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Rates of sexual activity, pregnancies, and births among adolescents have continued to decline during the past decade to historic lows. Despite these positive trends, many adolescents remain at risk for unintended pregnancy and sexually transmitted infections (STIs). This policy statement has been developed to assist the pediatrician in understanding and supporting the use of condoms by their patients to prevent unintended pregnancies and STIs and address barriers to their use. When used consistently and correctly, male latex condoms reduce the risk of pregnancy and many STIs, including HIV. Since the last policy statement published 12 years ago, there is an increased evidence base supporting the protection provided by condoms against STIs. Rates of acquisition of STIs/HIV among adolescents remain unacceptably high. Interventions that increase availability or accessibility to condoms are most efficacious when combined with additional individual, small-group, or community-level activities that include messages about safer sex. Continued research is needed to inform public health interventions for adolescents that increase the consistent and correct use of condoms and promote dual protection of condoms for STI prevention with other effective methods of contraception.

The primary goal was to describe the health care coverage of detained youth. An exploratory second goal was to describe the possible relationship between redetention and coverage. Health care coverage status was abstracted from electronic detention center records for 1,614 adolescents in an urban detention center (October 2006 to December 2007). The majority of detained youth reported having Medicaid coverage (66%); 18% had private insurance and 17% had no insurance. Lack of insurance was more prevalent among older, male, and Hispanic youth. A substantial minority of detained youth were uninsured or had inconsistent coverage over time. While having insurance does not guarantee appropriate health care, lack of insurance is a barrier that should be addressed to facilitate coordination of medical and mental health care once the youth is released into the community.

Tobacco use and secondhand tobacco-smoke (SHS) exposure are major national and international health concerns. Pediatricians and other clinicians who care for children are uniquely positioned to assist patients and families with tobacco-use prevention and treatment. Understanding the nature and extent of tobacco use and SHS exposure is an essential first step toward the goal of eliminating tobacco use and its consequences in the pediatric population. The next steps include counseling patients and family members to avoid SHS exposures or cease tobacco use; advocacy for policies that protect children from SHS exposure; and elimination of tobacco use in the media, public places, and homes. Three overarching principles of this policy can be identified: (1) there is no safe way to use tobacco; (2) there is no safe level or duration of exposure to SHS; and (3) the financial and political power of individuals, organizations, and government should be used to support tobacco control. Pediatricians are advised not to smoke or use tobacco; to make their homes, cars, and workplaces tobacco free; to consider tobacco control when making personal and professional decisions; to support and advocate for comprehensive tobacco control; and to advise parents and patients not to start using tobacco or to quit if they are already using tobacco. Prohibiting both tobacco advertising and the use of tobacco products in the media is recommended. Recommendations for eliminating SHS exposure and reducing tobacco use include attaining universal (1) smoke-free home, car, school, work, and play environments, both inside and outside, (2) treatment of tobacco use and dependence through employer, insurance, state, and federal supports, (3) implementation and enforcement of evidence-based tobacco-control measures in local, state, national, and international jurisdictions, and (4) financial and systems support for training in and research of effective ways to prevent and treat tobacco use and SHS exposure. Pediatricians, their staff and colleagues, and the American Academy of Pediatrics have key responsibilities in tobacco control to promote the health of children, adolescents, and young adults.

The purpose of this policy statement is to address the serious underinsurance (ie, insurance that exists but is inadequate) problems affecting insured adolescents' access to needed preventive, reproductive, and behavioral health care. In addition, the statement addresses provider payment problems that disproportionately affect clinicians who care for adolescents.Among adolescents with insurance, particularly private health insurance, coverage of needed services is often inadequate. Benefits are typically limited in scope and amount; certain diagnoses are often excluded; and cost-sharing requirements are often too high. As a result, underinsurance represents a substantial problem among adolescents and adversely affects their health and well-being.In addition to underinsurance problems, payment problems in the form of inadequate payment, uncompensated care for confidential reproductive services, and the failure of insurers to recognize and pay for certain billing and diagnostic codes are widespread among both private and public insurers. Payment problems negatively affect clinicians' ability to offer needed services to adolescents, especially publicly insured adolescents.

Although adolescent pregnancy rates in the United States have decreased significantly over the past decade, births to adolescents remain both an individual and public health issue. As advocates for the health and well-being of all young people, the American Academy of Pediatrics strongly supports the recommendation that adolescents postpone consensual sexual activity until they are fully ready for the emotional, physical, and financial consequences of sex. The academy recognizes, however, that some young people will choose not to postpone sexual activity, and as health care providers, the responsibility of pediatricians includes helping teens reduce risks and negative health consequences associated with adolescent sexual behaviors, including unintended pregnancies and sexually transmitted infections. This policy statement provides the pediatrician with updated information on contraception methods and guidelines for counseling adolescents.

Background Our objective was to describe familial, intrapersonal, and partner-related factors associated with time of day of sexual activity among adolescent women. Methods Annual questionnaires and daily diaries were collected from 106 adolescents. Participants contributed up to 3 questionnaires and 5 12-week diary periods over 27 months. Predictor variables included type of day (weekend, school day, vacation day); partner variables (argument with partner, partner emotional support, time spent with partner); parent/family variables such as supervision, monitoring, and attitudes about adolescent sexual behavior; and mood and behavior variables such as negative mood, positive mood, and sexual interest. The outcome variable for each diary day was no coitus, coitus between noon and 6 pm , or coitus after 6 pm . Results Coitus occurred on 12.0% of the diary days. Coital events were more than twice as likely to occur after 6 pm (8.5% of days) than in the afternoon (3.5% of days). Afternoon sex was least likely to occur on school days whereas evening sex occurred most often on weekends. An argument with a partner, partner emotional support, time spent with partner, sexual interest, and coital frequency were associated with increased likelihood of afternoon sex, whereas parental supervision and negative mood were associated with decreased likelihood of afternoon sex. For school days, skipping school was associated with increased likelihood of afternoon sex. Evening/night sexual activity was not associated with any parent/family variables. Conclusion Afternoon sex on school days is relatively uncommon. Direct parental supervision may decrease afternoon sexual activity but relationship and intrapersonal factors also are important factors in the timing of sexual activity on any given day.

There are several issues that arise regarding the evaluation of teens with urethritis and cervicitis. What are the appropriate treatments for adolescents? What are the issues regarding rescreening and do we need to consider tests of cure? Chlamydia is the most common bacterial sexually transmitted disease in adolescents in the United States. The prevalence appears to be leveling off or decreasing which may reflect several reasons. More frequent screening utilizing more sensitive diagnostic techniques such as nucleic acid amplification techniques and screening populations that are traditionally more difficult to reach may have led to the lower rates. However there still are many young men and women with high-risk behaviors who are not receiving appropriate screening. (excerpt)

Study Objective: To describe frequency of douching and reasons as timing to menses, vaginal symptoms, and coitus and the association of these behaviors to the diagnosis of three sexually acquired infections. Design, Setting, Participants: The study involved 160 females between the ages of 14 and 25 yrs attending a STD clinic and/or community adolescent health clinics. Subjects were eligible to enter the study if they had a positive test(s) for and/or were a contact of chlamydia, gonorrhea, trichomonas, and/or nongonococcal urethritis (NGU). Reevaluation for these infections occurred at the 1-month, 4-month, and 7-month visit with one-dose antibiotic treatment provided for positive tests. Data on douching was collected at the 7-month visit only. Main Outcome Measure: Results of tests for STI's using urine-based DNA-amplification techniques for chlamydia and gonorrhea and using self-obtained vaginal swabs for trichomonas culture. Results: Nearly two-thirds (106/160) of the subjects ages 14–25 yrs completing the 7-month visit reported douching, with 67.7% (69/102) reporting douching once a month or more. Douching was more common in older, black participants, using injectable progestins for contraception. Douching was more common in those reporting more recent sexual partners. Douching related to menses was not associated with any of the three infections, while douching related to symptoms and coitus was associated with positive tests for infections. Conclusions: Results suggest that for this subset of teens at high risk for sexually acquired infections, douching is a commonly reported behavior. This study suggests that the linkage of douching and sexually acquired infections is associated with contraceptive choices, self-treatment of vaginal symptoms, and sexual risk behaviors but not menstrual hygiene.

This study describes associations of partner‐specific relationship characteristics with consistent condom use among 297 young people (ages 13–24) with sexually transmitted diseases (STD). Relationship‐specific variables were relationship quality, reasons for sex, relationship duration, duration of sexual relationship, coital frequency, “established” versus “new” sexual partner, cohabitation, children, sexual coercion, and drug or alcohol use associated with coitus. Relationship characteristics associated with consistent condom use included lower relationship quality, lower emotional reasons for sex, lower coital frequency, sex with a new partner, noncohabitation, and not having a child with the partner. Controlling for sociodemographic variables, factors exhibiting independent associations with consistent condom use were lower relationship quality, lower coital frequency, and not having a child with the partner. While condom use with potentially high risk new partners is important, other types of relation...

Pelvic inflammatory disease is the most significant consequence of sexually transmitted infections. Statistics suggest that adolescents have a significantly higher rate of PID than does any other age group. Even asymptomatic and minimally symptomatic PID can lead to adhesions, infertility, and ectopic pregnancy, so clinicians should maintain a high index of suspicion when evaluating female adolescents with lower abdominal pain. Empiric treatment, including appropriate partner notification and treatment, should be initiated early.

Teenage pregnancy is still a medical and economic concern. Early anticipatory counseling with an emphasis on abstinence is helpful. Contraception information and sexually transmitted disease prevention should be part of the counseling. This article reviews common contraception methodology.The topic of preventing adolescent pregnancy in developed countries is introduced by noting that 1) adolescent pregnancy in the US, the UK, and Canada is associated with financial dependence on social services and with increased health risks for the mother and child; 2) these negative outcomes call for preventive efforts that target adolescents at risk and provide contraceptive information to adolescents at an early age; 3) poverty is the most prevalent risk factor; and 4) one screening technique, dubbed HEADS, considers home life, education, activities, drug use, sex behavior, and suicidal tendencies. After recommending that primary care givers first emphasize abstinence and then give accurate and complete information about contraceptive methods, the remainder of the article reviews the following methods: barrier methods, IUDs, oral contraceptives (OCs), Norplant, injectable progesterone, and postcoital (emergency) contraception. The text is illustrated with tables that 1) compare female barrier methods, 2) describe OC contraindications, 3) compare hormonal components in common OCs, 4) list the contraindications to Norplant, 5) show OC noncompliance rates among adolescents, 6) show barrier method noncompliance rates among adolescents, and 7) illustrate the failure rates of different contraceptive methods. The article concludes by recommending that counseling on prevention of sexually transmitted diseases should accompany contraceptive counseling and by noting that increased knowledge is not associated with increased sex behavior or decreased age of initial intercourse.

Statistics suggest that the adolescents have a higher rate of diagnosis of pelvic inflammatory disease than any other age group. Early recognition improves the chances of preventing the long-term consequences of ectopic pregnancy and tubal infertility. For a significant number of teens, the symptoms are mild or vague, requiring a high index of suspicion by the physician to initiate treatment. The purpose of this article is to review the currently accepted guidelines for diagnosis and management of pelvic inflammatory disease in the adolescent patient.

Teen pregnancy and parenting remain an important public health issue in the United States and the world, and many children live with their adolescent parents alone or as part of an extended family. A significant proportion of teen parents reside with their family of origin, significantly affecting the multigenerational family structure. Repeated births to teen parents are also common. This clinical report updates a previous policy statement on care of the adolescent parent and their children and addresses medical and psychosocial risks specific to this population. Challenges unique to teen parents and their children are reviewed, along with suggestions for the pediatrician on models for intervention and care.

Privacy and security of health information is a basic expectation of patients. Despite the existence of federal and state laws safeguarding the privacy of health information, health information systems currently lack the capability to allow for protection of this information for minors. This policy statement reviews the challenges to privacy for adolescents posed by commercial health information technology systems and recommends basic principles for ideal electronic health record systems. This policy statement has been endorsed by the Society for Adolescent Health and Medicine.

Study Objective: To obtain follow-up pregnancy data on adolescent women in order to examine the effectiveness of anti-chlamydial therapy in the prevention of early infertility. Design: A longitudinal follow-up of adolescent women originally enrolled in a study of prevalence and recurrence of genital chlamydial infection. Setting: Public health adolescent clinics in Marion County (Indianapolis), Indiana. Participants: Sexually active female patients between 11 and 20 years old receiving gynecological care between October 1985 and February 1990. Interventions: None. Main Outcome Measures: Pregnancy during the follow-up period was ascertained using self-report during a telephone survey and/or the computerized record system of the county hospital. Rates were compared among the women separated into three groups: more than one documented chlamydial infection, a single infection, and no documented infection. Results: Using both data sources, the lowest proportion of women who became pregnant during the follow-up period was observed in the single infection group (34.9%, p = 0.029), but the other two groups were similar (multiple infections 54.2%, no documented infection 51.0%). Among women who were contacted by phone, the overall proportion was higher (68.3%) and did not differ by group even after adjustment for sexual activity and condom use. Conclusions: These data do not show an association between a history of treated genitourinary chlamydial infection and infertility. The frequent monitoring and treatment featured in the original study may have affected this.

Our objective was to understand the relationship between mental health screening results, health disparity, and STI risk among detained adolescents. In this 24-month cross-sectional study of 1,181 detainees (age 13–18 years), we examined associations between race, gender, mental health screening results (as measured by the Massachusetts Youth Screening Instrument—2nd Edition) and sexually transmitted infection rates (STI; chlamydia, gonorrhea, and trichomonas). Consistent with previous research, females and black youth were disproportionately affected by STI. Race and gender differences were also noted in mental health screening. The odds of having an STI increased by 23% (OR = 1.23, 95% CI = 1.06, 1.37) with each one-unit increase in the alcohol/drug subscale score for females. Gender-specific STI interventions for detained youth are warranted. For young women with substance abuse, specific interventions are necessary and may help reduce health disparity in this vulnerable population.

Purpose To understand how diversion of low-risk youth from juvenile detention affected screening practices for detained youth. Methods In a 22-month cross-sectional study of 2,532 detainees (age, 13–18 years), mental health and sexually transmitted infection (STI) screening data were compared before and after the beginning of diversion efforts through implementation of a Risk Assessment Instrument (RAI). Results Detention diversion resulted in a 30% census reduction. In a logistic regression, younger age (odds ratio [OR] = 1.10 for a 1-year increase; confidence interval [CI]: 1.03, 1.17), Hispanic versus white race/ethnicity (OR = .53; CI: .35, .82), and less severe crime (OR = .90 per 1 point; CI: .89, .91) predicted reduced likelihood of detention. Mental health and STI screening increased significantly after implementation of the RAI. Additionally, the rate of positive STI tests increased among detained males (9% pre-RAI to 14% after implementation of the RAI, p = .01). However, implementation of the RAI did not result in a significant increase in the number of positive mental health screens. Conclusions Universal mental health and STI screening are increasingly common public health practices in detention centers. The results of this study indicate that juvenile justice diversion programming affects public health screening rates among detained youth in our population. Future study of the possible unintended consequences of criminal justice initiatives on public health outcomes is recommended.

Study Objective Although underutilized, the vaginal contraceptive ring has several advantages over other contraceptive methods that could benefit adolescents. We examined factors that may influence willingness to try the vaginal ring including: sexual and contraceptive history, genital comfort, and vaginal ring characteristics. Design Cross sectional Setting Midwestern adolescent health clinics Participants Adolescent women (N = 200; 14–18 years; 89% African-American) Interventions/Main Outcome Measures All participants received education about the vaginal ring and viewed pictures demonstrating insertion; they then completed a visual/audio computer-assisted self interview. The primary outcome variable, willingness to try the vaginal ring, was a single Likert-scale item. Results Over half the participants reported knowledge of the vaginal ring with healthcare providers identified as the most important source of contraceptive information. Comfort with one’s genitals, insertion and removal, using alternative methods of insertion, and knowing positive method characteristics were significantly associated with willingness to try the vaginal ring. A decreased willingness to try the vaginal ring was related to concerns of the ring getting lost inside or falling out of the vagina. Conclusions Willingness to try the ring was associated with positive feelings about genitals (e.g., comfort with appearance, hygiene, function). Thus, to increase willingness to try the vaginal ring among adolescents, providers should make it common practice to discuss basic female reproductive anatomy, raise awareness about female genital health and address concerns about their genitals. Providers can offer alternative insertion techniques (e.g., gloves) to make use more accessible. These strategies may increase vaginal ring use among adolescents.

To determine the recurrence rate of chlamydial infections, we initially screened an urban population of 1308 sexually active female adolescents for chlamydial infection at the urethral and endocervical sites; these young women were followed and had additional examinations for infection. Chlamydial infection was documented by tissue culture in 31.1% (407) of them at some time during the study. After appropriate antibiotic treatment, 68.3% (278/407) returned for test-of-cure cultures within 3 months of their initial infection; of those 278, a total of 254 had sterile cultures. These patients were followed to determine the recurrence rate of chlamydial infections. Of these 254 patients, 177 (69.7%) had one or more follow-up visits; 38.4% (68/177) had a recurrent chlamydial infection. The majority of recurrent infections were documented within 9 months of the initial infection. Recurrent infections with the same serovar were frequent, suggesting reinfection by untreated partners or possible relapse of the initial chlamydial infection. This high rate of recurrent infection suggests that female adolescents should be rescreened frequently for genitourinary chlamydial infections.

A health belief model of condom use was used to identify factors associated with condom use in 390 sexually active female adolescents, aged 12 through 19 years, recruited at the time of a visit for reproductive health care. Fifty-six percent were white and the remainder black. Nineteen percent had genitourinary infections with Chlamydia trachomatis . Forty-six percent reported having had more than one sexual partner in the preceding year. Reported condom use for at least one specific reason (prevention of pregnancy, sexually transmitted disease, or acquired immunodeficiency syndrome) increased as behavioral, emotional, and sexually transmitted disease risk decreased, and as cognitive maturity and positive condom attitudes increased. Although uses of condoms to prevent pregnancy, sexually transmitted disease, and acquired immunode-ficiency syndrome were positively intercorrelated, each made a contribution to explaining condom use at most recent coitus (odds ratios 2.95, 3.96, and 2.81, respectively). After statistical adjustment for the reported reasons for previous condom use, behavioral risk was the only additional factor associated with condom use at the most recent sexual encounter; women who participated in more risk behaviors (substance and alcohol use and minor delinquency) were less likely to have used a condom (odds ratio 0.61). Knowledge about sexually transmitted disease and acquired immunodeficiency syndrome, and concurrent use of contraceptive pills, were not related to condom practices. The data suggest that adolescents' perceptions about condoms, including the individual functions of condoms for contraception and for prevention of sexually transmitted disease, may be important in determining their use. Engaging in unprotected intercourse may be part of a larger behavioral domain that includes other unhealthy behaviors.

In recent years, there has been an increased national focus on assessing and improving the quality of health care. This statement provides recommendations and criteria for assessment of the quality of primary care delivered to adolescents in the United States. Consistent implementation of American Academy of Pediatrics recommendations (periodicity of visits and confidentiality issues), renewed attention to professional quality-improvement activities (access and immunizations) and public education, and modification of existing quality-measurement activities to ensure that quality is delivered are proposed as strategies that would lead to improved care for youth.

In this article, adolescent sexual behavior is discussed within a biopsychosocial framework. Prevalence rates for both coital and noncoital behaviors are presented, and trends in coital behaviors are noted over time. Special attention is paid to the role culture plays in the development of sexual behaviors. The discussion includes prevalence rates and trends of pregnancies/births and sexually transmitted diseases among adolescents and the impact of these outcomes for both adolescents and their offspring.

Objectives To determine the 3-month incidence of unwanted sex and to examine relationship factors and health-risk behaviors associated with incident unwanted sex. Design Data collected from face-to-face interviews every 3 months in a longitudinal study with a minimum of 2 interviews and maximum of 10 across 27 months. Setting Primary health care clinics for teens in an urban setting. Participants Adolescent women aged 14 through 17 years. Main Outcome Measures At each 3-month visit, cervical and vaginal specimens were obtained for the evaluation of Chlamydia trachomatis , Neisseria gonorrhoeae , and Trichomonas vaginalis infection; for each partner, relationship characteristics and sexual behaviors were assessed, as well as the occurrence of unwanted sex. A logistic model was used to account for within-subject variability to model the probability of unwanted sex as a function of predictor variables. Results A total of 279 participants with a mean age of 15.9 years were enrolled, and most were African American (88.5% [247/279]). Unwanted sex was reported by 40.9% (n=114) of participants and in 15.5% (292/1880) of partner-visits. The most prevalent type of unwanted sex was due to fear that the partner would get angry if denied sex (37.6%, or 105 participants). Factors associated with unwanted sex included having a baby with the partner, lower relationship quality, lack of sexual control, less condom use, and partner marijuana use. Conclusions Unwanted sex occurs often within the sexual relationships of teens. These unwanted sexual experiences result in risk for sexually transmitted infections and pregnancies. Sexual health counseling to reduce risk should focus on both the patient's and the partner's behaviors.

Adolescents are faced with many developmental tasks related to sexuality, such as forming romantic relationships and developing their sexual identities. Many adolescents will engage in a variety of sexual behaviors, including perhaps oral and anal sex, during this time period. Almost half will engage in vaginal sexual intercourse by the end of high school. A number of biological, psychosocial, and sociocultural factors can influence adolescents' romantic relationships and sexual behaviors. Some of these factors (eg, exposure to violence in the home, early pubertal development) may increase an adolescent's risk of being in an unhealthy relationship or engaging in sex at an early age. Parents, healthcare providers, and communities can support adolescents through these developmental tasks by forming close, connected relationships with teens and devising age-appropriate messages about the development of healthy sexuality.

As adolescents progress through puberty, many biological changes occur and, for young women, this includes the onset of menses and the capability for reproduction. During this time, sexual identity is developed and expressions of sexuality become more frequent. Adolescent women engage in a variety of sexual behaviours, both non-coital and coital. As teens begin dating relationships, they are at risk for dating violence and sexual abuse. Some may even be raped after sedation with a 'date rape' drug. As adolescents attempt to develop intimate sexual relationships, they may be at high risk for health consequences associated with sexual activity, such as pregnancy and sexually transmitted diseases (STDs). Providers, such as physicians, nurse practitioners, physician assistants and nurses, must know current STD diagnosis and treatment recommendations to decrease morbidity caused by these infections. By knowing how to interview, understanding legal issues and anticipating concerns pertinent to teens, providers have the opportunity to decrease barriers to health care for adolescents.

Pediatricians are called on to become involved in the identification and management of eating disorders in several settings and at several critical points in the illness. In the primary care pediatrician’s practice, early detection, initial evaluation, and ongoing management can play a significant role in preventing the illness from progressing to a more severe or chronic state. In the subspecialty setting, management of medical complications, provision of nutritional rehabilitation, and coordination with the psychosocial and psychiatric aspects of care are often handled by pediatricians, especially those who have experience or expertise in the care of adolescents with eating disorders. In hospital and day program settings, pediatricians are involved in program development, determining appropriate admission and discharge criteria, and provision and coordination of care. Lastly, primary care pediatricians need to be involved at local, state, and national levels in preventive efforts and in providing advocacy for patients and families. The roles of pediatricians in the management of eating disorders in the pediatric practice, subspecialty, hospital, day program, and community settings are reviewed in this statement.

Health care providers must recognize the specific challenges and rewards of providing services for adolescents. Quality care begins with the establishment of trust, respect, and confidentiality between the health care provider and the adolescent. Data suggest that the normal age for beginning puberty is decreasing, which has important clinical, educational, and social implications. The health care provider should be aware of the broad range of potential sexual behaviors involving adolescents, as well as the teen's acceptance of such behaviors, often dictated by age, gender, culture, and education. When providing gynecologic care to adolescent girls, the physician should not only provide contraception and screen for sexually transmitted diseases but should contribute to the development of the patient's sexual health. Especially when providing care for the younger teen, the health care provider must focus on involving a member of the family or another significant adult to provide needed support and guidance. Anticipatory guidance for parents should focus on assessing their parenting styles and promoting supervision. Although parents should strive to maintain open communication with their adolescents, they may not accurately estimate the sexual activity of and the sexual risk for their teenage children. Parents need to be encouraged to consider the implications of their own sexual behaviors. The provider should attempt to foster a comfortable environment in which youth may seek help and support for appropriate medical care while reserving the right to disclose their sexual identity when ready. Health care professionals cannot exclude heterosexual behavior on the basis that a young woman self-identifies as homosexual. Her reported sexual behaviors may not indicate her sexual orientation. Self-definition of sexual orientation is a dynamic process including factors such as fantasies, desires, and behaviors. Self-definition of sexual identity is affected by individual variations in sex, gender, sexual roles, and sexual orientation. Most adolescents want to discuss sexual-related issues with their health care providers and will welcome direct questions about sexual behaviors and possible risks when posed in a confidential and nonmoralistic manner. Discussion of the physical, emotional, familial, and social changes related to adolescence will encourage healthy sexual development.

Purpose: To investigate the comparability of health behavior data obtained from adolescents via notebook computer versus those obtained via written questionnaire. Methods: We interviewed adolescent patients (ages 13–20 years) receiving services at community adolescent health clinics. Participants anonymously completed either a computer-assisted self-interview (CASI) or a self-administered questionnaire (SAQ), both assessing health-protective behaviors, substance use (i.e., tobacco, alcohol, marijuana) and sexual behaviors. From a pool of 671 adolescent participants (348 completing CASI, 323 completing SAQ), we matched 194 SAQ participants with 194 CASI participants on the basis of gender and race. We could not match individually on the basis of age, but were able to match each gender–race subgroup by mean age. Results: Across the majority of health behaviors (i.e., all health-protective behaviors, tobacco use, sexual behaviors), mode of administration made no significant difference in the reporting of information by adolescents. However, girls reported a greater frequency of alcohol use and marijuana use on CASI than on SAQ, whereas boys reported a lower frequency of alcohol use and marijuana use on CASI than on SAQ. Conclusions: The findings of this study suggest that there may be gender-related differences between modes of anonymous collection of specific adolescent health behaviors such as alcohol and marijuana use. Future studies should incorporate direct questions regarding adolescents' attitude and comfort levels toward completing different modes of data collection.

To identify factors associated with subsequent sexually transmitted infection (STI) (within 1 year of initial infection) due to Chlamydia trachomatis, Neisseria gonorrhoeae or Trichomonas vaginalis.Prospective cohort study.A sexually transmitted diseases clinic and four community-based primary care clinics for adolescents.Female patients (ages 15 to 19 years) with initial diagnosis of chlamydia, gonorrhea, or trichomonas.Subsequent infection by chlamydia, gonorrhea, or trichomonas.More than 40% of subjects were subsequently infected by at least one STI. Reinfection was common, but infections with sexually transmitted organisms other than the initial infecting organism were also common. Predictors of subsequent infection were black race, gonorrhea as the initial infection, two or more sex partners in the previous 3 months, and inconsistent condom use.Subsequent STI frequently follow an initial STI, but there is substantial variation in the causal organism. These data suggest the importance of comprehensive STI prevention programs for adolescents rather than organism-specific interventions.Factors associated with subsequent sexually transmitted infection due to Chlamydia trachomatis, Neisseria gonorrhoeae, or Trichomonas vaginalis were investigated in a prospective study of 236 female adolescents 15-19 years of age who had presented to US sexually transmitted disease (STD) and adolescent health clinics with one of these infections within the previous 12 months. At the second visit, 58 (29.7%) of 195 initially infected women were again infected; 13 were infected with more than one organism. At the third visit, 59 (37.6%) of 157 subjects were reinfected, 20 with more than one organism. Overall, 97 (41.1%) of 236 subjects were again infected within 12 months of an initial STD. Many subsequent infections were due to a sexually transmitted pathogen other than the one causing the index STD. The risk of a subsequent infection was significantly elevated among Blacks, those with gonorrhea at enrollment, and women with 2 or more sex partners in the previous 3 months and significantly reduced among condom users. These findings suggest that organism-specific screening programs would fail to detect a substantial number of subsequent infections due to the presence of other organisms.