Adolescent Medicine Clinic Research Articles

Menstrual bleeding patterns in adolescents using etonogestrel (ENG) implant

Etonogestrel (ENG) implant is an effective method of contraception. The implant is designed to provide contraceptive efficacy for 3 years with a relatively quick return of fertility upon its removal. Menstrual irregularities are not uncommon on long-acting progestins and can often be the factor for discontinuation or removal. A retrospective chart analysis was done on 58 patients who chose to be on the ENG implant. Age ranged from 12 to 24 years. The cycle ranged from 1 to 17 months. The mean length of use of the implant was 10.9 months. Over the 20-month period, 13 ENG implants were removed because of menstrual bleeding problems. We conducted a chart review of the adolescent patients who received the ENG implant in our adolescent clinic. An analysis was done based on symptoms experienced by patients who were on the ENG implant and their management, which in some cases resulted in its removal. The data is presented on adolescent and young adult patients who receive their reproductive care in the Adolescent Medicine Clinic at the University of Kentucky, Lexington, KY, USA. ENG implant when used correctly and as indicated is extremely effective in providing contraception for up to 3 years. However, menstrual irregularities can be very troublesome and often a reason for its removal. In our experience, 22.4% (13 out of the 58 subjects) had menstrual problems post-insertion that led to its removal. It is crucial for a clinician to inform and be informed about such side effects.

How Physicians Test: Clinical Practice Guidelines and HIV Screening Practices with Adolescent Patients

The aim of this study is to examine how physicians use clinical practice guidelines that call for routine HIV screening in a general adolescent medicine clinic and to determine how adolescent patients respond to routine screening. Physicians offered screening to 116 of 217 patients (53%) aged 13-21 who completed a survey. Physicians' offers conformed to the latest Centers for Disease Control and Prevention (CDC) guidelines with 73% of patients because some patients not offered a test had been screened within the last year. Physicians were three times more likely (OR = 3.0; 95% CI = 1.3-6.8) to offer HIV screening to sexually active adolescents than to adolescents who reported no sexual history. Adolescent medicine physicians and their patients endorse the idea of routine screening as embodied in the latest CDC recommendations, but adolescents with no sexual history are less likely than other adolescents to accept screening when it is offered and to support a clinic policy of routine screening. Both physicians and their adolescent patients continue to test based on risk assessments.

Attitudes and Perceptions of the HPV Vaccine in Caribbean and African-American Adolescent Girls and their Parents

Objective To describe attitudes and perceptions toward acceptability of human papilloma virus (HPV) vaccination among inner city Caribbean (CA) and African American (AA) adolescents and their parents, and discuss correlates that may be associated with these factors. Design Questionnaire survey. Setting An adolescent medicine clinic. Participants A convenience sample was recruited of 175 adolescent girls aged 13 to 19 years and 74 parents attending adolescent clinic. Intervention Participants completed an anonymous confidential 10-minute questionnaire. Main outcome Measures Data on knowledge about HPV, cervical cancer (CC), attitudes and acceptance of the HPV vaccine. Results Responses of 175 adolescent girls and 74 parents were analyzed. Overall, 48.9% of the teens were sexually active (SA) and had a 2.2-fold greater odds (OR = 2.21; 95% CI = 1.13–4.36) of being interested in HPV vaccination versus girls who were not SA. While only 55.8% of girls knew what HPV is, this knowledge was significantly associated with knowing that most CC is caused by HPV ( P < 0.001) and with interest in receiving HPV vaccination ( P < 0.001). Less than half (44.5%) of adolescent girls were interested in receiving the HPV vaccine and only 37.5% of parents. There were no significant influences in parental acceptance of the vaccine with regard to age, ethnicity and educational level, insurance, and living situation.The majority of parents wanted the vaccine for its role in preventing CC. Conclusions Although controversy surrounds HPV vaccine in regard to its supposed role in promoting SA, only a minority of our parents showed concern for that association. The level of acceptance of the HPV vaccine was overall lower than what has been reported among other racial/ethnic populations. Knowledge about HPV and its association with CC were significantly associated with interest in getting the HPV vaccine and both parents and teens seem to accept the HPV vaccine more for its role in CC prevention.

Toward instituting a chaperone policy in outpatient pediatric clinics

Objectives We sought to evaluate child, parent and medical provider preferences for chaperones for outpatient encounters and to evaluate the acceptability and frequency of utilization following institution of a chaperone policy. Secondarily, we sought to understand what medical history and examinations teens consider “sensitive.” Design We conducted an observational study 1 month before and 1 month after institution of outpatient clinic chaperone policy. Post clinic questionnaires were used for patients ≥12 years old, parents, and clinicians. A research assistant observed chaperone use. Setting Adolescent Medicine, Urology, and Rehabilitation Clinics at a regional, tertiary-care pediatric hospital, in a major metropolitan area were studied. Participants Convenience sample: 117 clinic patients during control period and 119 after policy implementation. Main outcome measures Preferences for and satisfaction with chaperone use were documented. Results Although non-parent chaperones were usually declined (99.6%), offers were appreciated. Non-parent chaperone use increased modestly (5.3–18.1%). Most patients preferred not to have non-parent chaperones. This preference was greater among older patients (88%), than early teens (52%). After experiencing sensitive examinations, more young adolescent patients (89%) wished their parent had been present than older patients (38%). Patients’ opinions about what constitutes “sensitive” questions and examinations and chaperone preferences varied widely. Providers often did not recognize issues patients and parents considered sensitive questioning (21% agreement), but recognized sensitive physical examinations better (74% agreement). Providers felt chaperones had been a detriment to examination and exams would have gone better without one only 1% of the time. Conclusions Although usually declined, offers of chaperones were appreciated and use of non-parent chaperones increased modestly. Offering chaperones for sensitive examinations may remind providers about appropriate, respectful patient encounters. Implications for children's hospitals’ patient safety and satisfaction, and institutional staff protection and costs are significant. Practice implications Questions and examinations which patients consider sensitive vary widely. Asking patients for their preferences for examination chaperones may reassure them about the appropriateness of examinations, remind staff to conduct respectful examinations and protect providers from accusations of impropriety. Since most chaperone offers are declined, the cost of asking is likely to be minimal.

Uso de suplementos alimentares por adolescentes

OBJETIVO: Revisar crititcamente o uso, benefícios e efeitos adversos dos principais suplementos alimentares utilizados por adolescentes. FONTES DOS DADOS: A pesquisa bibliográfica, realizada nos últimos 10 anos, utilizou os bancos de dados MEDLINE e LILACS. Foram examinados 377 artigos, sendo selecionados 52. SÍNTESE DOS DADOS: O consumo de suplementos dietéticos é amplamente difundido entre adolescentes. Tal fato é constatado, com frequência, nos consultórios de pediatria e hebeatria. Na maioria das vezes ele ocorre sem uma necessidade específica, sendo motivado pela busca do corpo ideal. Outros motivos para essa suplementação são: compensar dieta inadequada, aumentar imunidade, prevenir doenças, melhorar o desempenho competitivo e superar os próprios limites. Os suplementos alimentares mais utilizados e discutidos nesse artigo e para os quais existem poucas evidências de um efeito benéfico de sua utilização por adolescentes saudáveis são: proteínas, aminoácidos, betahidroxibetametilbutirato, microelementos, carnitina, creatina, vitaminas, cafeína e bicarbonato. CONCLUSÃO: O uso irrestrito de suplementos dietéticos deve ser desaconselhado, uma vez que expõe o adolescente a vários efeitos adversos, além da falta de evidência de que tal prática levará a melhora no desempenho. Uma nutrição balanceada, com aquisição da energia e dos nutrientes necessários é geralmente suficiente para boa performance nas atividades físicas. A reposição com suplementos dietéticos deve ser reservada para atletas competitivos que não consomem uma dieta balanceada, após a comprovação de alguma deficiência específica.

Dietary supplement use by adolescents

To review the use, benefits and adverse effects of the main dietary supplements consumed by adolescents. The literature review was performed using MEDLINE and LILACS databases (1997-2008). We analyzed 377 articles, and 52 of them were selected as references. Consumption of dietary supplements is widely spread among adolescents. This habit has often been detected in pediatric and adolescent medicine clinics. Most of the time, the use of supplements is motivated by the search of the ideal body. Other reasons for this practice are: attempt to compensate for an inadequate diet, increase immunity, prevent diseases, improve athletic performance and overcome their own athletic limits. The dietary supplements most frequently used and for which there is little evidence of beneficial effects in healthy adolescents are: proteins, amino acids, beta-hydroxy-beta-methylbutyrate, microelements, carnitine, creatine, vitamins, caffeine, and bicarbonate. This dietary supplementation may be beneficial for competitive athletes who do not have a balanced diet after a specific dietary deficiency has been detected. The unrestrained consumption of dietary supplements should be avoided, since, besides the lack of evidence that such practice will lead to improvement of performance, it exposes adolescents to several adverse effects. Balanced nutrition, with intake of essential energy and nutrients is usually enough to achieve good athletic performance. The use of dietary supplements must be allowed only for selected cases in which specific nutritional deficiencies are identified.

It is more than just a reproductive healthcare visit: Experiences from an adolescent medicine clinic

The gynecologist may be the only physician that an adolescent depends on for primary and reproductive healthcare services. Because adolescent females often make personal healthcare decisions without the benefit of supportive parents/caregivers, it is imperative that the gynecologist understands the developmental issues encountered during this phase of life. The objective of this study is to identify cited complaints of adolescent females seeking reproductive care and, thus, provide gynecologists with needed information about the medical/mental health issues that may be encountered during routine reproductive care exams. The study group was adolescent females between the ages of 12 and 20 years old. The medical records of 479 adolescent females seeking reproductive care from an adolescent medicine clinic at a southeastern teaching medical center were reviewed to determine the most frequently cited medical/mental health complaints of adolescent females initiating a "routine" gynecological exam. Results indicated that adolescent females present for "routine" reproductive care exams with a myriad of concerns without formally requesting medical/mental health intervention upon initial presentation. The identified primary healthcare needs of adolescent females seeking reproductive healthcare include: 1) issues related to reproductive dysfunction (60%); 2) gastroenterological pain/issues (15%) 3) mental health issues (15%) and 4) general medical physical complaints (10%). Gynecologists are often asked to serve as a primary care provider as well as a reproductive healthcare specialist. Identification of the specific healthcare needs (reproductive and otherwise) of adolescent females will assist gynecologists in being uniquely prepared to practice in the setting of their choice.

The Protective Value of Parental Sex Education: A Clinic-Based Exploratory Study of Adolescent Females

Study Objective This exploratory study compared the impact of sex education provided by parents to female adolescents against the same education provided in formal settings to female adolescents. Methods Females, 16–24 years old, attending an adolescent medicine clinic in an urban area of the South were recruited prior to examination. Each patient completed an anonymous self-administered questionnaire. Data from 110 respondents were analyzed to compare those indicating they had learned about each of four topics from parents to those not indicating learning about all four topics from a parent. The same process was repeated relative to learning about the four topics in formal educational settings. Results In controlled, multivariate, analyses, adolescents not communicating with parents on all four topics were nearly five times more likely to report having multiple sex partners in the past three months. Further, these adolescents were 3.5 times more likely to have low self-efficacy for condom negotiation, 2.7 times more likely to report ever using alcohol or drugs before sex, and about 70% less likely to have ever talked about HIV prevention with a partner before engaging in sex. Differences relative to learning about the four topics in formal settings were not found. Conclusion Findings suggest that teen females (attending teen clinics) may experience a protective benefit based on communication with parents. This protective effect was not observed for education delivered in formal settings.

The Clinical and Laboratory Characteristics of Girls Presenting with Precocious Puberty in Korea

waiting rooms. We developed an obstetrical clinic within an existing, very successful adolescent-friendly community center. The pregnant adolescent benefits from the ‘‘one stop shopping’’. By developing a satellite clinic that came to the adolescent mother, instead of having her come to the physician, we were able to achieve a 49% rate for first obstetrical visits in the first trimester compared to the 26% rate quoted in the literature. This weekly clinic, staffed by an obstetrician and an obstetrical nurse, allows the health care provider to address the risks in pregnancy and initiate appropriate interventions leading to healthier pregnancies, and improved outcomes. In the first 18 months of the program, we accumulated data on 58 completed pregnancies. The mean gestational age is 39.4 weeks, birth weight 3190 grams, rate of preterm delivery 9%, and rate of cesarean section 6.8%. Because of its overwhelming results, the pilot project became an established program in 2006. We plan to report the outcome of our unique adolescent obstetrics clinic within the next year. In 2007, we added contraception and adolescent medicine clinics at St Mary’s Home for the continued care of these young women. The monthly contraception clinic provides family planning and free contraception to adolescents in need, with the goal of decreasing the rate of repeat pregnancies. The bimonthly adolescent medicine clinic is designed for adolescents with mental health, addiction, and self esteem issues. Psychiatry and Psychology consultations are available at the hospital when indicated. We are currently working at securing these important services on-site at St. Mary’s Home. Comments: St. Mary’s Home’s community outreach program for pregnant adolescents has proven beneficial for the health of the pregnant adolescent and her unborn child. Attempts should be made to develop such centers across North America.

Case 10-2009

A 23-year-old woman came to the adolescent and young adult medicine clinic at this hospital to establish care and to receive counseling regarding oral contraception, screening for sexually transmitted infections, and vaccination against human papillomavirus. Pathological examination of a Papanicolaou smear disclosed a high-grade squamous intraepithelial lesion. Additional diagnostic testing was performed, and management decisions were made.

Trends in mental health of an adolescent medicine clinic patient population

The correlation between exposure to forms of violence and development of mental disorders in victims is well established. The purpose of this paper was to identify mental health problems in an adolescent medicine clinic population in Lexington, KY and to investigate potential correlation of mental disorders with psychosocial factors. Data were gathered from the charts of 169 adolescent clinic patients (age 10-22) seen in the clinic for mental health care and analyzed using Excel. Of the patient population, 68% were urban, whereas 32% were rural. In terms of gender, 40% of the patients were male and 60% were female, 80% were white, 13% black, and 7% had other racial background(s). The most prevalent mental disorders in this group were depression 32.12%, 13% with generalized anxiety disorder, 8.2% with an attention deficit disorder (including ADHD), and 5.76% with an adjustment disorder. The abovementioned demographic trends showed that depression continues to be the most common mental health problem in this population regardless of gender, ethnic origin, or economic status. This finding highlights the need for availability of mental health support to this patient population. Further work is needed to spotlight the most significant psychosocial factors and root causes of mental health conditions in this age group.

Does Knowing about an HPV Infection Influence Behavior Change? A Feasibility Study of Females Attending a Teen Clinic

Objective To test the feasibility of a brief, clinic-based, behavioral intervention designed to foster the adoption of three protective behaviors among adolescent females testing positive for any of 13 oncogenic strains of HPV. This feasibility study also included non-statistical comparisons of risk behaviors assessed at follow-up. Design A non-randomized clinical trial. Participants Twenty-eight sexually active, 17–23-year-old females were recruited from a hospital-based adolescent medicine clinic. Intervention Adolescents testing positive for HPV received a physician-delivered intervention designed to emphasize the association of high-risk HPV with cervical cancer and to promote protective behaviors. Those testing negative for HPV did not receive intervention. Main Outcome Measure Several indicators were used including sexual risk behaviors, intent for subsequent Pap testing, intent to quit smoking, and intent to be vaccinated against HPV. Results Those testing positive (39.3%) received the intervention. Recruitment and retention rates were high. In comparing the two groups after a 30-day follow-up period, modest differences, favoring the intervention, were observed. At follow-up, teens testing positive reported lower levels of risk taking behavior, greater intent to return for next Pap testing, greater intent to quit smoking (if applicable), and greater intent to be vaccinated against HPV. Conclusion Overall, the findings suggest that a larger study is indeed feasible and may produce meaningful differences between groups. Although the source (i.e., testing positive vs. the receipt of intervention) of these differences cannot be determined, findings suggests that further investigation of a testing/behavioral intervention regarding HPV and cervical cancer prevention for adolescent females may be warranted.

Proporção de anemia de acordo com o estadiamento puberal, segundo dois critérios diagnósticos

OBJETIVO: Identificar a proporção de anemia ferropriva e sua distribuição por estadiamento puberal, em pacientes atendidos em ambulatório de adolescência, e comparar os valores de corte habitualmente utilizados na adolescência para esse diagnóstico. MÉTODOS: Estudo retrospectivo, por análise de 453 prontuários dos pacientes atendidos de janeiro a dezembro de 2003, no Centro de Atendimento e Apoio ao Adolescente do Departamento de Pediatria da Universidade Federal de São Paulo, Escola Paulista de Medicina. Destes, 215 (47,0%) rapazes e 238 (53,0%) moças. Utilizaram-se os testes de Kappa e McNemar para avaliar as concordâncias e discordâncias entre dois critérios distintos; teste "t" de Student para determinar as diferenças entre hemoglobina e índices hematimétricos nos grupos anêmico e não anêmico; e teste de Mann-Whitney para comparar os valores de hematócrito. RESULTADOS: A proporção de anemia, segundo os critérios adotados, foi de 7,50% (n=34) e 6,84% (n=31) na população; por estadiamento puberal encontrou-se, no sexo feminino, maior proporção nos estágios de mama 3 (30,00%) e 4 (50,00%) e no sexo masculino, em genitais 3 (40,00%), havendo concordância entre os dois critérios. CONCLUSÃO: Embora baixa, a proporção de anemia é relevante. A concordância obtida entre os valores propostos mostra que é possível usar qualquer um dos critérios. Há predomínio de anemia nas moças em estágio de mamas 3 e 4, justificado pela maior necessidade de ferro e perdas menstruais, que ocorrem nessas fases, respectivamente; nos rapazes, a proporção maior em estágio 3 (fase de aceleração de crescimento) pode sugerir que eles já estavam depletados antes de entrar na puberdade.

Physical and Sexual Abuse and Unstable Housing among Adolescents with HIV

Stable housing is a necessary component of treatment of adolescents with HIV. This study examines the housing status at two points in time of a sample of 224 adolescents with HIV seen at an adolescent medicine clinic in New York City. It addresses whether unstable housing is associated with several forms of abuse, and what factors predict continued instability. 38.6% (n = 86) had a prior history of unstable housing, reduced to 12.9% at the time of program entry. Multivariate logistic regression models predicting current and prior unstable housing revealed two variables related to both outcomes: physical abuse and referral from youth/social services entities. Continued unstable housing was associated with all abuse variables and adolescent history of arrest. When adolescents in abusive situations come to the attention of programs for youth, they have a positive impact on transitioning most adolescents to safer households, potentially improving adolescents' accessing of health care services.

Predictors of Sexual Satisfaction in an Adolescent and College Population

Study Objective To assess the degree to which adolescents/young adults are satisfied in their current sexual relationships and to evaluate intrapersonal and interpersonal predictors of sexual satisfaction among that population. Design Cross-sectional analysis. Setting Participants were recruited from an adolescent medicine clinic and a college in Cincinnati, Ohio. Participants A total of 313 sexually experienced adolescent/young adults ranging in age from 14 to 24 participated. Fifty percent were white and 60% female. Methods Participants completed a questionnaire about their demographics, romantic relationships, mental health, sexual history/behavior, and sexual satisfaction. Univariate logistic regression models were conducted to determine the relationship between each predictor and satisfaction with their current sexual relationship. To identify the most important predictors of sexual satisfaction, a final multiple logistic regression model was created using backward elimination. Results Approximately 85% of adolescents/young adults in the present study reported feeling satisfied in their current sexual relationships. Those who were in an overall positive relationship, who were less sensitive emotionally within interpersonal relationships, and who had more frequent sex, fewer lifetime sexual partners, and more condom-protected sex were more likely to be satisfied with the current sexual relationship. Conclusions Sexuality develops within the context of both intrapersonal and interpersonal factors. Thus, researchers should incorporate a multi-factorial approach when designing studies on adolescent sexuality.

The Developmental Association of Relationship Quality, Hormonal Contraceptive Choice and Condom Non-Use among Adolescent Women

Purpose Consistent condom use is critical to efforts to prevent sexually transmitted infections among adolescents, but condom use may decline as relationships and contraceptive needs change. The purpose of this research is to assess changes in condom non-use longitudinally in the context of changes in relationship quality, coital frequency and hormonal contraceptive choice. Methods Participants were women (aged 14–17 years at enrollment) recruited from three urban adolescent medicine clinics. Data were collected at three-month intervals using a face-to-face structured interview. Participants were able to contribute up to 10 interviews, but on average contributed 4.2 interviews over the 27-month period. Independent variables assessed partner-specific relationship quality (five items; scale range 5–25; α = .92, e.g., this partner is a very important person to me); and, number of coital events with a specific partner. Additional items assessed experience with oral contraceptive pills (OCP) use and injected depo medroxy-progesterone acetate (DMPA). The outcome variable was number of coital events without condom use during the past three months. Analyses were conducted as a three-level hierarchical linear growth curve model using HLM 6. The Level 1 predictor was time, to test the hypothesis that condom non-use increases over time. Level 2 predictors assessed relationship quality and coital frequency across all partners to assess hypotheses that participants’ condom non-use increases over time as a function of relationship quality and coital frequency. Level 3 predictors assessed the participant-level influence of OCP or DMPA experience on time-related changes in condom non-use. Results A total of 176 women reported 279 sex partners and contributed 478 visits. Both average coital frequency and average condom non-use linearly increased during the 27-month follow-up. At any given follow-up, about 35% reported recent OCP use, and 65% reported DMPA use. HLM analyses showed that condom non-use increased as a function of time (β = .12; p = .03, Level 1 analysis). Increased condom non-use over time was primarily a function of increased coital frequency (β = .01; p = .00), although higher levels of relationship quality were associated with increased condom non-use at enrollment (β = .44; p = .00, Level 2 analysis). The temporal rise in condom non-use significantly increased among DMPA users (β = .06; p = .00) but not OCP users (Level 3 analysis) (β = −.04; p = .06). Conclusions Developmentally, relationship characteristics and coital frequency appear to have increasing weight in decisions about condom use. Hormonal contraceptive methods are not equivalently associated with the overall temporal decline in condom use. Future research associated with dual contraceptive/condom use should address differential factors associated condom use in combination with different hormonal methods.

On‐site mental health care: a route to improving access to mental health services in an inner‐city, adolescent medicine clinic

On‐site mental health care: a route to improving access to mental health services in an inner‐city, adolescent medicine clinic

The relationship between dietary calcium intake and body composition in adolescents

Objective To examine the association between dietary calcium intake and measures of body composition in adolescents. Methods Adolescents (n=91), attending an urban Adolescent Medicine clinic, were recruited to participate. Using a cross-sectional design, body mass index, skinfold thicknesses (4 sites), natural and navel waist circumferences, and dietary intake via 24 hour dietary recalls were obtained by a trained technician. Percent body fat was calculated using the equations of Durnin and Passmore. Dietary data was analyzed with Food Processor™ (Esha Research), and a calcium/kcalorie ratio was calculated to account for underreporting. Spearman correlation analysis was used to explore the relationships in the data. Results Mean age for the subjects was 15 ± 2 years. Mean total kcalorie intake, calcium intake, and calcium/kcalorie ratio were 1907 ± 1004 kcal/d, 644 ± 584 gm/d, and 0.33 ± 0.2 respectively. Mean BMI (kg/m2), % body fat, and natural and navel waists (cm) were 26.2 ± 7.1, 32.9 ± 7.9, 80.7 ± 14.6, 82 ± 16.6. There was a significant relationship between calcium/kcalorie ratio and percent body fat (r = 0.22, p < 0.05). There were no significant relationships between total calcium, total kcalories, or frequency of calcium consumption and percent body fat, waist circumference measures, or BMI. Conclusion In contrast to previous reports, our results suggest a positive relationship between calcium intake and percent body fat,. To adjust for underreporting, we divided calcium intake by kcalories. This may not have been sufficient to overcome underreporting by adolescents.

The biopsychosocial approach to adolescents with somatoform disorders.

Somatoform disorders are presented in the first article in this issue of Adolescent Medicine Clinics because the physical symptoms that cause the adolescent to present for diagnosis and treatment reflect the interaction of the psyche and the soma in ways that are poorly understood. Because of dualistic conceptualizations that are encouraged by technology such as MRI, CT scans and other technologically advanced tools, patients who have these conditions often suffer. As noted by Cassell [35], "suffering is experienced by persons, not merely by bodies, and has its source in challenges that threaten the intactness of the person as a complex social and psychological entity." Clinicians who care for adolescents who have somatic complaints also suffer when they are unable to provide relief of an adolescent's suffering. Cassell [36] noted that "physicians are less skilled at what were once thought to be the basic skills of doctors-discovering the history of an illness though questioning and physical examination, and working toward healing the whole person." The biopsychosocial approach offers a means of working toward healing the whole person, and the focus of this article is on practical solutions to difficult challenges that are presented by adolescents and their families.

HIV/STD Risk Reduction Interventions for African American and Latino Adolescent Girls at an Adolescent Medicine Clinic: A Randomized Controlled Trial

Laura L. Hayman is a Professor, The Steinhardt School of Education, New York University, New York, NY, and an Editorial Board Member MCN . She can be reached via e-mail at[email protected] Lynn Clark Callister is a Professor, College of Nursing, Brigham Young University, Provo, UT, and an Editorial Board Member of MCN. She can be reached via e-mail at[email protected].