Teen Health Clinic Research Articles

125 Galveston County Youth Risk Survey: A Glimpse into Our Children’s Health and Wellbeing

OBJECTIVES/GOALS: The 2020-2021 Galveston County Youth Risk Survey continues past efforts to characterize behavioral risks for local youth, identify disproportionate risks among groups, and provide the data needed for action and intervention to improve the health and safety of our youth in Galveston, Texas. METHODS/STUDY POPULATION: While the survey is based on the CDC Youth Risk Behavior Surveillance System (YRBSS), there was community need for an expanded survey and thus a workgroup was formed to create the Galveston Youth Risk Survey, including members from UTMBs Institute for Translational Sciences, a number of other UTMB departments and Centers, the Research, Education, and Community Health (REACH) Coalition, several school districts, Teen Health Clinic, and a variety of other community health organizations with vested interest. The survey was administered in November 2020 via ScanTron and REDCap to two local high schools with populations greater than 2,000. CDC guidelines for administration of the YRBSS were followed. RESULTS/ANTICIPATED RESULTS: A total of 2,428 students completed the survey from GISD and DISD. The survey provided insight into the following categories, with mental health emerging as a pressing issue, specifically stress and depression, particularly among females. All results are reported in several contexts, including comparisons by gender, grade, and ethnicity, a comparison to state and national statistics when available, as well as risk trends from previous surveys. Demographics Safety, including driving, violence, and bullying Mental Health: stress, depression, suicidal ideation, and ACEs Human Trafficking Substance Use, including smoking, alcohol, marijuana, and other drug use Sexual Behaviors, including contraceptive use Body Weight and Body Image Health Conditions Home Life: Support and Security DISCUSSION/SIGNIFICANCE: The report has been presented to the school districts, immediate stakeholders, REACH membership, and the general public. Several presentations have been given to groups to report the findings. Workgroups will now be formed to address the needs of our students, as well as a possible follow-up survey to look at data specific to COVID-19 and mental health.

Trends of Contraceptive Choices Among Young Women in Inner City Houston.

Although long-acting reversible contraceptives (LARC) such as intrauterine devices and subdermal implants remain the most effective methods of contraception for teenagers, most adolescents continue to use less reliable methods. The purpose of this study was to determine: (1) the distribution of contraceptive type according to age of the patients in our clinic system (Baylor Teen Health Clinic); and (2) the differences in this distribution over the past decade. This study was a comprehensive chart review of at least 15,500 charts for the years 2005 to 2014. Baylor Teen Health Clinic. Charts of patients less than 25 years of age who attended one of the 9 Baylor Teen Health Clinics were reviewed. Contraceptive uptake by age and year was the main outcome measured. The percentage of women younger than age 25years who used LARC increased for all age groups from 2005 to 2014, with the greatest increase for women 20-24years old (<1% to 9%). The percentage of women using no method decreased for all age groups from 2005 to 2014 with the greatest decrease for women 15-19years old (9% to 5%). The percentage of women using less effective methods decreased for teenagers younger than 18years old, but increased for women 20-24years old and remained the same for women 18-19years old. Use of pills/patches/rings decreased for all age groups and use of hormonal injections increased for all age groups, with the greatest increase for teenagers younger than 15years of age (35% to 68%). Our clinic population has a greater proportion of teenagers and young women using LARC than the national average, possibly because of the increased access to LARC when these women enter our clinic system. Nevertheless, less than 10% of all age groups studied used LARC, with the proportion being lowest in teenagers younger than 18years. More efforts need to be placed on determining the reasons for low LARC uptake despite greatest efficacy in this young, vulnerable population.

Research and Statistics: Understanding and Identifying Bias in Research Studies

1. Jacky M. Jennings, PhD, MPH* 2. Erica Sibinga, MD* 1. *Assistant Professor of Pediatrics, Division of General Pediatrics & Adolescent Medicine, Johns Hopkins University, Baltimore, Md. You are seeing a healthy 18-year-old patient who is interested in contraception and, specifically, the “Depo shot” or medroxyprogesterone. The information you have gathered from her during your visit and her medical history suggest that she is a good candidate. You take a few minutes out of the visit to review the literature for issues of safety. Most of the articles and reviews suggest that medroxyprogesterone is a good choice for healthy young women, but a recent study shows an association between medroxyprogesterone and the development of hypertension. You look more closely at the study and discover that the young women taking medroxyprogesterone had their vital signs (including blood pressure) checked every 3 months when they came in for the medroxyprogesterone injection. The other women included in the study for comparison only had their vital signs checked every year at annual health supervision visits. You are unclear about whether the study design might have introduced bias and how the bias might affect your reading of the study results. Bias is a major issue in epidemiologic research studies and can lead to inferences that systematically deviate from truth. Bias has been defined as “any systematic error in the design, conduct or analysis of a study that results in a mistaken estimate of an exposure's effect on the risk of disease.” (1 …

Point-of-care testing for sexually transmitted infections increases awareness and short-term abstinence in adolescent women.

To evaluate the effect of point-of-care (POC) testing for sexually transmitted infections (STIs) on reported awareness of test results and STI risk-reduction behaviors in adolescents. Adolescent and young adult women aged 14-21 years were recruited from the Emergency Department or Teen Health Clinic for this longitudinal study and were tested for STIs. Baseline demographics, risk behaviors, treatment, POC tests (wet mount and rapid antigen tests for Trichomonas vaginalis), and other STI test results (available 24-48 hours postvisit) were measured. These were compared to subject's report of test results, abstinence, partner discussion, and partner testing during a postvisit telephone contact. Of 294 subjects, 155 (53%) were contacted: 65 (42%) had a positive STI test result; 28 (43%) were POC positive; and 52 (33.5%) believed their STI results were positive. A positive POC test result increased the proportion of subjects aware of being positive for an STI (89 vs 21%, p < .01). Postvisit, 62% reported abstinence, 82% discussed testing with her partner, and 48% reported partner testing. Predictors of abstinence included a positive POC test result (adjusted odds ratio (AOR) = 4.6, confidence interval (CI) = 1.5-13.6, prior abstinence of >14 days (AOR = 3.9, CI = 1.7-9.0), and black race (AOR = 3.5, CI = 1.2-9.7). Women who believed their STI results were positive were more likely to report partner discussion (odds ratio [OR] = 3.0, CI = 1.0-8.8) and partner testing (OR = 5.1, CI = 2.4-11.2). Awareness of STI results increases with POC testing. Effective communication of results can increase patient understanding and compliance with risk reduction strategies, which may affect the STI epidemic.

Social, Economic and Health Costs of Unintended Teen Pregnancy: The Circle of Care Intervention Program in Troup County, Georgia

Unintended teenage pregnancy in the United States is a public health concern with ramifications that include a variety of social, economic and health costs. It has been estimated that adolescents giving birth before the age of 18 cost the United States at least $9.1 billion dollars annually (NCPTUP, 2008). Latest available national data indicate a slight increase in rates of unintended teen pregnancy after a 15 year period of steady decline. The unintended teen pregnancy rate in Troup County, Georgia in 2006 was 51.9/1,000 which was higher than the national average of 41.9/1,000(Kids Count, 2008). The purpose of this study was to review the Circle of Care intervention program, a collaborative multi-agency teen pregnancy prevention program. The Circle of Care program was developed in 1997 through the efforts of multiple community partner organizations. These organizations included the local school system, the Division of Family and Children Services, Public Health, Troup County Family Connection, the local teen clinic, the local hospital and other organizations. Participants in the Circle of Care program receive multiple services, including case management, a family assessment, parenting classes, home visits from the case manager, family planning assistance, services from the teen health clinic and the Division of Family and Children Services. Preliminary data indicate that Circle of Care participants gained social, economic and health benefits from participation in the program including: higher rates of high school enrollment, no repeat pregnancies, and no reported incidences of child abuse or child neglect. Projected cost savings from these outcomes are also reported. Preliminary examination of the Circle of Care program supports the efficacy of multi-level, collaborative efforts to reduce unintended teen pregnancy and subsequent social, economic and health risks. Future research should examine longer term outcomes of this program.

Predictors of Narghile (Water-Pipe) Smoking in a Sample of American Arab Yemeni Adolescents

To explore the predictors of water-pipe smoking among American Arab Yemeni adolescents, a descriptive correlational design was used, and regression models representing the proposed relationships in the study were tested from a convenience sample of 297 adolescents who attended a teen health clinic and two high schools. The participants completed five measures. Fourteen hypotheses were tested. Experimentation with tobacco was found to be significant in predicting narghile smoking. Tobacco use prevention and cessation interventions for this population can be focused on targeting the family and peer units, from which their identity is likely derived.

Arab-American adolescent tobacco use: four pilot studies

Objectives Four pilot studies were conducted to determine the (1) current tobacco use patterns and predictors among 14- to 18-year-old Arab-American youths; (2) psychometric properties of study measures (English and Arabic); (3) cultural appropriateness of Project Toward No Tobacco (TNT) for intervention; (4) accessible population for a longitudinal study. Methods Three studies were descriptive and one used a pretest–posttest design. From four Pilot Focus groups ( N = 28 smokers) key tobacco use themes emerged along with information on study measures and the Project TNT intervention; Pilot Intervention tested the tailored Project TNT intervention with 9 Arab-American teens; Pilot Clinic ( N = 44) determined the characteristics of the accessible teen health clinic population; and Pilot School ( N = 119) obtained tobacco use data only. Results From Pilot Focus seven themes (being cool, “nshar ma'a al shabab” [hanging out with the guys], present [time] orientation, smoking feels and tastes good, keeps your mind off trouble, easy to get, and (many) “barriers to quitting”) emerged from the data. In the Pilot Intervention a 37.5% cessation rate was found. In the Pilot Clinic study, 24% males and 17% females smoked. The current smoking rate in the Pilot School ( N = 119) sample was 17%; 34% admitted to having ever smoked (even a puff). Significant predictors for current tobacco use included poor grades, stress, having many family members and peers who smoke, being exposed to many hours of smoking each day, receiving offers of tobacco products, advertising and mail, and believing that tobacco can help one to make friends. Conclusion The four pilots contributed unique and essential knowledge for designing a longitudinal clinical trial on tobacco use by Arab-American adolescents.

Out of Harmony on the Cherokee Boundary: Clinics, culture and the sex ed curriculum

Based upon fieldwork on the Cherokee Boundary in the USA during the mid-1990s, the author explores why a community that supported a teen health clinic and whose high school curriculum met the state standards for sexuality education continued to have a teen pregnancy rate that was one of the highest in western North Carolina. In the process, this study examines the conflicting views about adolescent sexuality, particularly teen pregnancy and homosexuality, held by Cherokee progressives and traditionalists as well as the resulting contradictory approaches to sex education within a community that values harmony. Arguing that the tribe's education policies worked at cross-purposes, the author details the mismatch between the school's sex education curriculum and health clinic vis-à-vis students' sexual interests, knowledge, and behaviors. Difficulties in integrating native culture and an absence of communication further inhibited the policies' effectiveness. Paradoxically, by avoiding the disharmonious issue of sexuality education, the community has become further out of harmony.

The role of condom motivation education in the reduction of new and reinfection rates of sexually transmitted diseases among inner-city female adolescents

The purpose of this study was to document the effectiveness of small group condom motivation education in reducing new and reinfection rates of sexually transmitted diseases (STD) among female teenagers. Two hundred and five (205) female adolescents (age 13–20) with a current STD were studied at two sites of a Teen Health Clinic. There were 86 teens in the Study Group and 119 in the Comparison Group. Patients were sampled from December 1992 to July 1993. The patients in the Study Group received a condom motivation class given by the clinic STD educator in small groups of four or more adolescents. The Comparison Group, comparable in age and ethnicity, received treatment for their STD but did not participate in condom motivation classes. All teens were given treatment and condoms. The sample was followed for 6 months. The total number of patients returning with new infections was 21 (14.7%). The total number of patients with reinfections was 14 (9.8%). There were no significant differences between the Study and Comparison Group on return rates, new and reinfection rates or on any socio-demographic variables. The comparison of these groups suggests that a specific condom motivation class has minimal effectiveness in urban teens. However, almost 70% of the teens returned to the clinic for their scheduled visits. It is suggested that adolescent clinics which combine family planning and STD treatment services maintain high client enrolment and therefore may be ideal locations to initiate new and continuous interventions for condom use especially for high risk teens.

Identifying depressed and suicidal adolescents in a teen health clinic

This study examined the 6-month prevalence of depression and suicidal probability among new referrals to an adolescent health clinic. All subjects (n = 104) completed the Beck Depression Inventory (BDI) and the Suicide Probability Scale (SPS) prior to being seen by a physician and were categorized according to presenting problem (physical complaints only, psychological complaints only, and physical and psychological complaints combined). Fifty-nine percent of the sample was depressed with 21% falling in the moderate range and 21% falling within the severe range of depression. Almost 23% of the sample demonstrated significant suicidal probability. The BDI and SPS were highly correlated (r = .73, p < .001) and 22% of the sample met criteria for both moderate to severe depression and suicidal probability. A significantly greater proportion of patients presenting with physical and psychological complaints combined (60%) met BDI criteria for depression than was found for the other two groups. Suicidal probability was most prevalent in patients presenting with psychological complaints only (26%) and moderate to severe depression and significant suicidal probability also coexisted to a greater extent within this group (26%). Results suggest that depression and suicidal probability represent significant mental health problems within the adolescent clinic and the identification of high-risk individuals can be achieved through comprehensive screening practices.

The Behavioral Implications of Myths and Medical Knowledge About AIDS Among Indigent Female Adolescents

Although AIDS among adolescents accounts for only 1% of the total number of AIDS cases in the United States, these cases increased by 51% between 1988 and 1989. The current literature indicates that knowledge about AIDS remains poor among adolescents. This study examined the relationship between medical knowledge and myths about AIDS and risk behaviors and attitudes. A secondary analysis was conducted on data collected between 1988 and 1989. The sample consisted of 510 adolescent females at the Baylor College of Medicine, Teen Health Clinic. The findings indicated that those adolescents who expressed a lack of interest in educational programs about AIDS had the lowest scores on the Myth and Medical Knowledge Scales. This study will be helpful to health educators when identifying those adolescents at highest risk for HIV infection. Health educators should assess attitudes about AIDS education when working with high-risk adolescents.

Urban adolescents: what are their health needs?

Abstract A health needs assessment of inner‐city, low‐income adolescents was conducted by the staff of a nurse‐managed, community‐oriented primary care clinic. A multiethnic sample of 568 high school students was studied. The findings indicated that the most commonly used source of health care was the family doctor. Barriers to receiving care were fear and costs. Subjects reported insufficient knowledge about many health‐related topics, and desired services in the areas of drug and substance use, reproduction and sexuality, family relations, mental health, and dental health. Eighty‐four percent of the subjects were interested in using the services of a neighborhood clinic specifically for teens. Survey results were used for decision making, program planning, and implementation of a teen health clinic.

Contraceptive use among high-risk adolescents.

Despite awareness of the growing number of pregnant teens in the US, little information has been published concerning factors that predict early childbirth among individual girls. To begin to address this issue, the influence of specific life and social factors was examined in 50 adolescent girls with documented histories of good and poor contraception use. Patients selected for participation were 50 indigent nulliparous adolescent and young adult females from 14-22 years old receiving health care at the Teen Health Clinic at the Jefferson Davis Hospital in Houston, Texas. 25 adolescents who indicated that they had been able to use oral contraception prescribed by the clinic for at least 6 months without major problems or complaints were classified as good contraceptors. 25 adolescents assigned to the poor contraceptors group were those who missed 2 or more appointments in a 6-month interval, experienced at least one suspected pregnancy during this time, and indicated verbally that they had not been completely compliant. Each subject was assessed with a structured interview consisting of 25 questions on the patient's past history of contraception, school performance, family birth, employment, residence patterns, and accessibility to contraceptive services. Data from each of the 25 questions of the interview were pooled for the good and poor contraceptors. Where applicable, Chi-square frequency tests and t-tests were used to determine whether differences were statistically significant. Some of the results follow. 1) Reasons for occasional nonuse of oral contraception in the 12 months prior to the interview were assessed in both samples; no statistical differences were observed. The majority of nonusers attributed it to a random event, such as a memory lapse. 2) Sources of birth control education were equivalent in the 2 groups. 3) Good contraceptors reported intercourse 2.6 times/month, as compared to 4.7 times/month for poor contraceptors. 4) 3 of 25 good contraceptors had dropped out of school, while 9 out of 25 poor contraceptors had left school. 5) 72% of the good contraceptors intended to complete at least 2 years of college, but only 52% of the poor contraceptors did. 6) Poor contraceptors had a greater frequency of sisters who had become pregnant relative to good contraceptors. 7) Good contraceptors were more likely to be employed either part- or full-time (52%) than were the poor contraceptors (28%). 8) Good contraceptors reported fewer changes in residence relative to the poor contraceptors in the preceding 5 years. 9) Poor contraceptors had significantly longer travel times to the clinic (mean of 54.5 minutes) relative to good contraceptors (mean of 33 minutes).

Teenagers' assessment of reproductive health-care services

Adolescent clients of a Teen Health Clinic were surveyed to determine those aspects of the service that were considered crucial to patient acceptance and program continuance. A simple one-page questionnaire enabled the clients to express their feelings about personnel, services, environment, and educational materials used in the clinic. Eighty-five percent of the clients expressed positive reactions to the clinic, while only 25.5% offered negative statements. Most respondents indicated clinic staff as the feature they liked most about the service and mentioned routine clinical activities as the part they liked least. Of the topics on which teenage clients wanted more information, 68% indicated that they wanted factual data rather than information about feelings, emotions, or relationships.

Selected family planning and general health profiles in a teen health clinic

To assess client utilization trends, selected characteristics including some aspects of family planning behavior of adolescent families were examined during the first two years of a Teen Health Clinic's operation. The majority of the girls attending the clinic were 16 years and under, nulliparous, and still living with one or more of their parents. While birth control services were the primary motivation for attendance, 25% of the girls came for a general health examination, information or counseling. Potentially significant problems, including venereal diseases, were found in 20% of the patients. Reproductive health trends and their implication for improving health care delivery and family planning for teenagers are discussed.