalence of self-reported aggression and alcohol consequences.

Trial Registration clinicaltrials.gov Identifier: NCT00251212

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Screening for Obesity in Children and Adolescents: US Preventive Services Task Force Recommendation Statement

Screening for Obesity in Children and Adolescents: US Preventive Services Task Force Recommendation Statement
US Preventive Services Task Force.
Pediatrics published online Jan 18, 2010;DOI: 10.1542/peds.2009-2037

DESCRIPTION: Update of the 2005 US Preventive Services Task Force
(USPSTF) statement about screening for overweight in children and
adolescents.
METHODS: The USPSTF examined the evidence for the effectiveness of
interventions that are primary care feasible or referable. It also examined
the evidence for the magnitude of potential harms of treatment in
children and adolescents.
RECOMMENDATION. The USPSTF recommends that clinicians screen
children aged 6 years and older for obesity and offer them or refer
them to intensive counseling and behavioral interventions to promote
improvements in weight status (grade B recommendation).

A school-based program to prevent adolescent dating violence: a cluster randomized trial

A school-based program to prevent adolescent dating violence: a cluster randomized trial.Wolfe DA, Crooks C, Jaffe P, et al. Arch Pediatr Adolesc Med. 2009 Aug;163(8):692-9.
OBJECTIVE: To determine whether an interactive curriculum that integrates dating violence prevention with lessons on healthy relationships, sexual health, and substance use reduces physical dating violence (PDV). DESIGN: Cluster randomized trial with 2.5-year follow-up; prespecified subgroup analyses by sex. SETTING: Grade 9 health classes. PARTICIPANTS: A total of 1722 students aged 14-15 from 20 public schools (52.8% girls). Intervention A 21-lesson curriculum delivered during 28 hours by teachers with additional training in the dynamics of dating violence and healthy relationships. Dating violence prevention was integrated with core lessons about healthy relationships, sexual health, and substance use prevention using interactive exercises. Relationship skills to promote safer decision making with peers and dating partners were emphasized. Control schools targeted similar objectives without training or materials. MAIN OUTCOME MEASURES: The primary outcome at 2.5 years was self-reported PDV during the previous year. Secondary outcomes were physical peer violence, substance use, and condom use. Analysis was by intention-to-treat.
RESULTS: The PDV was greater in control vs intervention students (9.8% vs 7.4%; adjusted odds ratio, 2.42; 95% confidence interval, 1.00-6.02; P = .05). A significant group x sex interaction effect indicated that the intervention effect was greater in boys (PDV: 7.1% in controls vs 2.7% in intervention students) than in girls (12.1% vs 11.9%). Main effects for secondary outcomes were not statistically significant; however, sex x group analyses showed a significant difference in condom use in sexually active boys who received the intervention (114 of 168; 67.9%) vs controls (65 of 111 [58.6%]) (P < .01). The cost of training and materials averaged CA$16 per student.
CONCLUSION: The teaching of youths about healthy relationships as part of their required health curriculum reduced PDV and increased condom use 2.5 years later at a low per-student cost.

Natural History of Genital Warts: Analysis of the Placebo Arm of 2 Randomized Phase III Trials of a Quadrivalent Human Papillomavirus (Types 6, 11, 16

Garland SM, Steben M, Sings HL, et al. Natural History of Genital Warts: Analysis of the Placebo Arm of 2 Randomized Phase III Trials of a Quadrivalent Human Papillomavirus (Types 6, 11, 16, and 18) Vaccine. J Infect Dis. 2009 Jan 2

Background. The placebo arm of human papillomavirus (HPV) vaccine trials helps define the natural history of genital warts (GW). Methods. Women enrolled in the placebo arm ([Formula: see text]) of 2 randomized trials of a quadrivalent vaccine were examined for the presence of GW for up to 9 visits over approximately 4 years. A comprehensive examination of the perianal area, vulva, and vagina prompted biopsy. Biopsy samples were analyzed by a blinded panel of up to 4 histopathologists and tested for 14 HPV genotypes (6, 11, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, and 59) by use of a polymerase chain reaction-based assay. Risk factors for the development of GW were assessed. Results. Women were followed up for an average of 3.6 years (range, 0-4.9 years). Overall, 298 (3.4%) of 8800 participants developed GW related to HPV-6 or HPV-11 (incidence rate, 0.87 cases per 100 person-years-at-risk). In total, 520 distinct lesions were diagnosed as GW. HPV DNA was detected in 472 (90.8%) lesions, with HPV-6 and HPV-11 detected in 447 (86.0%) of these lesions (94.7% of 472 HPV DNA-positive lesions). We found high-risk HPV types in 161 (31.0%) of 520 lesions. Risk factors for HPV-6- and HPV-11-related GW included infection at baseline, acquisition of new sex partners, a higher number of sex partners, and DNA positivity at baseline for a high-risk HPV type. Conclusions. We confirm the major role played by HPV-6 and HPV-11 in GW, as well as associated risk factors. A vaccine that includes these types of HPV could substantially reduce the overall burden of HPV disease.

Behavioral counseling to prevent sexually transmitted infections: U.S. PreventiveServices Task Force recommendation statement.

U.S. Preventive Services Task Force.
Collaborators: Calonge N, Petitti DB, DeWitt TG, Dietrich AJ, Gordis L, GregoryKD, Harris R, Isham G, Leipzig R, LeFevre ML, Loveland-Cherry C, Marion LN, MoyerVA, Ockene JK, Sawaya GF, Yawn BP.

Ann Intern Med. 2008 Oct 7;149(7):491-6, W95.

DESCRIPTION: New U.S. Preventive Services Task Force (USPSTF) recommendations about behavioral counseling of adolescents and adults to prevent sexuallytransmitted infections (STIs).
METHODS: The USPSTF reviewed the evidence on the benefits and harms of counseling. The review included studies evaluating behavioral counseling interventions conducted in primary settings, those judged feasible in primary care, and those to which patients might be referred from primary care.
RECOMMENDATIONS: The USPSTF recommends high-intensity behavioral counseling for all sexually active adolescents and for adults at increased risk for STIs. (B recommendation) Current evidence is insufficient to assess the balance of benefits and harms of behavioral counseling to prevent STIs in non-sexually active adolescents and in adults not at increased risk for STIs. (I statement).

Body mass index in adolescence in relation to cause-specific mortality: a follow-up of 230,000 Norwegian adolescents

Bjorge T, et al. Body mass index in adolescence in relation to cause-specific mortality: a follow-up of 230,000 Norwegian adolescents. Am J Epidemiol. 2008 Jul 1;168(1):30-7

Abstract

The prevalence of obesity in childhood and adolescence has increased worldwide. Long-term effects of adolescent obesity on cause-specific mortality are not well specified. The authors studied 227,000 adolescents (aged 14-19 years) measured (height and weight) in Norwegian health surveys in 1963-1975. During follow-up (8 million person-years), 9,650 deaths were observed. Cox proportional hazards regression was used to compare cause-specific mortality among individuals whose baseline body mass index (BMI) was below the 25th percentile, between the 75th and 84th percentiles, and above the 85th percentile in a US reference population with that of individuals whose BMI was between the 25th and 75th percentiles. Risk of death from endocrine, nutritional, and metabolic diseases and from circulatory system diseases was increased in the two highest BMI categories for both sexes. Relative risks of ischemic heart disease death were 2.9 (95% confidence interval (CI): 2.3, 3.6) for males and 3.7 (95% CI: 2.3, 5.7) for females in the highest BMI category compared with the reference. There was also an increased risk of death from colon cancer (males: 2.1, 95% CI: 1.1, 4.1; females: 2.0, 95% CI: 1.2, 3.5), respiratory system diseases (males: 2.7, 95% CI: 1.4, 5.2; females: 2.5, 95% CI: 1.4, 4.8), and sudden death (males: 2.2, 95% CI: 1.2, 4.3; females: 2.7, 95% CI: 1.1, 6.6). Adolescent obesity was related to increased mortality in middle age from several important causes.
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Pues eso, que los gorditos adolescentes mueren más en los años medios de la vida adulta... si son noruegos ;-)

Abstinence education has no effect on US teenagers' sexual activity.

Tanne JH.
BMJ. 2007 Apr 28;334(7599):867.

Although the United States spends about $88m (£44m; 65m) a year teaching teenagers to abstain from sex outside marriage, young people in the programmes are just as likely to have sex as those who don't receive counselling, a new study says.
Teenagers who received abstinence education did not delay sexual activity any longer than those in a control group. When they became sexually active they had the same number of partners and were as likely to use condoms or other contraceptives as those who had not been counselled.
This rigorous, well designed study adds to and confirms previous research findings that abstinence only education programmes are ineffective and a waste of taxpayer dollars. It is called for more comprehensive programmes that not only teach abstinence but also provide information on contraception and safe sex.

Youth and Road Safety, report published by the World Health Organization (WHO).

Road traffic crashes are the leading cause of death among young people between 10 and 24 years, according to a new report published by the World Health Organization (WHO). The report, Youth and Road Safetysays that nearly 400 000 young people under the age of 25 are killed in road traffic crashes every year. Millions more are injured or disabled.

http://whqlibdoc.who.int/publications/2007/9241594640_eng.pdf

http://whqlibdoc.who.int/publications/2007/9241595116_eng.pdf